The National Network for Children presented the twelfth edition of the monitoring report “What is the Average Government Score for Childcare?” in the National Assembly.
The overall assessment for the work of the state and institutions in 2022 is an average of 3.33 (on a scale of 2 to 6).
The conclusions in “Report Card 2023” were presented at a meeting with politicians and policy-makers, hosted by the Parliamentary Commission on Children, Youth, Family, and Sports.
The annual report evaluates the progress of state institutions in the care of Bulgarian children in eight areas – Child participation, Child Welfare, Family Environment and Alternative care, Protection from all forms of Violence, Child Justice, Early Childhood Development, Child Health, Education, Sport, Culture and Leisure. The expert study is based on information provided by over 25 national and local institutions, including ministries. The independent monitoring includes the analysis and assessments of 30 authors and 7 external evaluators – experts from international and national institutions and organizations. The report gives special emphasis to the opinions of children and young people, as well as those who have a role in supporting them – parents, teachers, health and social workers, and others.
The report notes the greatest progress in the care for early childhood development but highlights a decline in the area of child healthcare. Despite being slightly higher than previous years, the state’s success has not significantly improved for the 12th consecutive time.
“Ironically, the instability in the state has forced the government and institutions to address truly important issues for society. Thus, policies for Bulgarian children, which for years were mainly the effort of the civil sector, have finally been noticed. If there is the will, legislative and executive initiative, many problems can be quickly addressed,” commented Plamena Nikolova from NNC one of the authors of the report.
Maria Brestnichka from NNC: “There is progress noticed in certain areas. However, everything done in previous years and even in the past is ‘piece by piece.’ It should be clear who is responsible for children’s policies in Bulgaria, and they should have the mandate to plan and coordinate in a way that ensures every child has the best opportunities in life, and families in Bulgaria are supported. In Bulgaria, such a structure does not exist. There is no vision or plan for what we want for children – for the fourth year, Bulgaria is in violation of its own legislation, and there is no National Strategy for Children. That is why, for years, the significant change that would make all children in Bulgaria well and their families feel supported in their upbringing does not happen.”
Highlights from Notebook 2023
Children’s Participation I Rating 3.11
In our country, there is no common understanding of priorities and necessary policies in the field of children’s participation. There is a lack of clear awareness in society of how critically important it is to meet the needs of children and young people in terms of self-expression, to request and hear their opinions on issues that affect them. Children in Bulgaria remain poorly informed about their own rights, and the reason for this is the lack of access to understandable, important public information and key documents such as the National Strategy for Children, Youth Strategy, Strategic Framework for Education Development, UN Convention on the Rights of the Child, and others.
An example of good practice from the past year is the development of a framework for a civic education curriculum by the Ministry of Education and Science, UNICEF, and the “Together in Class” Foundation. The implementation of this framework in the curriculum and work on teachers’ skills and attitudes towards democratizing Bulgarian education are on the agenda. The State Agency for Child Protection also showed activity through the procedure for selecting members of the Children’s Council to the agency in 18 regions of the country. The Ministry of Education, on the other hand, supported the establishment of a National Student Parliament in Plovdiv.
A significant question remains the lack of mechanisms that place the student at the center of the educational process, reaching out to children about their needs in the classroom and addressing those needs in an effective manner that gives them clear evidence that their opinions are important and heard. Functional forms of genuine children’s and youth participation, as well as feedback from institutions to children regarding their expressed opinions, are needed. One of the recommendations in the report is the establishment of a children’s ombudsman institution in Bulgaria to enable children to express their views on documents, policies, and programs that affect them.
Welfare I Rating 3.57
The rating in the section on Children’s Well-being is the highest in the report. There have been positive developments in terms of social support, such as tax relief for parents, abolishment of fees for kindergartens, increased family allowances, and more. However, social measures alone remain insufficient. They are not implemented as part of a comprehensive strategy that would lead to coordinated measures for significant change. The proportion of children in Bulgaria has been decreasing year after year (by 40% since 1992!). Every third child is at risk of poverty and social exclusion, and 17% face severe material and social deprivation. Children live in just over 22% of all households in our country. The number of live births is decreasing, and our country has the highest child mortality rate in Europe for the past year. For every 100 individuals leaving working age (60-64 years), they are being replaced by 61 young people entering working age (compared to 70 in 2011 and 124 in 2001).
Bulgaria consistently ranks among the highest in terms of the risk of poverty and social exclusion for children. Every third child in our country is at such risk (33% compared to the EU average of 21.7%). The long-term consequences for Bulgarian children in low-income households result in poorer cognitive, behavioral, and health outcomes. Children in households with more than three children are at the highest risk. Although such households account for only 1.2% of all households, they are the actual home for 20% of children in Bulgaria. In other words, every fifth child in our country is growing up in households with the highest risk of poverty and social exclusion.
In 2022, some positive developments were observed regarding social payments, assistance, relief, and allowances for families with children. These include the elimination of fees for kindergartens and nurseries for all children in the country, an increase in the compensation for child-rearing during the second year of maternity leave, increased tax relief for working parents, compensation for children not admitted to state kindergartens, updates to tax relief for working parents, and more. However, when implemented outside a comprehensive strategy, pure social support fails to address other important issues. As a result, it has become more advantageous for parents in poorer regions to stay in maternity leave, highlighting the lack of measures to encourage mothers to return to the labor market. Only 1,083 families have been compensated for the lack of space in nurseries or kindergartens, while there are over 12,000 children on the waiting list in Sofia alone, and a solution to the insufficient early childhood care places is still lacking. These examples demonstrate that when it comes to early childhood care, as well as all other policies for children and families in our country, the implementation of isolated social measures without a comprehensive approach tends to result in more costs than investments.
A key obstacle to planning and implementing policies for child well-being is the lack of a responsible institution and/or structure in both the legislative and executive branches. Currently, the State Agency for Child Protection has more symbolic than functional significance, while the Parliamentary Commission for Children, Youth, and Sports primarily focuses on sports policies and is colloquially known as the “sports commission.” Our country has been without an adopted National Strategy for Children 2019-2030 for four years, leaving policies for children and families in Bulgaria without common goals and synchronized coordination.
Family Environment and Alternative care I Rating 3.13
Systems such as education, social care, and child protection continued to fail to integrate effective models of parental participation and influence. The frequent change of governments and interim cabinets once again threatened the proper functioning of foster care as the next necessary step in the deinstitutionalization process. The planned closure of the remaining 4 Medical-Social Care Homes in 2022 did not occur due to the delayed construction of the necessary infrastructure for the new 26 specialized centers. The reason is the need for additional funding and actions by the Ministry of Health. As a result, 209 children continue their childhood in specialized institutions, with over ⅓ of them being over 3 years old and permanently institutionalized, with all the consequences that come with it.
At the same time, a significant problem persists, namely the fact that almost every fifth foster family does not have any placed children. Trained professionals in whom funds have been invested for training and development withdraw from foster care when they do not have children placed with them for a long time. Additionally, due to the lack of information and motivational campaigns, there is a clear decline in interest in foster care. Only 85 candidates submitted documents in 2022, which is a decline for another year and a 50% decrease compared to 2019.
The trend of increasing the number of discontinued adoptions and the return of children to residential care continues. There is a lack of support for prospective adoptive parents, and the change in the motivation of future parents, which is the foundation of successful adoption, is not being investigated. The necessary changes to the Family Code regarding adoptions have not been made, such as providing comprehensive information to adoptive parents to support informed decision-making and expanding the opportunities for adoptees to obtain information about their biological origins. These changes are still pending until the formation of the next regular parliament.
Protection and integration of unaccompanied refugee children continues to be fragmented between the child protection system, social system, and their refugee status. This includes 3,348 children compared to the previous year when there were 799. According to the provisions of the Law on Child Protection, unaccompanied minors are children at risk, and cases should be coordinated by local child protection departments and the State Agency for Child Protection. Thus, in line with EU guidelines, placement in residential services should be a measure of last resort. By their nature, secure zones specifically provide residential services. Their methodology is not publicly accessible and has not been approved by the State Agency for Child Protection and the Social Assistance Agency. This raises questions about the extent to which national standards for providing residential care for children are being met. It also raises questions about the conditions within these facilities, the number of staff, the quality of care, and the capacity to prevent risky situations.
Child Protection from all forms of Violence I Rating 3.33
The problem of the lack of a unified system for registering cases of violence against children continues to exist in 2022. Currently, the data cannot be adequately analyzed and become the basis for effective prevention and response policies. Cases of violence in schools against and among children continue to increase, while only the more severe and serious ones are included in the Ministry of Education’s list and public discourse. In the 2021/2022 academic year, there were 1,498 registered incidents of physical bullying and 2,160 incidents of verbal aggression. These described cases represent the more severe ones, while many others, which may appear “less severe” at first glance or go unrecognized as bullying cases, remain unreported due to the difficulty and lack of systematic reporting. A positive trend is the increase in the number of psychologists and educational counselors in schools and kindergartens. Currently, there are 2,000 professionals, but greater collaboration among various systems and support through different services to schools and parents is still needed to effectively address the most serious cases. Therefore, the important work of prevention continues to be implemented through initiatives supported by the civil sector. It is commendable that the Ministry of Education initiates or participates in a number of these initiatives. Regarding domestic violence, the most significant progress in the past year was the drafting of the Law amending and supplementing the Law on Protection against Domestic Violence. Despite the declared readiness of the National Assembly to prioritize the topic, the expected progress did not materialize due to the transition to interim governments.
The abuse of children in cyberspace is also becoming a matter of great concern. In Bulgaria, there are approximately 16,000 cases of children annually who fall victim to online violence, bullying, abuse, trafficking, and sexual violence. The majority of calls received through the Consultative Line of the Safer Internet Center are related to stolen profiles and fake profiles, while approximately 90% of reports received through the hotlines are related to online sexual exploitation. The lower age limit for online bullying has dropped to 8 years old, even 7 years old. Against this backdrop, two mechanisms that provide support to Bulgarian children who are victims of violence – the National Child Helpline and the Safer Internet Center – underwent unwanted and unjustified transformations in 2022, jeopardizing their functioning and thus, the support provided to children, parents, and professionals. The National Child Helpline was moved from the State Agency for Child Protection to the Social Assistance Agency, where its quality significantly deteriorated due to the lack of necessary expertise among officials who are not qualified to provide psychological support to the children calling for help. The Safer Internet Center, on the other hand, faced the threat of closure due to the exhaustion of project funding, and at this moment, a sustainable solution for its existence is still lacking.
Justice I Rating 3.52
The area of Justice for Children receives a higher rating compared to previous years due to progress made on various topics that have so far been on the periphery of legislation and the political will for reforms.
Through the draft Law amending and supplementing the Code of Criminal Procedure (amendments to the CCP), introduced by the Ministry of Justice to the National Assembly in October 2022 (https://parliament.bg/bg/bills/ID/164366), steps were taken to fully implement Directive 2012/29/EU establishing minimum standards for the rights, support, and protection of victims of crime. The Council of Ministers (CM) approved and submitted to the National Assembly a Law amending and supplementing the Law on Protection against Domestic Violence (amendments to the LPDV), which provides for significant improvements in the prevention and protection against domestic violence. The Supreme Judicial Council initiated a program for piloting mandatory mediation in certain family disputes. In 2022, the CM also approved two draft laws (amendments to the Code of Civil Procedure and the Law on Mediation) introducing the so-called mandatory initial meeting with a mediator in family disputes for the first time. One of the recommendations for the Justice for Children section is to ensure sustainable funding for the National Center for Safer Internet due to the continuously increasing number of cases of violence against children in the virtual environment. It is also recommended to fully implement the right of every child to be heard in all procedures affecting their life and well-being – criminal, civil, and administrative – as well as to make changes in legislation that comply with international standards for guaranteeing the rights and best interests of children who are witnesses or victims of violence.
Early Childhood Development I Rating 3.48
In the field of early childhood development, there is a lack of shared understanding and a national strategy. There is a lack of mass early screening for all children. There is also a lack of a unified system for referral to early childhood intervention services. Undoubtedly, a positive step from last year is the improvement in access for uninsured women to pregnancy monitoring.
The Ministry of Health has implemented changes that improve access to healthcare for the uninsured, including hospital medical assistance up to twice during pregnancy, up to four preventive check-ups, and an expanded package of laboratory tests. This measure is a step in the right direction, considering that 5% of children in Bulgaria die before the age of 1, and stillbirth rates have risen to 6.7% (per 1,000 live births). Over 90% of deaths in children under 12 months are attributed to conditions detected during pregnancy. From here on, it is important to conduct informational campaigns among expectant mothers, with healthcare mediators playing a key role. The procedure by which doctors record check-ups should also be simplified, as it is currently unnecessarily complex.
A barrier to accessible child and maternal healthcare is the lack of a national pharmaceutical policy and insufficient funding to cover medications for children. According to a study by the Bulgarian Pediatric Association for Child Healthcare, around BGN 100 per month is spent on additional expenses for a child up to 1 year, with half of that amount going towards medications. As a result, access to healthcare for children up to the age of 3 is limited for the poorest and most vulnerable groups.
Regarding early learning, a proposal for a National Quality Framework for Education and Care Services in Early Childhood was developed in the context of the European Framework (EYFS). Changes have been made to the operation of childcare facilities, allowing for the appointment of educators, medical assistants, or physician assistants in cases where there is a shortage of registered nurses. The regulation has been in effect since January of this year, and conclusions regarding its impact are yet to be drawn. However, the consolidation of childcare facilities and kindergartens under unified institutional management (under the Ministry of Education) was rejected, despite a drafted bill. The separate systems perpetuate inequalities in terms of children’s access, staff qualifications, and funding. Unified institutional management will help overcome the identified deficits and shortcomings, particularly in the earliest stages of childhood. The care and education of children are inseparable, and they should be guided by a coordinated pedagogical framework that spans the entire period from birth to the start of compulsory education (in line with UNICEF, UNESCO, World Bank, OECD, etc.).
Municipalities in Bulgaria are supported to carry out activities aimed at early childhood intervention through a number of programs funded by EU structural funds. However, in many cases, the services operate partially, have limited coverage, or fail to reach the most critical age for early intervention, from 0 to 3 years. There is a lack of unified standards, rules, and procedures, as well as requirements for the qualification and ongoing training of specialists. The absence of a systematic approach leads to diverse services without the ability to monitor quality and outcomes. Early screening of cognitive development should be widely implemented for all children, both in the healthcare and educational systems, in order to properly guide children and parents towards early services in the healthcare and social systems. In the long run, this would save a lot of resources and prevent more serious problems, ensuring a dignified and fulfilling life for all Bulgarian children.
Healthcare I Rating 2.98
This is the lowest rating in the “Scorecard 2023” and the lowest for this area in the past ten years. Bulgaria lacks a plan for child healthcare, and the National Strategy is delayed and being developed in a closed and publicly opaque process. Child mortality is increasing, and we are now first in the EU, while regional disparities are deepening – the levels of child mortality in different regions show differences of over ten times. Our country is the only one in Europe without a National Children’s Hospital, pediatric nurses are becoming a disappearing profession, and Bulgarian children with serious illnesses are either waiting in line for life-saving treatments or competing for sympathy in donation campaigns. The emerging threat among addictions is the alarmingly growing number of gambling addicts. Online platforms’ advertising is everywhere, and it reaches absurd situations where sports-playing children wear jerseys with gambling advertisements.
Child mortality in our country is the highest among European states and twice the EU average. The increase is entirely due to a worsening indicator in rural areas. Perinatal child mortality has seen a significant rise, reaching 8.8 per 1,000 live births. Stillbirth rates have increased to 6.7% (per 1,000 live births), compared to a rate of 5.9% in the previous year. Over 90% of deaths within the first year of a child’s life are caused by six specific disease categories. The majority of fatalities occur due to conditions detected during pregnancy.
Access to pediatric care is becoming an increasingly significant challenge. In 2021, there were 755 doctors with a specialization in pediatrics under contract with the National Health Insurance Fund (NHIF). However, in 2022, there were only 604 pediatric practices. Around 50% of pediatricians are nearing retirement age, and only 15% are below the age of 35. There is also a shortage of child psychiatrists, with only 21 registered practices in Bulgaria, according to NHIF data.
The coverage of vaccination remains a challenge. In 2022, the coverage for the measles, mumps, and rubella vaccine was 91.2%, showing improvement compared to 2020. However, there has been no progress regarding the recommended human papillomavirus (HPV) vaccine. The vaccination rate for HPV among 15-year-old girls in our country is below 3%.
In terms of addictions, there has been a conditional decrease of 9% in the most commonly used narcotic substance among students in grades 8 to 12 – marijuana. The reason for the “reduction in usage” is actually due to the increasing availability of other smoking products such as e-cigarettes, tobacco heating devices, and hookahs. The second most commonly used group of narcotics is stimulants. In 2022, the average age of drug use initiation among students was 14-16 years. The earliest age of first use is observed for opioids, inhalants, and cannabis at 14 years, while for synthetic cannabinoids and hallucinogens, it is 15 years. The first use of stimulants (cocaine, amphetamines, methamphetamines, and ecstasy) occurs at the age of 16. There is a growing threat of gambling addiction, and institutions completely fail to implement even the minimum restrictive measures provided for in the Gambling Act. Gambling addiction is internationally recognized as a medical condition described in the ICD-10. In Bulgaria, around 3 million people engage in gambling, with approximately 300,000 playing regularly.
In 2022, there continues to be a lack of current regulations governing healthy eating for children in schools, as well as an updated formulary. There is a problem with dietary foods for special medical purposes for home treatment, which many children require, including those for enteral application, as well as some foods for rare diseases. Currently, they are not covered by the National Health Insurance Fund (NHIF) for all conditions. This puts hundreds of people in a situation where they literally go hungry and rely solely on their own or donated resources. Bulgaria is the only country in Europe that does not provide medical foods for children regardless of their diagnosis.
Three years later, there has been some progress in the case of the National Children’s Hospital (NCH). As of today, the decision has been announced that an analysis of pediatric care in Bulgaria will be conducted to serve as a basis for determining the structure, scope, and functionality of the healthcare institution. However, as of the publication date of “Notebook 2023,” this decision had not yet been finalized. In reality, no progress was made on the NCH last year, except for the selection of a site, which was done under conditions of complete non-transparency and without any coordination regarding access to ambulances, vehicles, public transportation, or other communication to the chosen location.
Education I Grade 3.40
In our education system, there is a significant disparity – we have brilliant Olympians from specific schools and poor performance in general education for 40% of children. There are no policies addressing regional differences. Ideas for military education are being discussed instead of working with parents and educational mediators. The school, as a place that usually first identifies children’s problems outside the family, fails to become a trusted environment that provides support for stress, acts of violence, etc. Inclusive education does not happen because it is delegated to the mass teacher, there are no inclusive models, and teachers do not know how to work with them, and even admission is refused in kindergartens. Among all the existing problems, important topics such as media literacy, safe internet use, civic education, sexual education, etc., are pushed to the background. They are not addressed at all and remain neglected. Overall, the system gives the impression that there is funding for education, but it is not being spent wisely and does not contribute to the effectiveness, sustainability, and return on investment.
Educational differences and segregation are becoming deeper, and children’s success in school is directly linked to their place of residence and the socio-economic status of their families. Due to “hidden” educational expenses (materials, food, transportation), access and full participation of children in the educational process are actually limited by the families’ capabilities. In early 2023, changes were introduced making textbooks free for grades 1 to 12, which is certainly a step forward, but the disparity in the level of preparation and access quality exists at all levels. According to data from the Institute for Market Economics, 7th graders in 181 municipalities have a Weak (2) level in mathematics – in nearly 70% of municipalities. This indicates a significant concentration of quality education in mathematics (and exact sciences in general) in a very small number of elite schools. Outside of those schools, the quality sharply declines, resulting in fewer students being able to continue their education in directions that require more serious preparation. From an economic development perspective, this circumstance hinders the potential development of numerous industries and condemns entire regions to long-term shortages of skilled workers.
Municipalities are not effectively implementing (or not implementing at all) desegregation policies. The Ministry of Education even halted the national program for appointing educational mediators, which undermines the previously successful practices of supporting vulnerable groups, especially in schools with diverse ethnic compositions and small schools. It is alarming to see the Ministry of Education’s apparent reluctance to engage with topics such as the integration of children with disabilities in Bulgaria.
The educational system lacks a vision and a unified framework for what constitutes quality education, quality teaching, quality management, and quality assessment. Updating the professional profiles of school directors to include key competencies of the 21st century, with a focus on leadership skills, is necessary. There is a high dropout rate among newly appointed young teachers within the first five years, after which the number of those leaving the system sharply declines. This indicates the need for support, mentoring, and additional training for newly appointed teachers. In 2022, a process to modernize the curriculum was initiated, but not all stakeholders were included, and ultimately no concrete steps were taken.
In the inclusive education domain, the Ministry of Education demonstrates willingness to support children and students with special educational needs (SEN) through participation in various projects and national programs. However, the prescribed standards for adapting content, individual educational programs, and vocational training based on disabilities are followed only formally, and there is no tracking of outcomes. There are also inadequate mechanisms to guarantee the right of students with SEN to access quality vocational training, which diminishes their chances of succeeding in the labor market.
The first national survey on digital-media skills of high school students, conducted in early 2022, revealed low levels of reading literacy. Students widely use digital devices, but the full utilization of the Internet’s potential does not happen in practice. Correction is possible if our education system undergoes intensive reforms in teaching and assessment methods. However, digital-media literacy remains a neglected priority topic. The same applies to Systemic Health and Sexual Education (SHSE). The analysis shows that there is sufficient evidence of the need for all students to have access to SHSE. Over the past five years, the percentage of abortions among girls aged 15-19 has remained high, and in the past year, it increased to 8.7%. In practice, every tenth child in our country is born to a teenage mother, and it is precisely SHSE that can bring about effective change, including: delaying the onset of sexual activity, reducing the frequency of sexual acts and the number of sexual partners, reducing risk-taking behavior, and increasing the use of condoms and contraceptives.
Sports, Recreation, and Leasure I Rating 3.42
The topic of Sports, Recreation, and Free Time is discussed in the “Annual report – What is the average success of the state in caring for children?” for the third consecutive year and, for the first time, exceeds a score of 3. For 2022 and 2021, it had been 2.98 and 2.75, respectively.
The primary access of children in Bulgaria to sports and sporting activities is directly linked to the socio-economic opportunities of their parents, the locality in which they live, and, to a limited extent, the school they attend. Mass sports for children are chronically underfunded and left to the capabilities of families. Although the Ministry of Youth and Sports funds sports activities through various national programs, their coverage remains limited due to the lack of well-equipped sports facilities outside the largest cities in the country. Children’s sports should be part of not only national but also municipal policies.
It is worth noting the joint efforts of the two ministries – the Ministry of Culture and the Ministry of Education and Science – to expand the opportunities for children and students to participate in activities related to art and culture, including conducting classes in different environments such as museums, galleries, etc. At the same time, the selection of goals and activities of national programs that complement educational forms increasingly focuses solely on Bulgarian historical heritage, with less emphasis on other cultural contexts and neglecting various art forms.
Download the English edition of “Report Card 2023: What is the Average Government Score for Childcare?” from our website HERE.