Bulgaria’s paediatric healthcare crisis deepens

Bulgaria’s paediatric healthcare system is sliding deeper into crisis, with the resignation of the director of the country’s only specialised children’s hospital in Sofia. This follows the mass departure of an entire regional surgical team, exposing wide institutional failure.

Though the director was temporarily reinstated days later after a change of government, the underlying shortages, administrative pressure and staff exodus remain unresolved.

The Balkan country is facing a chronic shortage of paediatricians, while state hospitals in major cities are increasingly unable to retain key specialists, many of whom are moving to the private sector. The ministry of health acknowledges the “challenges facing paediatric healthcare” but insists the issue should not become a platform for political confrontation.

North-Eastern Bulgaria in health crisis

In January, the paediatric surgery department at St Anna regional hospital, the largest state hospital in Varna, Bulgaria’s third-largest city with a population of around 350,000, ceased operations after all surgeons resigned to join a newly opened private children’s hospital in Burgas.

The six regions affected – Varna, Dobrich, Shumen, Ruse, Razgrad and Targovishte – have a combined population of approximately 1.25 million people. In practice, the Varna paediatric surgery unit served much of North-Eastern Bulgaria, turning the departure of the entire surgical team into a regional healthcare crisis rather than a local hospital issue.

Health workers cite extremely low salaries and an excessive workload endured by the team over many years. Hospital sources say the combination of chronic understaffing, high responsibility and limited financial incentives ultimately made the situation unsustainable.

Institutional pressure

In mid-February, Bulgaria’s only specialised children’s hospital in Sofia was left without a director following the resignation of Dr Blagomir Zdravkov, who said he had been subjected to sustained pressure from the authorities.

“I am leaving the Specialised Children’s Hospital – Sofia with no sense of reconciliation, but with pain and sadness… I refuse to be part of an environment in which administrative pressure and endless inspections replace the meaning of medicine and turn work into mere survival,” Zdravkov said.

According to him, the past year had been marked by “systematic institutional pressure, financial restrictions and a refusal of dialogue”.

The Bulgarian Ministry of Health confirmed that since early 2025, the hospital has been subjected to numerous inspections, audits, reviews by the Medical Supervision Agency and several checks ordered by prosecutors. No public information has been released regarding any violations.

Hospital staff, speaking to Euractiv on condition of anonymity, said the administrative pressure had indeed been substantial and aimed at forcing the director to step down.

Only a week later, following a change of government in Sofia and the appointment of a caretaker cabinet, negotiations led to Zdravkov’s temporary reinstatement as hospital director. However, his future in state-run paediatric healthcare remains uncertain, as he is also a candidate to head the same private hospital in Burgas that has attracted doctors from Varna.

The health ministry says it continues to invest in paediatric care. Using funding from the EU Recovery and Resilience Plan, the Sofia children’s hospital is expected to receive medical equipment worth nearly €6 million later this year. However, the ongoing wave of staff departures has raised concerns that there may be insufficient personnel to operate the new technology.

Warnings from civil society

Zdravkov received support from colleagues and civil society groups. The ‘For the Good foundation’, which advocates the construction of a modern national children’s hospital, described his resignation as “another heavy blow to paediatric healthcare in Bulgaria”.

“The publicly stated reasons are institutional pressure, administrative harassment and a refusal of dialogue by the ministry of health. This should be a red alarm for the whole of society,” the organisation said, calling for an independent investigation.

Nadezhda Rangelova, chairwoman of the ‘For the Good foundation’, warned that Bulgaria risks being left without functioning paediatric healthcare. “This is a governance failure. Doctors are not leaving only because of money, but because they cannot treat children under adequate conditions,” she said, describing the situation as a “catastrophe” for Bulgarian paediatrics. The foundation is a member of the European Association for Children in Hospitals.

For nearly four years, successive governments have been preparing plans to build a modern national children’s hospital in Sofia, with preliminary estimates placing the project’s cost at around €500 million. Construction has yet to begin due to bureaucratic delays and postponed procurement procedures.

Health experts warn that Bulgaria still lacks sufficient specialists to staff a large, multi-profile paediatric hospital. If high salaries are used to attract doctors from across the country, regional paediatric services could be depleted; if not, the facility risks remaining understaffed despite the scale of the investment.

[VA, BM]