Human resources in Bulgarian health care Prof. Petko Salchev, MD LEONARDO DA VINCI – PARTNERSHIP EUGISMET-PREV STUDY VISIT IN BULGARIA 17th - 19th June 2013

Medical personnel

Medical personnel

Medical personnel - facts

Training of medical professionals in Bulgaria in 2011 - undergraduate 8 universities. students in the academic year 2011/2012 show that the number of places in the majors is as follows: Medicine - 612 (for the 2010/2011 - 558) Dentistry - 256 at 216 for 2010/2011g ., Pharmacy - 210 at 214 for the 2010/2011 Public Health - 700 at 562 for the 2010/2011 health care (no nurse and midwife) – 333(2011) - 685 in the previous year, nurse – 386 (2011) - 370 the previous year and Midwifery – 123 (20011) - 155 the previous year. The duration and content of training are synchronized with Community law.

Places of specialization - postgraduate Include: Physicians - 1043 in 2011 - 1577 in 2010, dentists – 56 in 2011 – 57 in 2010, pharmacists - 62 in 2011 - 9 in 2010, health care - 31 in 2011 - 118 in 2010, nonmedical - 106 in 2011 - 158 in 2010, medical and medical education - 52 (at 38 in 2010), Military specialties - 14 with 5 for 2010 The total number of places for graduates in 2011 was 1 364 and 2045 through 2010, of which 100 state-funded, 486 places under Art. 20 of Ordinance № 34 of 2006, 412 –paid and 351 - for foreigners.

Certificates of professional qualifications Certificates of professional qualifications and specialization in Bulgaria in order to practice a regulated health care profession in the territory of countries - the EU, the EEA and Switzerland for 2011: total 1314, distributed as follows: 628 certificates of doctors who have acquired qualifications in the Republic of Bulgaria, of which 524 Bulgarian citizens and 103 nationals of other countries, nurses - 355 certificates of which 353 for Bulgarians and 2 foreigners dentists - 163; pharmacists - 33; midwives - 56, medical technicians - 12; ray technicians - 16; therapists - 12, inspector of Public Health - 2; paramedics - 15; masseur - 1; dental technicians - 9; assistant pharmacists - 4 . Most certificates of physicians with specialty issued in "Internal Medicine", "Surgery" and "Anesthesiology and Intensive Care."

Nursing education Bachelor Ordinance on Unified State Requirements for obtaining higher education in "Health Care " for educational qualifications "Master" and "Bachelor" of professional direction "Public Health" Approved by Decree № 215 of 18.08.2006, prom., SG, iss. 70 of 29.08.2006, in force from academic year 2006 - 2007, amend. No.. 87 of 7.10.2008 Health care – 2 semesters – 690 hours Master – 3 semesters – 990 hours – after bachelor

Public health courses Social medicine - 60 hour Epidemiology – 30 hours Medical Ethics and Deontology – 60 hours Hygiene and ecology – 60 hours Medical statistics – 45 hours

Medicine and dental medicine – master degree ORDINANCE ON UNIFORM STATE REQUIREMENTS FOR ACQUISITION OF HIGHER EDUCATION in "Medicine" and "DENTIST" FOR DEGREE "MASTER“ Medicine Theoretical courses – 10 semesters – 4965 jours Practical courses Sixth semester – 30 days – 150 hours Eighth semester - 30 days – 150 hours internship before graduation after the tenth semester - 310 calendar days, or 1,320 hours.

Public health courses in medicine Social medicine with medical ethics – 120 hours – 2 and 3 semesters 60 hours – lectures 45 hours – practical 15 hours – ethics Epidemiology, Infectious Diseases, Medical Parasitology and Tropical Medicine – 150 hours Disaster medicine – 45 hours internship before graduation - 5 days in social medicine and 30 days in Epidemiology, Infectious Diseases, Medical Parasitology and Tropical Medicine

Dental Medicne Dental medicine Theoretical courses – 10 semesters – 4790 hours Practical training is carried out by practicals during the semester learning, teaching practices and Probation Practice as follows: 1. educational practice (clinical experience) after the sixth semester of not less than 30 calendar days - 150 hours; 2. educational practice (clinical experience) after the eighth semester of not less than 30 calendar days - 150 hours; 3. internship before graduation after the tenth semester - 135 days (6 months), or 1,080 hours.

Public health courses in dental medicine Social medicine and medical ethics – 45 hours Hygiene and epidemiology – 60 hours Disaster medicine – 30 hours Public dental health - professional organization, law, behavioral science, social aspects – 105 hours

Postgraduate education – professional qualification Ordinance № 34 of 29.12.2006 for professional qualification in the health care system Places – Medical Universities and National Centers of Public health Appendix № 1 to Art. 1, para. 1 Nomenclature of specialties and terms for their acquisition in the healthcare system Specialties for persons with degree "Master" in "Medicine“ Social Medicine and Health Management - 4 years Communal hygiene – 4 years Occupational health – 4 years Health Economics – 2 years Disaster medicine – 3 years General hygiene – 3 years

SOCIAL MEDICINE AND HEALTHCARE MANAGEMENT - MAIN TOPICS Methodology of social medicine. Health and illness. Socio-medical approach. Public health – indicators and assessment. Healthcare systems. International health cooperation and globalization. Healthcare system in Bulgaria. Medical care quality. Health promotion and disease prevention. Healthcare management. Resource management. Health information. Health policy. Strategic planning and management in healthcare. Operational management and control in healthcare. Medical ethics. Rights and obligations of medical staff and patients.

Doctor degree 4 years – individual plan Special law - Law on the Development of Academic Staff of the Republic of Bulgaria

Public Health Capacity in the EU – Final Report Strengths Weaknesses . Formal administrative structures for public health are established • Country has a system designed to identify potential threats to population health in place; there is a network of laboratories capable of supporting investigations of public health problems, hazards and emergencies • Regional Inspectorates of Public Health Protection and Inspection are relatively autonomously utilising a multisectoral and multilevel approach in their work, developing effective collaboration with other sectors’ institutions (Georgieva et al. 2007) • National plans are in place to address public health threats and emergencies • Capacities for public health training and education are available • Public health activities are often not based on research, evidence and best practices • Public debate on health is dominated by themes such as the organisation, management and financing of hospital care, and public health problems are often neglected • Incomplete formulation of laws and regulations and inconsistent implementation in practice • Worsening demographic, social and health indicators with a significant difference between urban and rural population • Lack of cooperation among different institutions on health issues • A large proportion of health sectorbased NGOs do not interact with other NGOs and thus limit their capacity for development and work on projects Recommendations • Focus on strengthening information and reporting systems. Public health needs to be more strongly based on scientific input and data • Strengthen intersectoral cooperation between organisations working in fields relevant to public health (e.g., social policy, environment, transportation) • Develop further undergraduate and postgraduate programmes in Public Health • Increase investments in training and professional development for public servants working in public health-related areas • Introduce more cost-benefit analyses of public health and health care expenditure