A tuberculosis (TB) screening initiative among refugees living in Bulgaria has reached more than 2700 people across 7 regions of the country. During the programme, 89 cases of TB were identified, leading to full diagnostic and medical care in line with national protocols. WHO used available channels to share information about the disease, the importance of early diagnostics and treatment, the availability of free-of-charge treatment in Bulgaria, and a list of TB hospitals across the country.
The WHO Country Office in Bulgaria – in partnership with the Bulgarian Ministry of Health, the National Centre of Infections and Parasitic Diseases, 7 Regional Health Inspectorates (RHIs) and the Bulgarian Red Cross (BRC) – launched the initiative to safeguard communities and care for those in need. Many refugees arrive in Bulgaria after a traumatic journey from communities with a high prevalence of TB, in conditions which increase the risk of spreading this and other infectious diseases.
Bridging the cultural gap
During the campaign, the BRC and RHIs kept records of refugees reached, screened, referred and diagnosed. Awareness sessions were held in the refugee and host communities to educate families about TB symptoms and the critical importance of completing TB diagnostics and early treatment when prescribed.
WHO and the BRC, working closely with the RHIs, established the TB testing campaign, trained local screening teams, provided detailed health communication materials and ran community awareness raising sessions. Information materials were made available in 5 languages: Arabic, Bulgarian, Dari, Russian and Ukrainian. Russian and Ukrainian speaking volunteers helped to bridge cultural gaps, build trust and reduce misunderstandings.
The RHIs mobilized the medical and epidemiological teams and conducted training on the screening routine and diagnostic and personal protective equipment provided by WHO to minimize infection – including masks, gloves, aprons and disinfectants.
Challenges and support
Bulgaria has granted “temporary protection” to more than 220 800 Ukrainian refugees since the onset of the full-scale invasion, and today an estimated 65 700 remain within Bulgaria’s borders.
As is common across refugee-hosting countries, Bulgaria has seen high numbers of refugees with pre-existing conditions, impacted by interrupted medical care and limited health screening, which can pose a high risk for the spread of infectious diseases, like TB.
Despite the support provided, many refugees remain uninsured, and have difficulty accessing health-care services due to language barriers, social challenges, existing conditions and needs, and challenges integrating into the labour market.
Regional goal
Bulgaria joins a number of European Union countries implementing TB screening programmes through WHO’s TB prevention and systematic screening (PASS) interventions, with the aim of eliminating TB in the WHO European Region by 2030; however, much remains to be done as reductions in donor funding are coupled with a prolonged war in Ukraine. Today, the PASS programme in Bulgaria continues to support:
- multisectoral collaboration among leaders in Bulgaria to expand TB prevention, systematic screening, and treatment, and improve surveillance and data sharing across borders;
- strengthening of infection prevention and control measures;
- access to health care for refugees and vulnerable populations;
- stigma-free TB testing and care for all communities; and
- leveraging both resources and technical guidance in Bulgaria to sustain TB prevention and care programmes.
WHO is sincerely grateful for the support of the Asia-Europe Foundation and the Embassy of Japan in Bulgaria. The WHO Country Office in Bulgaria expresses gratitude for the fruitful cooperation to the Ministry of Health, National Centre of Infections and Parasitic Diseases, RHIs of Blagoevgrad, Burgas, Dobrich, Haskovo, Plovdiv, Sofia and Varna, and to the BRC.