Instead of facilitating, the e-note procedure created a number of problems that could be avoided with a limit on school days for absences to be excused with a note from the parent.
The National Network for Children (NNC) has sent an Open Letter requesting that the excuse note for short-term medical absences be dropped. The document is addressed to the Ministry of Health and the Ministry of Education and Science, as well as to the Committee on Health and the Committee on Education and Science of the 49th National Assembly.
The letter is supported and expresses the position of the Bulgarian Pediatric Association and organisations working with children, part of the NNC.
We made the request to drop the medical note after less than a month after its introduction, instead of making the procedure easier for all parties – teachers, doctors and parents, we witnessed a huge wave of dissatisfaction and numerous reports received at the NNC due to a number of subsequent problems.
The note is issued on the basis of an outpatient list with the explicit presence and waiting of the child and his parent in front of the doctor’s office; which led to the following difficulties:
- A large interval is set between the issuing of notes to different patients, which further takes up the limited time of doctors for actual examinations and work with patients;
- In some cases , the notes are not taken into account by the school’s system when the GP is in one town and the school is in another;
- There is a problem when it is necessary to issue a note during routine and preventive examinations with a specialist, due to refusals of specialists to issue notes and referral again to the personal physician ;
- The budget of the parents is additionally burdened , since the issuance of a note is outside the package of activities covered by the NHIF, and some doctors require an administrative fee that reaches up to BGN 10.
Visiting a doctor for banal viral infections or short-term ailments of a different nature appear to be practically unnecessary. They complicate the work of private doctors and parents and children, who often have to wait for hours in front of doctors’ offices together with patients who are in an active phase of the disease and/or have a real need for the doctor’s attention. In reality, such a practice would lead to an increase in morbidity and an additional environment for the spread of viruses, especially in the autumn-winter season, when epidemiological recommendations require the exact opposite – limiting such practices. The physician resource is both too expensive and too limited to be misused for redundant administrative procedures and practices whose logic does not rest on medical necessity.
From the National Network for Children, the Bulgarian Pediatric Association and parents from all over the country, we appeal to the institutions to cancel the statutory requirement to excuse short-term absences by means of a medical note and replace this requirement with a note / confirmation from a parent that the absences allowed are good reasons.
If you, too, want the medical notes revoked and replaced with parental notification, support the Open Letter. Download from https://nmd.bg/zastupnik/ our badge # #AboutReleaseOfMedicalNotesForShortPeriod and show on social networks that you also want to cancel 
the procedure. Let’s work together with the institutions to drop medical notes for short-term absence.
European and global practice /EU countries, as well as the USA, Australia, Canada, etc./ have the established practice for absences of 1 to 3 or up to 5 days not to provide a medical document, but for the parent to declare orally, in writing or through the electronic log the reason for the admitted absences and their duration. For absences beyond this period, a medical document is required, assuming that conditions that require longer treatment anyway will in any case lead to a medical examination and the relevant document will be issued.
As there are public fears that this will lead to arbitrariness on the part of parents and excused absences without a real reason, the organisations behind the Open Letter clarify that such concerns can be prevented by setting a limit on the percentage of school time for absences that can be excused by the parent . If this limit is exceeded, the school should check in a personal conversation and contact with the parent what the reasons are for this happening and request additional medical expertise.
From the NNC, we believe that no administrative procedure should cancel the obligation of parents and the school to communicate with each other and in the context of this case – to investigate the reasons for the children’s absences. We believe that by giving more trust and responsibility to parents, both parties will be more committed to discussing and resolving issues of non-medical absence without the need to involve the health system as a party. Moreover, there is no way to impose a limit or challenge the veracity of a doctor’s note, but it is possible to limit and control the number of absences that the parent excuses.
It should be noted that the health system is in any case not a party to the cases that concern systematically absent students at risk of dropping out (children in a situation of social problems, poverty, marginalisation). Such cases are subject to work, support and control by the social and protection systems and require the implementation of other mechanisms to return and keep children in school.
Giving parents the right to excuse a certain number of short-term medical absences for children and students will facilitate both the health and education systems , while at the same time improving the relationship and communication between childcare facilities, schools and parents and ‘brightening up’ a number of previously existing practices to excuse with a medical note short-term absences that were admitted for non-medical reasons.
With the Open Letter, we also appeal for the dropping of the so-called “contact note”, which is required from nurseries and kindergartens when the child is absent from the nursery for more than 10 consecutive days. This includes even periods of vacations and days off in which the children are not sick, but even a doctor could not guarantee, despite an examination, whether or not they were in contact with a given acute infectious disease. With this note, GPs in practice declare information that they cannot verify themselves and is essentially rendered meaningless by the note’s validity period of 3 days, during which the child may come into contact with acute infectious diseases. For this reason, such a note has no administrative or practical value and only wastes the precious and limited medical and especially pediatric resource on empty clerical activities, instead of investing essentially in working with patients, prevention, prevention and treatment of diseases among the children.
The open letter was signed by: National Children’s Network, Bulgarian Pediatric Association, Experiential Learning Centre Association, Eureka Foundation, Safe Playgrounds Association, Umenie 2003 Primary School, Tsvete Theater, Parents Association “, Club of Non-Profit Organizations – Targovishte, SNC “VIA HUMANIKA”, “Future Now 2006”, RF “Iskra”.
See the full text of the letter here .
