With an overwhelming majority, the National Assembly decided that the National Health Insurance Fund (NHIF) budget will cover prescribed medications for home treatment of acute infectious diseases, including antibacterial drugs for children up to the age of 7. This amendment was adopted with the NHIF budget for 2025.
The amendment is expected to take effect on July 1, 2025, and until then, specific mechanisms and regulatory requirements must be approved to determine how exactly the medications will be prescribed, dispensed, and reimbursed. Additionally, a list of the exact medications covered under this scheme will be finalized.
According to the adopted provision, NHIF will reimburse antibiotics, corticosteroids, and medications for acute viral infections, prescribed by doctors via electronic prescriptions. Government estimates suggest that depending on when the amendment takes effect, between 10 and 20 million BGN will be needed to fund the measure. At the same time, calculations by civil organizations indicate that a significant portion of these funds will be saved by reducing complications from childhood illnesses and avoiding unnecessary hospitalizations.
Fewer unnecessary hospitalizations, prevention, fewer complications, and chronic diseases—these are just some of the expected benefits of the measure.
Long-Standing Advocacy Efforts Lead to Success
The parliamentary decision to provide free medication for infections is a major achievement and a success for the years-long efforts of a group of non-governmental organizations advocating for this policy change through several consecutive projects, led by the Trust for Social Achievement (TSA).
Ten years ago, TSA launched the pilot program for Bulgaria - Nurse-Family Partnership Program, one of the world's most effective early childhood development programs, aimed at vulnerable families with young children. During its implementation, an assessment of Bulgaria’s readiness to apply the program revealed two major systemic barriers that limited its expected positive effects:
- Lack of access to prenatal care for all pregnant women
- Lack of access to medications for outpatient treatment for children living in poverty
As part of the pilot project, TSA covered these costs for families who could not afford them. The accumulated experience and data on the impact of improved healthcare led to efforts for long-term policy change.
Since 2021, a group of civil organizations, united under the initiative "A Colorful Tomorrow for Our Children", began actively working towards removing these barriers through legislative changes. The goal was not only to ensure the prevention of serious illnesses and unnecessary hospitalizations among children but also to provide better development opportunities and reduce chronic diseases in early childhood.
This initiative and related activities were part of the "We Care" project, managed by TSA and funded by the Open Society Foundation and Porticus. Several civil organizations participated in the advocacy process, including:
- Crime Prevention Fund – IGA - Pazardzhik
- Liberal Alternative for Roma Civil Union Association – LARGO – Kyustendil
- Club of Non-Profit Organizations Association – Targovishte
- Initiative for Equal Opportunities Association – Sofia
- Women's Roma Association "Hayachi" – Novi Pazar
- Thirst for Life Association – Sliven
In September 2024, additional partners joined the initiative, including the National Network of Health Mediators and "Future" Association – Rakitovo, as the advocacy efforts intensified under the project "Network We Care 0 tо 3: Prevention of Family Separation", also led by TSA and funded by the Tanya’s Dream Fund. Through numerous forums, meetings, discussions, and communication with local communities, medical professionals, and government representatives, the organizations demonstrated the need for change and worked towards its adoption.
The Data
In February 2025, a report summarizing data from Eurostat, the National Statistical Institute (NSI), NHIF, and a specially conducted sociological in-depth study among parents, doctors, pharmacists, and community workers was published.
The study, titled "When Children Pay the Price – Public Funding for Children’s Medications Between Solidarity and Prejudices" (available in Bulgarian HERE), was conducted by the organizations within the "A Colorful Tomorrow for Our Children" initiative and authored by sociologist Venelin Stoychev, PhD.
According to the data:
- Every second parent in Bulgaria struggles to cover medication costs for their children
- 14.4% of parents are "severely burdened" by these costs
- The average annual cost for medications per child is 562.32 BGN
- In 2024, parents' total direct spending on children’s medical treatments exceeded 1 billion BGN, with over 63 million BGN spent on antibiotics alone
Meanwhile, in 2024, NHIF paid over 126 million BGN for pediatric hospital treatments:
- 30 million BGN for children aged 1–3 years
- Over 20 million BGN for children under 1 year old
In the past two years, more than 21,863 repeat hospitalizations of the same child were recorded, nearly 5,000 of which involved children aged 1–3 years.
Many of these hospitalizations could have been prevented with timely and adequate treatment at home if parents had access to the necessary medications. According to the study, state funding for a package of free medications for all children up to 7 years old could eliminate the need for at least 10% of pediatric hospitalizations.
Enormous Added Value for Proper Child Development
"Covering prescribed medications for children from 0 to 7 years does not only lead to public budget savings. Early diagnosis and prevention of serious illnesses among children have enormous added value for their proper development, reducing chronic diseases among youth, and ensuring a healthier generation," civil organizations emphasized.
"Let’s not forget that all public policies are based on specific values. Children should not suffer the negative consequences of social inequalities based on financial status, ethnicity, beliefs, or their parents' education. On the contrary, these inequalities must be addressed through various mechanisms, including those we have proposed," the organizations urged.
About the Network
The "Network We Care 0 to 3" unites 11 civil organizations in joint activities under the "Prevention of Family Separation" project, funded by Tanya’s Dream Fund. This project aims to deepen efforts to reduce the risks of family separation and improve support and preventive measures for vulnerable families.
The network's main objectives include:
- Informing and sharing expertise with stakeholders on the social and financial benefits of providing free prescription medications for children in early childhood.
- Advocating for vouchers or financial aid for nutritious food for families with children aged 0–3 years living in poverty.
- Testing an integrated service model in two communities to coordinate prevention efforts against family separation through the social services system.
- Supporting the implementation of legal changes in the Civil Registration Act regarding the issuance of identity documents for individuals without an official residential address, as well as ensuring the enforcement of existing legal provisions