Nurse-Family Partnership Program - Bulgaria

Since 2016 TSA has been testing the Nurse-Family Partnership (NFP) in Bulgaria, a program that’s proven to be an effective and internationally recognized model of home-visiting care. Our teams of family nurses carry out intensive home visits to vulnerable pregnant women up to the age of 22 who are expecting their first child – starting early in the pregnancy and continuing through the child’s second birthday.

Young mothers are consulted on matters about the prenatal period and parenthood. Family nurses also accompany them, whenever necessary, to medical check-ups and meetings with social service providers. Finally – the mothers receive vital support and guidance on their self-efficacy and future personal development.

The main goal of the program is to help young women build parenting skills key to assuring a healthy start for their babies while also envisioning a life of stability and opportunities for themselves and their family. The program addresses the needs of the whole family unit - mothers, fathers, children and other family members.

After completing the pilot phase of the NFP Program, TSA’s main strategic goals are to have the specialized home-visiting service adopted by the Bulgarian government and integrated into the national healthcare system.

Bulgaria is the first country in Eastern Europe licensed to implement the NFP model which provides important home visits to first-time, low-income mothers, starting from the pregnancy period and continuing through the child’s second birthday. NFP is a service targeting women under the age of 22 and prior to the start of 28th week of their first pregnancy.

The program provides specialized training to teams of nurses and midwives who then conduct between 50 and 64 home visits to young, first-time mothers-to-be, assuring ongoing support, care and relevant information necessary for new parents.  The NFP model was developed more than 40 years ago by Prof. David Olds, Professor of Pediatrics and Public Health at the University of Colorado Denver, USA. This program has the strongest evidence of its effectiveness (confirmed by numerous randomized controlled trials worldwide) in support of early childhood development. The program is currently being implemented in Australia, England, Canada, Norway, USA, Northern Ireland and Scotland, among other countries.

In all these countries, the program has been adopted by the national healthcare systems and is implemented through various governmental institutions – due to the perceived and assessed needs in the countries, the benefits of the program and the high-return investment in the first 1000 days for every child. Among the proven long-lasting and sustainable effects observed in all countries where the program is implemented are:

  • Improved prenatal health;
  • Improved pregnancy outcomes;
  • Decrease in infant mortality;
  • Fewer accidents and injuries among children;
  • Fewer cases of child abuse and neglect;
  • Longer intervals between pregnancies;
  • Increased employment rate among mothers;
  • Better school readiness;
  • Decreased likelihood of involvement in criminal activities;
  • Reduced use of social benefits.

In 2015, TSA purchased the license for the program and after the successful adaptation and translation of the working materials and resources, work with families from Sofia began in August 2016 and in partnership with the specialized hospital for gynecology II SAGBAL "Sheynovo". Since its beginning, more than 160 families in Sofia have been enrolled in the program - dozens have successfully completed the curriculum of home visits already, and there is a constant flow of new clients joining the program.  Specialized home-visiting care is carried out within the territory of the whole city, with a focus on the Fakulteta, Filipovtsi and Hristo Botev neighborhoods - due to the concentration of young, economically disadvantaged mothers (under 22) who live there.

In January 2019, the NFP national unit has successfully expanded the program implementation to the second largest city in Bulgaria - Plovdiv. This step was possible because of the partnership between TSA and the local St George’s University Hospital. In Plovdiv, the program is accessible to families from any part of the city (likewise in Sofia), with most of the clients living in the Stolipinovo and Sheker Mahala neighborhoods (over 80 families).

The three main goals of the program are:

  • Give birth to healthier babies;
  • Improve the early development of children;
  • Increase the economic independence of the parents

To achieve these results, the family nurses support the young mothers enrolled in the program, through both the intensive home visits, and also by taking into account their individual needs.  Examples of what this additional support could cover include health insurance taxes, medication for mothers and children, etc.

As part of the implementation of NFP Bulgaria we have established advisory boards - two local (one in Sofia and one in Plovdiv) and one national, whose members meet regularly (every 4 and 6 months). These meetings bring together key representatives of institutions and experts on maternal and infant health and development on both the local and the national level. The meetings are hosted by the Directorate-General for Health of the Sofia Municipality, the Municipality of Plovdiv and the Ministry of Health. The main purpose of the advisory boards is to support the quality implementation of the program which will hopefully lead to its integration into the system of national health and social services later on.

Besides the two hospitals - II SAGBAL "Sheynovo" and St George’s University Hospital - TSA is partnering with two foundations on the local level - Health and Social Development Foundation in Sofia and National Alliance for Volunteer Action in Plovdiv. The family nurses are supported by expert teams from these two foundations and have regular consultations with a psychologist and a social worker that enables them to work with families who experience the highest levels of risk and vulnerability.


On the other hand, the Open Society Institute - Sofia is responsible for the external evaluation of the program regarding the feasibility and acceptability of the model in the Bulgarian context. This study is conducted in parallel with the implementation of the program, following the requirements set by the University of Denver, Colorado for piloting the program.

The evaluation methodology is a combination of a variety of tools for collecting quantitative and qualitative data that examine three main groups – Site 1 and 2 team members, the clients, and various local and national stakeholders.

Implementation of the program

The program is operated by a national team, supported by external consultants who are part of NFP International under the leadership of Prof. Olds.  In the field, the service is provided by highly qualified medical professionals - nurses, midwives and health mediators, who develop skills through a large, ongoing volume of thorough, thematically diverse trainings.

Since December 2019, an expert from the National Center of Public Health and Analysis (adjacent to the Ministry of Health) has been working on adapting the Program’s methodology according to the Bulgarian healthcare system and the country’s social services. This includes further adaptation of the program materials, monitoring the implementation of the core model elements and nurse practices, and drafting a set of recommendations that would guarantee the quality of NFP implementation in case of scaling up.

The main goal of TSA is to complete the pilot phase and the following impact assessment, in order to then successfully integrate the program as a service into the national healthcare system.

What are the requirements to join the program?

To join the program, you must be:

  • A  woman under the age of 22;
  • Expecting your first child;
  • Under 28 weeks pregnant;
  • Economically disadvantaged (monthly income below the national minimum wage);
  • Living in Sofia or Plovdiv

Contact details for any additional information: Ivanka Puleva, project manager:; phone number 0886 778 313 or Facebook page: Nurse Family Partnership Bulgaria.


Every month we prepare a newsletter to inform our partners and supporters about the development of the NFP program in Bulgaria. You can subscribe for our newsletter by sending an email with a subject "NEWSLETTER" to

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