The infant mortality is one of the most important indicators for the material, health and cultural level of the population. For the first three years of the implementation of the strategy, children’s health has deteriorated on the whole and the infant mortality has increased – its level is still higher in comparison to the rest of the European countries and at least twice as high as the average for the EU. The level of the integrative indicator that characterizes the probability for children’s death before reaching the age of 5, is also twice as higher in Bulgaria than the EU. The level of infant mortality in the prenatal period is still high and rising. The children in the villages and the remote areas die more often than the children in the cities. This leads to the idea that there is a lack of equal access of all children to high-quality health care and that the efforts of the health care system for the children are not effective enough. The worsened health status of the children is a prerequisite for a social exclusion;
The NSC has not influenced children’s health because the measures in it are part of the general activity of Ministry of Health (part of the planning team of NSC) i.e. the strategy has not succeeded in making children a special priority in the national health policies, which are approved regardless of the existence of a strategy for the child;
In principle, health is part of social inclusion. Moreover, health itself is defined as social welfare (definition of World Health Organization). In NSC, though, the lack of intersectional measures for the improvement of children’s health indicates that identifying the objective related to improving children’s health in NSC is not in harmony with the philosophy of improving health as a way of improving children’s social well-being.
Objective 4. Encourage children’s participation in making and implementing policies related to their rights and responsibilities
The issue of children’s participation is relevant in NSC, but it is more a principle, a starting point rather than an objective, especially by the way it is formulated. At the same time, the topic of children’s participation is very discussed and planned at an international and European level;
The development of a system that provides children’s participation in making decisions and achieving certain results is a general priority in the work of the State Agency for the Child’s Protection(SACP), but despite that fact, a lot is still unclear when it comes to determining what are the specific outcomes expected from the work of the Council of Children(part of SACP);
The system is still in a process of gaining an understanding of what child participation is, it takes time and certain mechanisms for it to become a sustaining model and policy. Children’s participation is still at the level of informing and consulting, which is the lowest level of involvement;
There is no normative base or specifically described rules and procedures which would require and make the professionals, who work with children in all the sectors (health care, education, social policy), get trained to work on children’s participation and conform with their opinion in an appropriate way. Strategic documents are lacking either (political, law and normative) that would fully enforce children’s participation in making policies.
Utility
Until now almost all families are left out of the system of services that facilitate social inclusion. The level of individualization of the services is very low and is not sufficiently orientated towards the individual needs of the children and families. There is a serious lack of balance in the services focused on the prevention of the social exclusion and of those focused on the realized risk (i.e. of those who are already socially excluded);
Considering the opinion of the clients is not an obligatory part of the methodologies for analyzing the needs and assessing the effectiveness of the services. There are also no special methodologies for needs assessment in general. This holds a risk of discrepancy between the actual needs and services, which may be ineffective and/or inefficient;
In the last few years some groups of children have better access to education than before (for example the children with Special Educational Needs). Still, this does not hold true for all groups of children. The educational system does not collect data for all groups of children at risk and this creates barriers before the individualisation of the education. The children in the villages and the remote areas have a poorer access to high-quality education and poorer performance, respectively;
There is a growth in the number of children who do not go to school and there are no practices in the educational system focusing on the prevention of social exclusion as a result of not visiting school. Almost 70% of the students who drop out of school in Bulgaria become socially excluded adults;
Children’s health in the last few years has become worse, so has the infant mortality. The children from the villages and the remote areas die more often. This suggests that not all the groups of children get access to high-quality medical care, including prevention, and that there are not enough services focused on the prevention of the social exclusion so that health issues are avoided(for example, due to lack of provision or an ability to use high-quality medical care).
General recommendations
A reorientation of the strategy is necessary. It should not be focused only on children at risk, but on all Bulgarian children as a condition for their meaningful development;
It is necessary to achieve a shared understanding of all key concepts used in the strategy ( e.g. “equal access”, “high-quality education”, “family environment”, etc.), because they contain the philosophy and values on which any strategy is based;
It is necessary to create a small management team within SACP to make sure that the whole strategy is well-applied and make decisions for corrections in its implementation where necessary;
It would be useful to include a team of specialists in strategic planning and change management that will consult and support:
the process of achieving shared understanding of the key concepts;
the process of analyzing the problems and achieving a shared understanding of the approaches which would lead to improving the situation of children and a common vision of children’s welfare.
