On September 30, the Municipal Council in Nedelino will discuss whether to build three outpatient clinics in small villages in the municipality – Gurnati, Izgrev, and Kundevo, according to the published agenda. The proposal comes from Mayor Boyan Kehayov, who wants Nedelino to take advantage of the Ministry of Health’s (MOH) project “Development of Outpatient Care.” Municipalities can apply for the project, and the resources are estimated for about 100 clinics in the country. The idea is for them to be located in small and remote villages with more than 100 inhabitants. They must have a waiting room, a reception area, an examination room, and a treatment room.
The Ministry of Health announced the program on July 25 with a budget of BGN 8,260,951.86 and an application deadline of 5 p.m. on September 24, 2025. This deadline was later extended to October 24.
What does the Ministry of Health offer?
It will cover 100% of the municipalities’ capital costs for the renovation of the premises, electrical and plumbing installations, network connectivity, and their commissioning. The deadline for completion is June 30, 2026. The furnishings and medical equipment are provided for in a separate procedure of the Ministry of Health. The activities in the clinics must be paid for by the National Health Insurance Fund (NHIF) and the national programs of the Ministry of Health, but only when there are contractors with a contract with the fund and actual reported activity. In his report, Mayor Kehayov states that the Ministry of Health will enable nurses, midwives, paramedics, physician assistants, and rehabilitation specialists to open independent practices, using the built and equipped facilities free of charge. At this stage, the National Health Insurance Fund does not pay directly to independent nursing practices, and the dispute over funding remains open.
According to current legislation, contracts with the National Health Insurance Fund (NHIF) can only be signed by healthcare providers – general practitioners, diagnostic and consultation centers, and medical institutions. The municipality cannot secure a contract with the fund, nor does it have the resources to hire medical specialists. The fund pays providers for actual services rendered, and in villages with a population of 100–200 people, it is impossible to provide even minimal income for a doctor, nurse, or medical assistant.
Photo: Ivaylo Burdev
A model without people
There are about 22,000 nurses working in Bulgaria, 341 per 100,000 people, compared to an EU average of 786. The difference is almost double. Professional organizations indicate that there is a shortage of over 30,000 nurses in the country. The ministry’s draft does not answer how nursing services would be financed outside of medical practices. The law allows for independent healthcare practices, but the National Health Insurance Fund does not pay nurses directly. The Bulgarian Medical Association opposes this change. This leads to a key absurdity: the state will build and equip facilities, but there will be no one to work in them and no one to pay salaries if someone decides to open a practice in a small town. This is especially true in municipalities such as Nedelino, which, even if they wanted to pay, have no means to do so. Their own revenues are less than 9% of the budget.
It appears that the ministry is simply spending money without analyzing local needs, available and potential human resources, or what kind of healthcare model is feasible in villages with fewer than 200 inhabitants. With this capital scheme, without reforms in remuneration, clear incentives for contractors in the periphery, and regulatory solutions for the financing of nursing services, the Ministry of Health is shifting responsibility to municipalities and private doctors, who have neither the authority nor the tools to remedy the systemic shortage of personnel.
There is money, but no plan
Mayor Boyan Kehayov’s proposal is expected to be accepted unanimously by the municipal councilors. Who would not want small towns to have better access to healthcare, who would oppose 100% state funding for the construction of rural clinics? But if the Ministry of Health does not provide staff, the project risks remaining a demonstration project. With a new and equipped, but locked clinic. Healthcare services are only available when a doctor or nurse enters, reports on preventive care, chronic follow-ups, procedures, screening, and receives payment. Today, with a shortage of tens of thousands of nurses and a lack of funding for independent nursing services, the ministry owes us answers, not just invitations to apply. Otherwise, as much as we want to believe that “after 2026” things will work out, the facts point to something else: we are throwing money at infrastructure without securing the most scarce resource – people.
