[size=55:3n9i3uv5]Sofia echo 01 October 2010
In sickness and in health
For weeks, the warning symptoms of a severe malaise in health care in Bulgaria had been worsening, along with the political fortunes of Anna-Maria Borissova, in office for only about five months as health minister.
On September 29, amid calls for her to resign, aggravated by a new national political opinion poll listing her as one of Bulgaria’s three least popular ministers, Borissova quit. The announcement that Prime Minister Boiko Borissov had accepted her resignation, minutes after it was offered – going by the official statement – came just two days before the opposition Bulgarian Socialist Party was due to table a motion of no confidence in the Cabinet for the Government’s poor handling of health care.
The motion of no confidence, which it appeared only would be backed by Ahmed Dogan’s opposition Movement for Rights and Freedoms, appeared certain to fail given the majority that Borissov and his customary allies usually command in Parliament. But this was cold comfort given the profound problems facing Bulgaria’s hospitals and health care.
Out patience
Minority party the centre-right Union of Democratic Forces (UDF) also had called for Borissova to resign, and also wanted the heads of National Health Insurance Fund (NHIF) director Neli Nesheva and Deputy Finance Minister Vladislav Goranov.
UDF leader Martin Dimitrov said that confidence in Borissova was "
exhausted"
and described as "
cynical"
a proposal by the Health Ministry – which Dimitrov described as having become a subsidiary of the Finance Ministry – to make patients make co-payments for treatment.
The plan for these co-payments, which the Health Ministry said should be 20 per cent of costs, would not go ahead, Prime Minister Borissov said on September 29.
But, in turn, the furore around health care ran deeper than just the Health Ministry’s controversial proposals. A flood of media reports illustrated the dire situation in health care – and led to criticism of Borissova for resigning at the wrong moment.
Stanimir Hassardjiev, head of the National Patients Organisation, told journalists that Borissova had chosen a very unsuitable moment to go. "
We are at the end of a very hard year;
the doctors will go on strike;
no tenders for next year have been called;
patients are in shock,"
he was quoted by local news website Focus as saying.
Ailing
According to media reports, Bulgarian hospitals were breaking out reserve supplies of bandages and medicines that had been stockpiled for major disaster situations.
Hospitals reportedly lacked syringes and anaesthetics, and were facing court action for unpaid bills. These reports, on the day that Borissova resigned, came after weeks of articles spelling out problems from failures of tender processes to acquire medicines – which collapsed for technical or procedural reasons – to a growing exodus of doctors from Bulgaria.
More than 150 doctors reportedly had left the Black Sea city of Varna for abroad to take up better-paid posts. A company recruiting medical staff for Sudan and Kuwait said that it was receiving applications at a rate not seen for several years.
Of those doctors who were still in Bulgaria, many were planning to join in a nationwide protest scheduled for October 15.
‘Chaos’
On September 24, mass-circulation daily 24 Chassa said that two vaccines for infants were unavailable, news that prompted the Health Ministry to announce the next day that it had placed an order for the vaccines.
On top of reports that the Transplantation Agency was under investigation (for a third time) in connection with allegations of illegal exports of organs, came news that Deputy Health Minister Ivan Milanov had written to the Bulgarian Medical Association (BMA) to say that at hospitals, emergency cases, pregnant women, women in labour and ill children should be admitted immediately.
"
The rest should wait for their turn,"
the letter was reported to have said.
On September 21, Evgeni Doushkov, of the Podkrepa labour confederation, said after attending a meeting on health reform attended by Borissova and directors of university hospitals that hospitals had started turning away emergency patients. The reason was a lack of funds, which already had been used to pay for emergency treatements and haemodialysis, Doushkov said.
On September 19, daily Standart quoted Milan Milanov, head of the BMA’s ethics committee, as saying that the BMA would complain to EU institutions that the constitutional rights of Bulgarian patients were being violated.
A few days later, heart surgeon professor Alexander Chirkov said that there was "
unprecedented chaos"
in hospitals.
"
Hospitals have turned into commercial organisations which, in the pursuit of profits, have stopped offering medical services of the highest professional and humane level,"
Chirkov said.
To make matters worse, professor Nikolai Tsankov, head of the association of dermatologists in Bulgaria, predicted an increased rate of sexually-transmitted diseases, for reasons including a lack of mandatory examinations of pregnant women and the overall state of the health system.
Voices
The BMA, which has been increasingly strident in its criticism of the Government’s handling of financing for health care, reacted to Borissova’s departure by underlining that, in fact, it had wanted Finance Minister Simeon Dyankov to step down.
Earlier in September, Deputy Finance Minister Goranov, who chairs the National Health Insurance Fund, had faced angry doctors at a BMA conference, when he told them that a 125 million leva sum owed to hospitals for the March – June 2010 period would be paid by the end of March 2011. The statement prompted Milen Cholakov, a doctor from Shoumen, to hurl a half-empty bottle of water at Goranov.
The day she resigned, Borissova told reporters: "
The money is indeed insufficient. I have said that"
.
Borissova’s successor would be the third health minister since Borissov’s Cabinet took office in July 2009. Her predecessor, Bozhidar Nanev, resigned in March after allegations of irregularities in state acquisitions of medicines (the socialist-led tripartite coalition government that was in power from 2005 to 2009 went through two health ministers).
While it seemed certain to survive the no-confidence motion, the current Government faces discontent about health care that is by no means limited to medical professionals but is a syndrome becoming increasingly widespread.
Fri Oct 01, 2010 8:54 am
fingers crossed 
