The municipality of Nikola Kozlevo is the smallest and poorest of the ten municipalities in the Shumen region. According to the National Statistical Institute, 5,268 residents live in its 11 villages as of last year.
About 60% of the population is of working age, with nearly 700 unemployed individuals who most often find seasonal work or rely on social assistance. Meanwhile, young skilled workers prefer to leave their hometowns for jobs in larger cities or abroad.
In the Integrated Development Plan of the municipality of Nikola Kozlevo for 2021-2027, healthcare is described as follows:
“The access to healthcare and medical assistance for the population of the municipality of Nikola Kozlevo is generally severely limited.”
The municipality lacks hospitals, healthcare institutions, and an Emergency Medical Assistance Center.
Hospital care is mainly provided by the hospitals in Novi Pazar and Shumen.
Primary outpatient medical care in Nikola Kozlevo municipality is provided by four medical practices in renovated offices in the villages of Velnari, Pet Mogili, Nikola Kozlevo, and Tsarkvitsa.
A significant portion of the population in the municipality is uninsured or has interrupted health insurance rights, which further complicates access to healthcare.
School health care is provided by medical staff assigned to schools and children’s educational institutions. Equipped medical offices located within educational establishments are used for this purpose. Children most commonly suffer from common infectious diseases—seasonal flu, viral infections, musculoskeletal deformities, etc.
Healthcare in the Roma community is a complex issue. Risk factors such as high unemployment, deteriorating income and consumption structure, unfavorable living and environmental conditions, and lifestyle create circumstances and increase the likelihood of disease occurrence.
The tragic state of the municipality becomes evident immediately upon entering.
The square resembles a “plowed fallow field,” with weeds overgrown in front of the community center and the mayor’s office—there isn’t a single painted bench for the public even during a holiday.
The practice of Dr. Evgeniy Kara, the family doctor for the municipality’s residents, is situated in his home, where he has set up a clinic with very good conditions.
Not far from the center of Nikola Kozlevo, there is a new health center, but it is empty!
On June 6 of this year, it was officially opened after lying in ruins for over 20 years. In two years, the municipal enterprise “Nikola Kozlevo” completed both internal and external renovations of the building. The project cost 189,822 leva for major repairs, ensuring accessible environments, and implementing energy efficiency measures within the building. The grant from the project “Beautiful Bulgaria” was 93,013 leva, while the co-financing from the municipality amounted to 96,809 leva.
The with the idea that specialists from Shumen and Novi Pazar would work in the medical offices after purchasing an ultrasound machine, oxygen concentrators, and other equipment. However, Dr. Kara cannot move his general practice there because the building requires expensive heating and is not furnished with furniture and medical equipment. Under these circumstances, rural healthcare is merely about “utilization of funds from a project,” but cannot guarantee prevention and treatment for the local population within the empty building. Aging and ill residents need preventive examinations and early diagnosis of socially significant diseases with high mortality rates.
The funds allocated by the health insurance fund for insured patients are symbolic. General practitioners do not have enough referrals for all types of specialists (oncologists, cardiologists, pulmonologists, etc.), except for severe cases.
The population nostalgically remembers when a mobile fluorograph would come to the village to conduct mass screenings for tuberculosis among at-risk groups, especially in Roma neighborhoods. Women from factories, agricultural enterprises, and educational institutions were included in preventive gynecological check-ups. After 2000, when health insurance started and GP practices were introduced, the population was forgotten when it came to preventive care.
Preventive programs are rare in this region, but they are remembered for having saved many lives.
It is still recalled how, in the summer of 2013, the municipality of Nikola Kozlevo, together with the Center for Protection of Rights in Healthcare, conducted free breast cancer screenings in the municipal administration building. A team led by Dr. Mladen Mladenov from “Sv. Sofia” hospital came from the capital. A total of 191 women aged 40 to 60 from the municipality’s villages were transported to the mayor’s office in Nikola Kozlevo, where diagnostic rooms with mammography were provided.
Now there is a new health center, but the ten rooms for offices and manipulation remain empty. Patient organizations that work on projects for European funding are located in Sofia. Some municipal budgets allocate 20,000 to 30,000 leva to ensure specialists for organized preventive examinations of the population.
On June 20, 2018, two new dental clinics were opened in the villages of Pet Mogili and Velnari in the municipality of Nikola Kozlevo.
The municipal budget provided 36,000 leva each for modern equipment for them. Patients are served by Dr. Ahmed Ahmed, who graduated in dental medicine in Istanbul.
In September 2023, about ten dentists from the Shumen region, working in several municipalities, participated to limit the spread of dental caries among children aged 5 to 8 years through the sealing of their first permanent teeth. Adolescents in Nikola Kozlevo municipality, however, were again not covered, despite the procedures being free of charge.
The truth is that preliminary preparation requires a lot of time and energy. The sealing takes place with parental consent, and the information campaign is also supported by educators. We reached out to Dr. Ahmed, the dentist who uses the two new dental clinics. He said, “I do not want to deal with sealing children’s teeth.” It is worth noting that Bulgarian children have the worst dental health in the European Union. The lack of prevention for dental caries is a significant risk factor for the premature loss of primary teeth.
The oral hygiene of the population in remote rural areas is desperate.
The lack of knowledge among parents has severe consequences for the dental health of children later on.
Treatment for children up to 18 years of age is free, but they do not take advantage of this. Therefore, serious health education for the population is necessary. Fears of the dental chair are widespread, but this is a matter of health culture that should begin on the first day of school, dental professionals assert.
It is a public secret that when cardiology clinics seek patients, they conduct free preventive examinations in rural municipalities, and the population is undoubtedly in need of care. Years ago, obstetricians and neurologists did the same. People in Nikola Kozlevo municipality claim that no one has organized free diagnostics for them, and there are also no facilities to conduct such examinations in the villages.
Future mayors and municipal councilors must consider health prevention and screening for the population that remains in this area. It is aging, poor, and facing significant health issues.
Health policy must change at the municipal and regional levels. Simply renovating health facilities will not suffice. Municipal budgets should allocate funds for the prevention of socially significant diseases, equipping at least three clinics with heating, medical equipment, and furniture. There is always a way to find funding for this, as municipal property—lands and buildings—regularly appears on the agenda of municipal councils for sale.
