The demographic situation in the Blagoevgrad area, though slightly better than the average for the whole country, is the result of the prolonged influence of many factors and is characterized by a steady tendency to reduce the population and its aging. Impact on population demography has demographic processes common to developed countries – reduced birth rate, less marriages, increased urbanization, as well as the typical factors for countries in transition such as higher mortality rates and intense external migration. The low birth rate and the high mortality rate determine the negative natural population growth over the last ten years.

Blagoevgrad Region is part of the Southwest Planning Region (NUTS 2 level). The territory of the area occupies 6 452.3 km 2, which represents 5.8% of the country’s territory. The administrative district is divided into 14 municipalities, 96 city halls and 280 settlements. Blagoevgrad region ranks third in terms of territory and sixth in terms of population. The population in Blagoevgrad region as of 31.12.2015 is 315 577, which represents 4.4% of the population of Bulgaria. Compared to the previous year, it decreased by 11,234 (-3.56%). The structure of the urban and rural population remains 60% to 40%. There is also a tendency to increase the 51% female ratio – to 49% men, with women after working age having a higher survival rate than men.

Changes in the age structure of the population reflect the demographic aging process (the insignificant increase in the number and share of the population up to the age of 15, which is 15.0% of the total population in 2015. At the same time the relative share of the population which is over 65 Years, reaches 21.4% in 2015. The average life expectancy in Bulgaria is 74.5 years and remains lower than the one in the EU.

The long-term decline in birth rates (9.2%), objectively determined by the impact of a number of demographic, social and economic factors, remains below the EU average (10.02%), but is getting closer to the rates of most European countries. A problem for both Bulgaria and the Blagoevgrad region remains the high level of mortality, both common and premature. The tendency for higher mortality rate among men compared to women and the higher rate in villages compared to cities is maintained. The indicator remains significantly higher than the EU average.

In recent years among the deadliest diseases are the ones damaging organs of the blood circulation (65.4%) and  malformations (16.4%).

Positive trends are reported with respect to the mortality indicators in younger age categories, incl. premature and infant mortality, which are most sensitive to the impact on the population’s demographic situation of the health system.

The indicator of premature mortality (the relative share of deaths under the age of 65 from total deaths), which remains the same for the previous three years, decreased by 1.0% in 2015 compared to the previous year. In men, premature mortality is 2 times higher (28.3% vs. 13.9% for women).

The analysis of data on basic health-demographic indicators clearly shows that Bulgaria, compared to other EU countries, is currently facing much more serious challenges related to:

  • High level of total mortality and premature mortality;
  • High level of maternal and infant mortality;
  • High level of disability and permanent incapacity;
  • Low life expectancy in years and years in good health.

The main reasons for the deteriorated health indicators are:

  • Chronic non-communicable diseases, major causes of death and reduced working capacity, with the largest share of cardiovascular diseases and malignancies;
  • Conditions occurring during pregnancy, birth and postpartum periods; the perinatal period; congenital anomalies.

The unsatisfactory results of the policies pursued so far to address these challenges against the backdrop of the deteriorating demographic situation and the presence of significant social risks for large sections of the population determine the need for a comprehensive change in the approaches to ensuring the health and well-being of Bulgarian citizens.

Functioning of the healthcare system

Healthcare system is one of the social systems in which there is identified need for a key reform aimed at sustainable improvement of the health indicators of Bulgarian citizens, health promotion and disease prevention.

In 2015, the “Healthcare Objectives 2020” concept was adopted, which sets out Bulgaria’s national health goals for healthcare aimed at sustainable improvement of the health of Bulgarian citizens as a key factor for sustainable growth.

Under the National Health Strategy 2020, the provision of effective mechanisms for sustainable financing of the health care system is a key factor in implementing the wider reform agenda and reorienting the system to changing health care needs. In recent years, rising healthcare spending has put serious challenges for management institutions around the world. In many countries, the relative share of the healthcare budget as a percentage of GDP is greater than ever.

A number of health systems fail to contain costs, and financial pressures make it even more difficult to achieve the right balance between needs and resources and to provide adequate social protection. The increase in costs is mainly determined by the supply, incl. new treatments and technologies, as well as the increasing expectations and demands of people to protect against health risks and access to high-quality medical care.

According to experts, the main trends of the demographic state of the population and the exceptionally strong increase in health care costs coupled with labor market and GDP trends, which mainly cause income stagnation, lead to growing deficits in the government’s share of the health care budget .

“Demographic, epidemiological and economic trends, combined with the existing structural inefficiencies in the current health care system, pose significant challenges for the future adequate funding of health services for the Bulgarian population. This has led to a situation where the current health care system does not meet the needs of the population and where, without significant reforms, future health and financial outlook looks bleak. “World Bank Report 2015

Structure of the Healthcare System

The structure of the healthcare system reflects current policies in the healthcare system. It is characterized by:

  • unequally distributed and fragmented hospital network;
  • insufficiently developed and used capacity of outpatient care leading to unequal access of the population to basic medical care, especially in hard-to-reach and remote areas;
  • disinfected and resource-poorly provided emergency assistance;
  • lack of capacity to provide services related to long-term care for people with disabilities, chronic diseases, elderly people;

It is therefore imperative that the health system responds quickly and appropriately to this pressure by regrouping resources within the different types of health services and by seeking the best and most cost-effective solutions in the changing health needs and requirements of patients.

The number and type of medical institutions in Bulgaria, the available facilities and equipment, as well as the number and structure of the medical and other professionals working in these establishments should be reorganized in order to achieve better results in terms of clinical practice, funding and quality of health services.

Strengthening of the healthcare system and focusing on people’s needs for affordable and quality medical care and integrated care is the major challenge for health care policymakers in the coming years.

Blagoevgrad District includes the following health areas: Bansko, Belitsa, Blagoevgrad, Gotse Delchev, Garmen, Kresna, Petrich, Razlog, Sandanski, Satovcha, Simitli, Strumyani, Hadjidimovo and Yakoruda.

  • Bansko Health Area – the geographical borders of the health region coincide with the boundaries of Bansko municipality with administrative center Bansko.
  • Belitsa Health Region – the geographical boundaries of the health region coincide with the borders of Belitsa Municipality with the administrative center of Belitsa.
  • Blagoevgrad Health Region – the geographical borders of the health area coincide with the borders of Blagoevgrad municipality with administrative center Blagoevgrad.
  • Gotse Delchev Health Region – the geographical borders of the health region coincide with the borders of Gotse Delchev Municipality with the administrative center of Gotse Delchev.
  • Garmen Health Region – the geographical boundaries of the health region coincide with the boundaries of Garmen Municipality with Garmen Administrative Center.
  • Kresna Health Region – the geographical boundaries of the health area coincide with the boundaries of Kresna municipality with administrative center Kresna.
  • Petrich Health Region – the geographical boundaries of the health region coincide with the borders of the Municipality of Petrich with the administrative center of Petrich.
  • Razlog Health Region – the geographical boundaries of the health region coincide with the boundaries of Razlog municipality with administrative center Razlog.
  • Sandanski Health Region – the geographical borders of the health region coincide with the boundaries of Sandanski municipality with administrative center Sandanski.
  • Satovcha Health Region – the geographical borders of the health region coincide with the borders of the Municipality of Satovcha with the administrative center of Satovcha.
  • Simitli Health Region – the geographical boundaries of the health area coincide with the borders of Simitli Municipality with the administrative center of Simitli.
  • Strumyani Health Region – the geographical borders of the health region coincide with the borders of the Municipality of Strumyani with the administrative center Strumyani.
  • Hadzhidimovo Health Region – the geographical boundaries of the health area coincide with the borders of the municipality of Hadjidimovo with the administrative center Hadjidimovo.
  • Yakoruda Health Region – the geographical boundaries of the health area coincide with the borders of Yakoruda municipality with Yakoruda administrative center.

The structure of the health network and the provision of beds in the Blagoevgrad district are presented in the Table according to the National Healthcare Map and the Healthcare Plan for Blagoevgrad District, developed in 2016.

Existing health establishments are broken down by activity and type:

PRIMARY OUTPATIENT MEDICAL CARE
Individual practice for primary outpatient medical care
Group practice for primary outpatient medical care

SPECIALIZED OUTPATIENT MEDICAL CARE
Individual practice for specialized outpatient medical care
Group pactice for specialized outpatient medical care
Medical Center
Diagnostic-consultative center
Stand-alone medical-diagnostic laboratory
Stand-alone medical-technical laboratory

 Inpatient medical care
A multiprofile hospital for active treatment
Specialized hospital for active treatment
Specialized hospital for long-term treatment and rehabilitation
Hospital for long-term treatment
Specialized hospital for rehabilitation
State psychiatric hospital

OTHER HEALING ESTABLISHMENTS
Emergency Medical Center
Center for Transfusion Hematology
Complex oncology center
Mental Health Centre
Center for skin-venereal diseases
Home for medical and social care
Dialysis Center
Thick bank
Hospice