Civil society vs. Government in the Eastern Balkans: Who can build a better hospital?
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Over the last 30 years, children with rare diseases in Bulgaria and Romania have been waiting for a modern children’s hospital that could properly meet their needs. However, an insufficient healthcare system and political discourse have prevented this from happening
Vyara Yoncheva
Vyara Yoncheva is currently studying in Sofia University “St Kliment Ohridski”. Her research interests are focused on the culture and geopolitics of the Balkans, Caucasus region, the Middle East and their historical intertwining.
This article was published on 24 January 2022 at the Greek site Balkans In Site.
High-quality healthcare helps prevent diseases and improves the quality of life. Unfortunately, in many parts of the world, there are deep-rooted problems that make the system insufficient. Decades after the fall of communist regimes in 1989, countries of the former Eastern bloc continue to suffer from inadequate reforms and lack of funding regarding people’s health. Bulgaria and Romania have ranked last in terms of budgets spent on universal healthcare since joining the EU.
The absence of proper financing in both countries has led to a hiatus in building modern hospitals and facilities. The “brain drain” phenomenon is especially prominent in the medical field. Young professionals often pursue better-paid careers abroad or in the private sector, leaving the governmental system understaffed and forcing it to use out-of-date treatment methods.
These problems are visible to everybody, but people are prone to talk about them only when somebody dies. When this happens, we might even start throwing rocks at the on-duty teams, blaming doctors and barely addressing the bigger issues.
In Bulgaria, the question of a new children’s hospital remains unanswered. A project for a hospital building began in 1978 on the terrain of the multispecialty hospital “Aleksandrovska” in Sofia, but the construction remains unfinished. Parents unable to afford private care for their children are expected to search for solutions unguided, often “tossed around” numerous practitioners, hospitals, and even cities.
During the elections in 2021, the question was brought up once again. Multiple proposals have been made on how the project should be renewed. Earlier, the ex-prime minister, Boyko Borisov, suggested the old construction be demolished and a new site be built in its place. This, however, never happened. Later, the hospital was proposed to be created as an attached unit to the university hospital “Lozenets”, which was met with a wave of discontent from the facility’s management. There is even an idea to finish the old building, but this is rejected by architectural associations, arguing the old construction plan cannot meet the new norms of urban planning in Sofia.
The discourse continues, and the old, ugly building stands almost like a pillar of political irresponsibility and social apathy.
Across the border in Romania, almost in the center of Bucharest, rises the almost finished building of a new modern children’s hospital. A future governmental hospital, built not by the government, but by a private donations campaign. The campaign was created by Oana Gheorghiu and Carmen Uscatu, founders of the “Give Life” Association (Dăruieşte Viață Association).
Since 2015, more than €30 million (£25 million) has been raised. Donations were issued through the NGO’s website. Over 350,000 people and more than 5,600 companies have donated money to build the facility. Companies such as “OMV Petrom”, “Mastercard” and, believe it or not, the metal band “Metallica”.
Construction of the hospital began in 2018 and will be operational, probably in July 2022. The building has 12,000 square meters, 9 levels (basement, ground floor, mezzanine, and 6 floors), and 187 beds. The building is planned not only to meet the needs of children with serious health problems but also to ensure the comfort of their parents. In addition, one of the most important components of the hospital is the first children’s radiotherapy department in the country. Up until now, children would receive radiotherapy treatment in adult centers without the possibility of anaesthesia.
However, the project raises many questions that create rather critical opinions and misbelief.
Many think the hospital will stumble upon the obstacles of the healthcare system in Romania. Once the walls of the building are up and all the equipment is in its place, the government won’t be able to maintain it. There won’t be enough trained professionals to work in it, and slowly, the facility will progress into yet another private hospital.
There has been a tendency of promoting the free market economy in the health sector. This is a direct reaction to the decades of centralism and authoritarianism of the communist period. The healthcare policy in Romania after 1989 is marked by two main periods of development: one between 1989 and 1996, and one from 1997 to 2005, and many smaller ones. In low- and middle-income countries, health sector reforms usually emerge from continued macroeconomic adjustments under the influence of international financial bodies, which often cannot assess the social situation in the country correctly. Upgrading from reform to reform without eliminating previous systemic problems has led to the deepening of the same. Not only that, but to the creation of new ones.
The culture of receiving expedited care from doctors with petty bribes is notoriously hard to root out. More worrying, however, are the large sums of money laundered through heavily marked-up deals with providers of equipment and supplies.
One of the founders, Oana Gheorghiu, in an interview for “Newsweek Romania”, in December of 2021, said:
“We don’t want to move old habits to the new hospital, we are proposing something completely new, the first real partnership between the civil society that built a hospital, and the Romanian state, through the Ministry of Health. Together, we will test a different way of doing management. Let us use outside models, think of efficiency-based management, look at where the holes are, why things are not working, what is good, and what can be kept. Efficiency means quality of medical services. The Romanian state has nothing to lose. Only the patient has something to gain. “
The new healthcare facility is being built on the site of one of the existing hospitals in the city and will become part of the public healthcare system upon completion. One hospital alone will not be able to change the whole system. Nor can it guarantee that its new ways of working will not be merely wishful thinking.
Anyway, in Romania people seem to have found a children’s hospital project to believe in, while in Bulgaria it is more difficult to go in a certain direction. Romanians have a similar knack for finding causes on other issues – for example, the cultural movements to protect the Roșia Montana area from gold mining or to protect the mines in the town of Petrila from destruction.
What is the Bulgarian public cause that can mobilize everyone and be realized as a collective project? I would like to believe that Bulgarians can do more than collect bottle caps “for the future” (a reference to the campaign for collection of bottle caps whose donation leads to money for infant medical care).
Photo: A screenshot from a commercial for the Romanian hospital built with donations (source: YouTube)
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