IPCHS. Integrated People-Centred Health Services


Sept. 6, 2016 Leading practice Europe

Introducing home care services in Bulgaria


The introduction of home care services was proposed as a patient-oriented solution for ensuring appropriate service provision closer to home; a pilot approach allowed the gradual rollout and testing of an existing home care model being implemented abroad, which was adapted to meet the Bulgarian context; efforts to introduce home care included creating new roles and responsibilities for the health workforce and developing information and communication resources; establishing the necessary health system conditions, including the development of a supportive legal framework, is an important area of focus for advancing the sustainability and scale of the current transformations.

Description of practice
City: Sofia Country: Bulgaria
The problem

Bulgaria is faced with an ageing population, with nearly a fifth over the age of 65 years in 2011. A parallel rise in chronic disease, comorbidities and disabilities can also be observed. In this context, the existing health system has faced difficulties in providing care to an increasingly complex patient population. Unmet care needs became increasingly evident within the elderly population, partly as a result of the narrow scope of services available, the exclusion of supportive social services and the lack of easily accessible care options for this group.

The solution

This initiative sought to introduce the concept of home care services to the Bulgarian health system. Working in partnership with the Swiss Red Cross and the nonprofit home care organization Spitex, the Bulgarian Red Cross designed and adapted international home care models for application in Bulgaria. In 2003, the first Bulgarian home care centre was launched and began offering services to the local elderly population; 11 additional centres have since been opened to provide home care services across the country. The centres employ nurses and home helpers, who are both required to complete a nationally-licensed training upon hire. Centre employees work as a team to provide services, with nurses leading patients’ care in a coordinating role. Nurses provide services such as blood pressure monitoring, heart checks, bandage changes, wound care and other primary care services. Home helpers assist patients with daily tasks, including managing personal hygiene, preparing meals and cleaning homes. As the concept of home care was foreign to Bulgarians, there was an initial lack of trust from patients and their relatives regarding home care services. It took several months for leaders to explain to communities what the initiative was trying to achieve. In most cases, trust and understanding were built gradually through the consistent provision of high-quality home care services, which enabled patients and communities to see and experience the benefits of home care first-hand. As home care centres rely on donor funding to function, the Bulgarian Red Cross is currently working with the national government to develop a more sustainable financial model for home care delivery. With this goal in mind, a common project between the Bulgarian Red Cross, government ministries and other stakeholders was started in 2012. Currently in the final stages, this joint project is working to establish the necessary political, legal and financial frameworks to fully integrate home care services into the health system and safeguard sustainability.

Implementation of practice
What stage is the practice currently in?


Who was/is responsible for the implementation of the practice?

Strong leadership from the Bulgarian Red Cross, working in partnership with international organizations such as the Swiss Red Cross and Spitex, propelled the initiative forward. The later partnership formed with the government, and the subsequent stewardship of the Ministry of Health, is working to develop the system conditions required to advance the initiative and fully integrate home care services within the health system.


While quantitative data on outcomes are limited, recently-introduced data collection systems will allow more detailed analysis in the future. Twelve home care centres have been set up across the country, providing services to over 800 elderly patients in total. Integrated health and social services delivered in the community are officially recognized for the first time in Bulgaria and are also included as a priority in national policy documents. As a result, elderly patients now have increased access to primary care services delivered conveniently in their own homes.

Additional information

This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".

© Copyright World Health Organization (WHO), 2016

The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.


Please click on the link below for more information about this practice. 

Contact information
Siana Karsheva
Bulgarian Red Cross

Andrew Naomi 17/04/2022 02:21

I was infected with Herpes (HSV) two years ago and I was devastated. I visited different hospitals but they only gave me drugs to treat the symptoms. One day I was browsing through Dr. SEBI then I found a lady who introduced me to an Herbal Doctor called Dr. OJAMO. She explained to me how Dr. OJAMO cured her from herpes with natural herbs and root products, she gave me the doctor Email:: dr.ojamoherbalhome@gmail.com I contacted him and asked him questions about his product. He explained to me how the product works and also showed me those he has cured with his product. He told me he would prepare the product and shipped it to me, the product got delivered after 5 days of delivery. I took the product as instructed by Dr. OJAMO and after 21 days I was having diarrhea and constantly urinating. I went for a test and I was tested for Herpes Negative. The product worked exactly the way Dr. OJAMO instructed and now I am free from HSV. I am very happy, I will recommend this great testimony to save a lot of people suffering from Herpes. Contact: Dr. OJAMO Whats-app:: https://wa.me/2349077406037 also Email dr.ojamoherbalhome@gmail.com His website https://drojamoherbalhome.wixsite.com/welcometodrojamoherb

Monica Raymond 18/04/2022 09:39

One day I was reading an article online we’re I found about Dr. Ojamo and how people have been cured using his herbs and roots so I message Dr. Ojamo on WhatsApp  https://wa.me/2349077406037   and I got a reply. He told me with God everything is possible. Dr. Ojamo told me about plants/herbs and it’s purpose that when he told me no matter the situation you found yourself in there is always a solution. I decided to try Dr. Ojamo Healing Herbs. He made a fresh herb and told me the plant and root because his product is 100% plants and root cooked and packaged inside a container and he shipped it through UPS. I received it and finished the product exactly 21 days ago and before then I was having diabetes and difficulties in breathing, I went to the hospital and my doctor was surprised how I got cured from all these diseases then I said praise to God .  Share Dr. Ojamo email: dr.ojamoherbalhome@gmail.com or you can call and WhAtsapp him on  https://wa.me/2349077406037   if you are infected with HERPES virus or having any health problems contact Dr. Ojamo and he will help you. Share his email so that everyone will know there are herbs and roots that cures every diseases because there can never be a smoke without a fire; dr.ojamoherbalhome@gmail.com   Check his Website https://drojamoherbalhome.wixsite.com/welcometodrojamoherb

Add your comment

Sign in to add your comment.