Bulgaria: MSF ends work to support the excluded

In 2004, the national health insurance organization started enforcing payment into a new insurance system, requesting that all of those who had not paid their monthly contributions since the start of the new system be excluded. Many of the country's poorest people owed money for months or even years of unpaid monthly contributions.

In response to this dire situation, MSF organized a media campaign in September 2004, demanding amnesty for back payments. MSF's message was that the amount of money owed was an insurmountable obstacle for many of the country's poorest people. MSF also called on authorities to better inform the public about the system and to let people know quickly if they fall behind in payments.

At the end of 2004, the Bulgarian government amended the health insurance law. The law now calls on those in arrears for 15 months to pay a small fee that will place them back on the insurance rolls. Once that is done, the person must continue to pay his or her monthly contribution. Failure to do so will result in removal from the list again. MSF's view is that the amendments are merely a cosmetic solution to the ongoing payment dilemma, and that the real social problem, poverty, needs to be addressed.

In 2004, MSF ended its work in the primary health care center in Fakulteta, the capital's largest Roma community. Six local general practitioners plan to continue the project, caring for some 20,000 people living in the area. However, the doctors' work in Fakulteta is also threatened by the changes in the health care system.

Today, 7,776 patients are registered with the six general practitioners. Of that group, 2,664 (34 percent) are on the list of those to be excluded from the insurance system if they do not pay their back contributions by the end of 2005. An MSF survey conducted in Fakulteta, found that 95 percent of those interviewed did not plan to pay, simply because they could not afford to do so.

Hand over of medical activities

From January 2000 until March 2005, MSF ran the diagnostic, treatment and prevention center MaÃ?¯chin dom (center for sexual health) in Sofia. MSF provided patients with free treatment for sexually transmitted infections and care to help prevent HIV/AIDS. The team's nurses also provided health education in schools within Sofia and in the countryside.

In March 2005, MSF handed over the center's work to national staff who plan to continue the activities. MSF will help finance the project for at least one year and continue to provide some operational support.

MSF worked in Bulgaria from 1997 until March 2005.