Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev ET
ISSN: 1312-773X (Online)
Issue: 2017, vol. 23, issue 1
Subject Area: Medicine
Pages: 1427-1431
DOI: 10.5272/jimab.2017231.1427
Published online: 19 January 2017

J of IMAB 2017 Jan-Mar;23(1):1427-1431
Maria RohovaORCID logoCorresponding Autor,
Department of Health Economics and Management, Faculty of Public Health, Medical University - Varna, Bulgaria.

Introduction: There are many factors influencing health inequities; health workforce availability and skill mix are among them. Regional distribution of health workers determines access to health services. The aim of this study is to analyse and to assess the distribution of health professionals among the statistical regions and districts in Bulgaria.
Methods and materials: The current study uses health professionals to population ratio, Gini index and Lorenz curve to measure and assess the proportionality of health workers distribution. Data are provided from the National Statistical Institute and European Health for All databases.
Results and discussion: In Bulgaria, health professionals per population ratio are comparable with the EU average except for the nurses. Beside the shortage of nursing professionals, geographically uneven distribution of health workers is among the main challenges in human resource management.Regional imbalances are significant among the districts in the country. More than half of the physicians are concentrated in 6 districts. The analysis shows an upward trend in imbalances, expressed as absolute or relative differences.The distribution of dentists is much more variant and diverse than this of physicians. The values of Gini index for specialised medical care also reveal considerable imbalances.
Conclusions: Differet coefficients have proved the unequal distribution of health workers among the districts.Regional imbalances are not the only reason for health inequities in Bulgaria but they have significant influence in rural and remote areas and in regions with high unemployment, low incomes and ageing population.

Key words: health professionals, imbalances, inequity, distribution, access,

- Download FULL TEXT /PDF 767 KB/
Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Rohova M. Regional imbalances in distribution of Bulgarian health professionals. J of IMAB. 2017 Jan-Mar;23(1):1427-1431. DOI: 10.5272/jimab.2017231.1427.

Correspondence to: Maria Rohova, Department of Health Economics and Management, Medical University – Varna, 55, Marin Drinov Str., 9002 Varna, Bulgaria; E-mail:

1. Human Resources for Health in Europe. Edited by Dubois CA, McKee M, Nolte E. European Observatory on Health Systems and Policies Series. 2006. [Internet]
2. Health Workforce 2030. A Global Strategy on Human Resources for Health. World Health Organisation, Global Health Workforce Alliance. 2014. [Internet]
3. Neubauer K. Developing a Health Workforce Policy for the European Union. Bad Gastein, 8 Oct 2010. [Internet]
4. The Health Care Workforce in Europe. Learning from Experience. Edited by Rechel B, Dubois CA, McKee M. European Observatory on Health Systems and Policies Series. 2006. [Internet]
5. Mackenbach JP. Health Inequalities: Europe in Profile. An independent, expert report commissioned by the UK Presidency of the EU, February 2006. [Internet]
6. Lemiere C, Herbst C, Jahanshahi N, Smith E, Soucat A. Reducing Geographical Imbalances of Health Workers in Sub-Saharan Africa. A Labour Market Perspective on What Works, What Does Not, and Why? Working Paper No209, World Bank, Washington DC. 2011. [Internet]
7. European Health for All database (HFA-DB). WHO/Europe. July 2016. [Internet]
8. Dimova A, Rohova M, Moutafova E, Atanasova E, Koeva S, Panteli D, et al. Bulgaria: Health system review. Health Syst Transit. 2012; 14(3):1–186. [PubMed]
9. National Statistical Institute. Medical personnel in Bulgaria [updated 2016 July 13]. [Internet].
10. Zafirova Tzv, Serafimova D, Mitev B. Strategic Aspects in Development of Health Care Establishments in Varna Municipality. University of Economics, Varna; 2010 [in Bulgarian].
11. Ministry of Health. National Health Strategy 2008-2013. State Gazette, No107, 2008 [in Bulgarian].

Received: 12 November 2016
Published online: 19 January 2017

back to Online Journal