No success without integration – emergency aid in the recovery plan

The emergency care system in Bulgaria plays a key role in ensuring quick and effective access to healthcare for people with life-threatening conditions. It currently faces several issues – obstructed access due to geographic obstacles, a declining number of specialists, poor road infrastructure, heavy traffic, etc. At the same time, Bulgaria can now utilize funds from the Recovery and Resilience Mechanism and therefore address these issues and speed up the development of emergency care.

The National Recovery and Resilience Plan includes two projects that are important for the advancement of emergency care. Both relate to the implementation of the third reform in the “Healthcare” component of the fourth pillar – “Just Bulgaria”: “Improving the appeal of healthcare careers and incentivizing a more balanced distribution of healthcare specialists across the country”. This pillar aims to overcome the shortage of medical professionals and ensure that the sector is well provided for financially and in terms of equipment. The first project is “Developing a system for providing emergency care via air” (N9). The name of the second is second is “Improving the national system for emergency communications 112” (P48).

N9 aims to establish a system that provides high-quality air medical services within the span of the so-called “golden hours” across the whole country, alongside further transportation to the right medical facility or between different hospitals and the delivery of medical equipment, blood, organs, and medication where they are urgently needed. The expected result is a 20% reduction in the number of deaths from road and work accidents and specific health conditions, requiring emergency care.

The project mentions several reasons why such a system is necessary:

  • restricted access to healthcare due to underdeveloped or ill-maintained road infrastructure
  • difficult access due to harsh weather
  • a varying terrain
  • unequal access of the population to emergency care due to reaction time increasing because of heavy traffic
  • the importance of saving time when it comes to transplantations or transportation of organs.

The project includes the purchase of helicopters and supplementary equipment, as well as the construction of operational bases and the training of pilots, engineers, and medics. The total budget is 119 181 032 leva with VAT included.

This project fills a gap in the provision of emergency care to Bulgarian citizens. It is well justified and relatively well described, though it lacks clear indicators for evaluating its results and effect. The text does not specify how the five helicopters correspond to the planned bases, which are six in total. There is a concept of how air medical services will function but there are no details on how it will fit within the entire system of emergency care. The creation of another government agency that will administrate this system will probably further hinder reaching the desired goal – faster access to emergency care and the decrease in the number of deaths from emergencies. Something positive about the project is the inclusion of funds for training staff. It is also noteworthy that project N9 seems more focused on making changes regarding the medical profession rather than improving healthcare provision. There is also no clarity on what will happen with the system for air emergency care once the NRRP is completed – we are yet to see who will maintain and fund it.

The project for improving the services of the common European phone number 112 is more “digital” than healthcare-related but it is still important for the timely provision of emergency care in Bulgaria. Its main goal is to improve the quality and the coverage of help, provided after a call to the number 112. This is to happen through the development of a common communication and information platform that will replace the current one.

The main activities included in the project are the delivery of software, purchase of licenses, creation of a common communication and grid infrastructure, as well as information infrastructure, development of workstations, integration within the current information systems, maintenance, and training. The project also includes the creation and integration of a medical module. Beneficiaries from P48 are the Ministry of Internal Affairs and the Ministry of Health and the total budget amounts to 56 million leva.

Unfortunately, the indicators for evaluating the effects of the project are not highly informative. It is unclear how the project will improve reaction time, connection robustness, and user satisfaction and therefore the quality of emergency care. Once again, the technical aspect is executed well but there is little clear justification for why these investments are necessary and how they will improve health services and the healthcare system. Most projects in the Recovery and Resilience Plan have this shortcoming.

The two projects aimed at improving emergency care include investments in activities that are currently not conducted (N9) and the replacement of an old system with a new one (P48). Despite the thorough descriptions, they seem to have been developed as standalone pieces that do not connect well with the current healthcare system. A more systematic approach would be better for achieving maximum results without wasting resources.


*This document is funded by Active Citizens Fund Bulgaria through the Financial Mechanism of the European Economic Area and Norwegian Financial Mechanism. All its contents are the sole responsibility of Institute for Market Economics and do not represent in any way the views of the Financial Mechanism of the European Economic Area and Norwegian Financial Mechanism and Active Citizens Fund Bulgaria. (

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