The work of the healthcare sector's representation in the Public Council attached to the parliamentary Committee on Direct Citizen Participation and Interaction with Civil Society is beginning. The mandate begins with representative Albena Drobachka, chairwoman of the Association for Progressive and Open Communication (APOC), and deputy representative Dr. Andrey Velchev, chairman of the Association for Accessible and Quality Food (AAQF). They are taking on the responsibility of presenting the common positions of organisations in a sector of direct importance to citizens' health, safety and quality of life. Here is what the two told FAKTI.
- Ms Drobachka, Mr Velchev, you are now representatives of the healthcare sector in the Public Council attached to the parliamentary committee. How will citizens be able to submit reports to you about health- and food-related problems?
- Dr Andrey Velchev (A.V.): First, we need to make an important clarification so that citizens' expectations are accurate. The Public Council is an advisory body attached to a parliamentary committee. Its role is to connect civil society with the legislative process, contribute expertise and support public discussion of significant issues. It has no administrative or supervisory powers over the executive branch.
Citizens can share their experiences, problems and proposals with the organisations we represent. This information is valuable because it shows where the rules are not working, where there are gaps and what changes are needed. Individual reports of violations, however, should be examined by the relevant competent authorities.
Our task on the council is to turn identified systemic problems into reasoned proposals for policies and legislative changes. This is the responsibility we are taking on.
- Albena Drobachka (A.D.): The Public Council includes 96 organisations divided into 21 areas of competence. Dr Velchev and I are in the “Healthcare” area, which includes 14 organisations with different profiles of work and expertise. In principle, civil society organisations are more easily accessible to people and their questions and problems. In our organisation, for example, we meet every day with people experiencing mental health problems and difficulties, as well as with their families, relatives and friends.
In our support programmes, we discuss the difficulties citizens face when seeking support for their mental health. We receive feedback on systemic problems and difficulties. For years, we have been trying to work towards resolving the serious obstacles faced by people with mental disorders, and my participation in the advisory council is an opportunity for some problems in the field of mental health to be regulated at legislative level.
- How will you organise the receipt, verification and monitoring of reports? How will you ensure that a report is not simply forwarded to the relevant institution, but that you receive information about what has been done in response?
- A.V.: It would not be correct to promise a mechanism for checking and monitoring administrative files on behalf of the Public Council. It has no such functions. Civil society organisations have their own activities and can use the opportunities provided by law to protect citizens, but this must be clearly distinguished from their participation in the council.
At the legislative level, the question is different: are the institutions' obligations to respond sufficiently clear, are the procedures understandable to citizens and is there the necessary transparency regarding the results?
When accumulated experience shows a recurring problem, we will propose that it be discussed and that a change in the relevant regulatory framework be sought. In this way, individual cases can help produce a solution that protects many more people.
- Dr Velchev, for years the AAQF has raised questions about food quality and safety, misleading labels and unfair commercial practices. What are currently the most serious problems on the Bulgarian market and what specific changes to oversight do you consider urgent?
- A.V.: The most serious problem with food is the substitution of trust: a person pays for a particular product but receives a different composition, lower quality or an unsubstantiated promise. This is compounded by misleading labelling, an opaque origin and food supplements presented as a solution to serious health problems.
Over the past five years, the AAQF has consistently raised these issues with institutions, political representatives and society.
In my opinion, food fraud was underestimated for far too long, while responses remained fragmented.
Today, we see the results of our efforts in three areas. First, there is more serious institutional action and more sanctions. Under the current government, we see steps that we regard as the first victories for the cause defended by us and by other organisations.
A telling example is the Commission for Protection of Competition’s sanctions totalling nearly 310,000 euros for a product marketed as butter, which was found to contain more than 95% non-dairy fats. In October, the court upheld them at first instance.
Second, we have gained public trust in the cause of accessible and quality food. More and more people understand the connection between composition, safety, the actual price and their own health.
Third, we have gained the trust of colleagues from related civil society and patient organisations to join forces. This is an opportunity to work with greater expertise and broader public support.
The next necessary step is to ensure that the rules are sustainable. We will insist on a review and amendments to the Food Act and related legislation — with regard to sanctions, repeat violations, traceability, transparency and protection against misleading offers.
When issues fall outside the competence of the committee to which the council is attached, we will seek dialogue with the competent parliamentary committees and members of parliament. Our contribution is to prepare and defend the proposals with evidence and expertise.
- One of the priorities set out in the work plan is combating counterfeit and dangerous food and food supplements. What needs to change in laboratory oversight, product traceability and online trade so that we do not learn about dangerous goods only after they have reached consumers?
- A.V.: We will insist that the regulatory framework ensure clear responsibilities throughout the entire food chain. Proper documentation must be capable of being compared with the actual composition of the product through reliable laboratory oversight.
An expert review is needed to determine whether the current rules provide sufficient opportunities to examine authenticity, identify undeclared substances and detect hazards in a timely manner. Testing capacity, funding and the use of results in subsequent action must also be assessed. In terms of traceability, the aim is to quickly establish where the affected batch came from and where it was distributed. In online trade, an identifiable seller, responsibility for the product being offered and action against misleading medical claims are particularly important.
On these issues, we will seek the involvement of food safety specialists, laboratory experts, doctors, lawyers and representatives of responsible businesses. The changes must protect both health and legitimate producers and traders.
- Ms Drobachka, your work with APOC is connected with prevention, mental health and overcoming stigma. Where, in your view, are the most serious shortcomings in Bulgaria — early recognition of problems, access to specialists, support for relatives or subsequent rehabilitation?
- A.V.: Ms Drobachka will present APOC’s experience most fully. From my position, it is important that these issues be considered as interconnected parts of one policy: early recognition, access to a specialist, support for the family and follow-up care.
Our contribution to the Public Council is to support discussions and proposals based on patients’ experience and the professional assessment of specialists. It must be established whether the obstacle lies in the law, in funding or in the organisation of services.
In the field of food, we also see abuses of people’s vulnerability through unsubstantiated treatment promises. This is a common issue for patient and consumer organisations, on which we can combine our knowledge.
A.D.: Mental health can be defined as one of the most vulnerable areas in Bulgaria. The problem is not only the number of people experiencing mental health difficulties, but also society’s and the healthcare system’s insufficient ability to recognise, prevent and treat these problems in time. Mental health has traditionally remained in the background compared with other medical fields because of insufficient funding for psychiatric services, insufficient funding for psychological assistance, psychotherapy and prevention, and a lack of sustainable programmes for long-term support. This is a systemic problem caused by underfunding, a shortage of specialists, stigma and social insecurity.
The World Health Organization (WHO) recognises mental health as a universal fundamental human right belonging to every person, regardless of their age, gender, social status, nationality or financial means. It is particularly important that the WHO emphasised this in its campaign for World Mental Health Day on 10 October 2023, under the motto: “Mental health is a universal human right.” And here lies the contradiction — many people in Bulgaria encounter financial, geographical, institutional and social barriers when they try to obtain the help they need.
This raises an important question: Can a right truly be guaranteed if a person has no real opportunity to exercise it?
That is precisely why mental health must not simply be recorded in international documents and national strategies, but must be turned into a genuine priority of state health and social policy. One of the important areas in which we are also working is to consider mental healthcare in its three important aspects — prevention and prophylaxis, inpatient treatment and rehabilitation. As a society and through our policies, we often neglect the first and third stages. Bulgaria has no official system for referring patients for psychotherapy and no free packages for citizens. This is one of the priorities that we, as the APOC association and a member of the Public Council, are setting for ourselves.
- The healthcare sector brings together organisations with different areas of expertise — patient rights, oncology and kidney diseases, reproductive health, mental health, prevention and food safety. How will you build common positions among them when their priorities and specific problems differ?
- A.V.: Health is a top priority for people in Bulgaria, Europe and around the world. This gives us a strong basis for cooperation despite our differences.
- A.D.: I agree with Dr Velchev — the direction of all organisations in our area of the Public Council is the same: accessible and quality healthcare for everyone. What is more, when choosing a common long-term priority for our field, we jointly settled on “Prevention and rehabilitation — protecting health, restoring independence and ability to work”. All of us working on health issues are convinced that developing and supporting policies for disease prevention, early diagnosis, and accessible, timely and quality medical rehabilitation are key to influencing the negative statistics in which our country leads compared with other European countries.
- We often speak of healthcare as a system that treats diseases that have already developed. How can we move towards a stronger prevention policy — and what is the connection between quality nutrition, an informed consumer, mental health and the reduction of preventable diseases?
- A.D.: The transition to a policy of health prevention and prophylaxis requires investment in outpatient care. Prevention means taking action to reduce the risk of a disease or health problem occurring. The aim is to prevent the problem before it appears. There are many good prevention models — from health education in schools to national health campaigns. Together with specific medical prevention for each citizen and the risks they face, we could avoid ranking among the countries with the highest rates of preventable mortality, cardiovascular disease, strokes and smoking.
In the field of mental health, if my colleagues from APOC and I propose introducing free psychological consultations for patients with symptoms from the affective /anxiety-depressive spectrum, bipolar disorders, including psychosomatic conditions/, schizoaffective and psychotic disorders, and behavioural problems /harmful use of psychoactive substances, including alcohol, gambling addiction and others/, the aim is precisely to prevent the onset of severe mental disorders, followed by prolonged and/or frequent hospitalisations and disability.
There is also a connection between physical health, mental health and nutrition, and it is the subject of numerous scientific studies and analyses. Many studies have found a link between consuming food high in refined sugar and impaired cognitive functions, and even a worsening of symptoms of depression. Dr Andrey Velchev and I plan to make this topic of nutrition and mental health accessible in Bulgaria as well and give it a broader public resonance.
- You have set the long-term goal of a health and social policy for prevention and timely rehabilitation by 2030. What does it include so that it does not remain merely a strategic document — early diagnosis, accessible rehabilitation, support for families or better coordination between the healthcare and social systems?
- A.D.: One of our priorities for creating the free social packages I mentioned also includes free psychological consultations for parents of children and adolescents with hyperactivity and attention deficit, challenging and oppositional behaviour, deviant and delinquent behaviour, psychosomatic conditions and dysgraphia before starting school and during their school years. We also have priority proposals for packages of psychological consultations for patients after hospitalisation in psychiatric clinics or departments of general hospitals. The aim is to prevent relapses of severe mental disorders, followed by prolonged and/or frequent hospitalisations. Our organisation manages the “Hidden Likes” House, a rehabilitation centre for people with mental health difficulties and disorders. In most cases, people referred to us have been discharged from psychiatric wards, but only after completing treatment. Our colleagues encounter the importance of rehabilitation every day. I believe this should become a national policy offering more opportunities and centres for psychological support. This is the state investment in prevention and rehabilitation that we are talking about, as well as accessible psychological counselling, which in fact means protecting the right to mental health of everyone who needs help.