Girls in the street, Bucharest, Romania, 2017. Flickr/J.Stimp. Some rights reserved.What can one say about a situation where institutions for treating sick children are put in place, but families have to desperately organize donation campaigns for the vast amounts of money needed for a life-saving treatment or vital equipment? In this situation, merciful citizens are those on whom the fate of ill children depend. How can a hospital work when 20 more nurses are needed to fill the work schedule? Last but not least, is it normal for a paediatric department to close when the only paediatrician there is on paid leave? All this happened in Romania last year.
The questions are too many, and in the meantime, children’s lives depend on their prompt response. However, there has been no response for years in a row against the backdrop of deteriorating child healthcare in Bulgaria. Similar problems are observed as in Romania, joined by Bulgaria at the bottom of the league table in terms of infant mortality in the EU.
A chaotic and unproductive series of reforms which began in 2000 has turned Bulgarian healthcare into a complex labyrinth that leads both hospitals and patients into a dead end. It was the year when the model of clinical pathways was introduced. Although it is a universal model applied in many countries, it does “not comply with international standards”, as stated by Journal of Public Health experts.
There is a deficit of 400 paediatricians in Bulgaria, with a particularly strong impact in certain provinces. It was the national neonatology consultant, Doctor Slancheva, who predicted that child mortality may increase and that hospitals may close due to lack of neonatologists.
The current clinical pathway model, the lack of medical personnel and equipment along with the poor working conditions are among the central child healthcare issues. These are the key factors for the crises of paediatrics in Bulgaria. Romania is in a similar situation.
There are bankrupt hospitals or hospitals on the brink of bankruptcy due to debts in Bulgaria. The only children's cardiac hospital requires urgent measures to save it. In the beginning of 2018, 20 nurses were said to be needed in the hospital, which may simply grind to a halt.
There is a fledgling consensus emerging among the Bulgarian authorities and civil society, that the clinical pathways have not been implemented properly since their introduction in 2000. However, it is still not being debated and stated strongly enough, and no alternative model is being discussed.
It is also a common approach by media and politicians, whether Bulgarian or Romanian, to emphasise one problem area at the expense of another, when monitoring child healthcare. A fully fledged piece of investigative research into the whole complex of relations, as well as causes, is all too rare and urgently needed.
It is important to analyse this complexity of the systemic problem, alongside the accumulation of facts and opinions of experts. And of course, the impact on children’s health must be analysed. Such a clear view is a key step, on the basis of which actions could be taken for a revival of these health systems.