The access to quality healthcare services continues to be a challenge in the state of healthcare reform that takes longer than the most pessimistic prognosis envisioned. The greatest challenge though remains for the persons belonging to ethnic minorities, especially for those living in rural areas far from municipal or district cities.
The health condition and the tendencies of the health condition of the nation, including of the people belonging to ethnic minorities, are assessed in the context of the demographic processes, morbidity, risk factors, physical development and self-assessment of the health. The main reasons for the worsening health of the Bulgarians, especially of those of Roma origin, are poverty, unhealthy life habits related to bad nutrition, distress, combined with other risk factors such as tobacco consumption, alcohol abuse, substance abuse, lack of physical activity and others. To all that are added different problems related to the execution of the healthcare reform. Those unfavorable processes are deepening in a moment when the state cannot increase the amount of resources for healthcare and the low purchasing power of the majority of Roma and Turkish households makes the paid medical services and drugs inaccessible for them. The poverty of people of Roma origin is another obstacle for provision of the necessary healthcare services and for their social adaptation. In Europe and in Bulgaria the inequalities in the field of healthcare are growing. The income, the possibility for influence and services are unequally distributed which leads to inequality in the field of healthcare in Bulgaria. The need of addressing of these problems is underlined also by the World Health Organization (WHO).
Improvement of the health and wellbeing are laid out in the new framework for health policy in Europe, Health 2020, adopted by the Regional Committee of WHO for Europe in 2012. The framework of Health 2020 Strategy is based on values and evidences, which allows a strategic approach to be undertaken to achieve that goal.
During the present period of executing the reform in healthcare we observe exceptionally negative tendencies related to the health of the Roma population: high morbidity, high mortality, low life expectancy, high child mortality.
According to the Roma the medical personnel shows lack of respect for their different cultural attitudes and traditions. Roma people rarely reach out for any preventive medical care and they rely on emergency medical care too much.
In addition, the provision of healthcare services in Roma community, within the places where they live, is also a serious problem especially in rural areas (where 66% of Roma in Bulgaria live). Similar is the situation in the biggest city Roma neighborhoods (ghettos) in Sofia, Plovdiv, Sliven, Stara Zagora and others. The insufficient number of general practitioners in places with large Roma population obstacles Roma’s regular access to healthcare where they live. For instance, in some villages inhabited mostly by Roma the general practitioners work only two days a week. For the rest of the time people would have to wait or travel to find a doctor.
Another important problem is the low health insurance coverage among the Roma population due to lack of resources for monthly payment of the health insurance and due to the low health literacy. In addition, since many Roma people are uninsured they cannot access healthcare services except for the emergency cases.