Area Handbook For Bulgaria Part 10

The cornerstone of the health service is the polyclinic, which provides general and specialized outpatient aid and consultation. Polyclinics may be attached to a hospital or may be independent units serving a designated geographic area. A separate network of polyclinics is attached to industrial mining, transport, and construction enterprises to serve their workers. Each polyclinic is divided into departments for the various specialties in medicine, and each department is staffed by one or more doctors and auxiliary personnel. Not all polyclinics, however, have departments for all the major fields of medicine; many have only sections for internal medicine, obstetrics and gynecology, pediatrics, and surgery. Patients needing consultation or treatment by other specialists are referred to the nearest hospital.

The health care provided by the polyclinic was under serious attack in the early 1970s both from the doctors who work there and from the patients. The main problem seemed to be overburdening and inefficiency imposed by the system of health care. One polyclinic in Sofia, for example, was responsible for the health care of 70,000 inhabitants of its area. Its physicians gave routine examinations to prospective students and job applicants, certified the legitimacy of claims for sick leave, and diagnosed and treated all complaints from the common cold to the most serious illness. During four hours each day, patients were seen on a first-come-first-served basis, except in emergencies. Waiting rooms were jammed, and people often waited for hours without seeing a doctor because the allotted time for office consultations had expired before their turn came.

Studies have indicated that one physician sees an average of thirty to forty patients in the four-hour period of office consultations, and then one-half again as many in a three-hour period of house calls, which often cover a wide geographic area. The average consultation between doctor and patient is six minutes, a time much too short for proper diagnosis. The result has been frequently wrong diagnosis and wrong or inadequate treatment.

A survey of polyclinic physicians conducted in 1970 revealed that over 50 percent of those surveyed considered the outpatient treatment provided by the polyclinic to be ineffective. They blamed poor organization and procedure in handling patients' needs, which resulted in the inefficient use of physicians' time, overloading of physicians, and shortage of drugs and equipment needed for complex treatment. More than two-thirds of the physicians questioned indicated that they would prefer to practice at a hospital or other medical unit and that they planned to leave the polyclinic as soon as another opportunity was available. The physicians recommended that their work schedule and method of handling patients be revised to make the system more efficient; that social workers be a.s.signed to polyclinics to handle some of the patients' social problems that aggravated their medical problems; that polyclinic doctors be given more specialized training in rapid diagnosis and other skills required by them and not by hospital physicians; and that the remuneration of polyclinic physicians be brought in line with their arduous a.s.signment.

The patient's response to the inadequacy and inefficiency of polyclinic health care has been to seek out a physician with a private practice and pay the necessary fee. Approximately one-fourth of the polyclinic physicians have a private practice during nonduty hours, as do almost all specialists. By consulting a private physician rather than the free polyclinic, the patient can choose his own doctor and establish a personal relationship with him, hoping to develop confidence and receive more effective treatment.

The outpatient work of the polyclinics is supplemented by a network of special dispensaries that provide long-term care for persons suffering from tuberculosis, venereal disease, tumors and psychoneurotic disturbances. The sixty-one dispensaries in 1971 also had a total of 3,670 beds for inpatient care.

A network of hospitals provides inpatient treatment and specialized diagnostic and clinical facilities. All hospitals are also teaching centers for physicians, nurses, and auxiliary medical personnel. In 1971 there were 195 hospitals throughout the country, at least one in each district. Certain districts, however, were inadequately equipped with hospital facilities. The total number of beds was 57,053, or 7.6 beds per 1,000 inhabitants. One hundred and fifty-four of the hospitals, with a total of 47,839 beds, were general hospitals. There were also fifteen special tuberculosis hospitals and fifteen psychoneurological hospitals with a total of slightly over 3,000 beds in each category; five pediatric hospitals with a total of 480 beds; four obstetric and gynecological hospitals with a total of 740 beds; one hospital for infectious diseases; and one for orthopedic and plastic surgery. In addition to these district-supported hospitals, the central government operated six hospitals with a total bed capacity of 1,036 in connection with the special medical research inst.i.tutes. Extended care and physical therapy for patients suffering from chronic ailments were offered by 182 sanatoriums and health spas with a total bed capacity of 16,104.

The Sixth Five-Year Plan (1971-75) envisages increasing the number of hospital beds to 8.4 per 1,000 inhabitants and focusing on those areas of the country that are underserved. An increase in operating funds for the hospitals is to be channeled mostly into improving plant and equipment. Although most hospitals suffer from poor or outmoded plant and equipment, they also suffer seriously from a shortage of staff, particularly of nurses and auxiliary medical personnel. The plan states specifically that alleviation of that shortage will have to be delayed.

In 1971 the country had a total of 16,183 physicians, 1.9 for every 1,000 inhabitants. The number of physicians had more than doubled in the twenty years since 1952; most of them, therefore, were between the ages of twenty-five and forty-five. The number of other medical personnel had expanded along the same lines. In 1971 there were 2,464 pharmacists; 26,381 nurses; 6,016 midwives; and 5,012 feldshers. Feldshers are paramedics trained to perform a variety of medical functions, including simple surgery, in the absence of a fully qualified physician. Many rural health centers are in the charge of feldshers and receive periodic visits from specialized physicians.

Physicians and auxiliary medical personnel are all employed by the state in the national health service. They are cla.s.sed as nonproductive workers, therefore their salary scales are lower than those for productive workers. This has been causing a great deal of dissatisfaction and is the princ.i.p.al reason for the serious shortage of medical personnel. One Bulgarian newspaper in 1971 reported the case of a hospital administrator trying to recruit women streetcleaners to fill the many vacancies for nurses and aides in the hospital. The streetcleaners refused because their wages and working conditions were better than those for the more highly skilled positions in the hospital.

PERSONAL INCOME AND EXPENDITURES

Cost of Living

Incomes and retail prices are controlled by the government and set in accordance with the overall economic plan. The cost of living, therefore, is also controlled and has been relatively stable. Several increases in the minimum wage during the 1960s were paralleled by price increases for some of the essential commodities and services. In 1973 the minimum monthly wage was raised to 80 leva per month (for value of the lev--see Glossary), and basic wages for the lowest categories of workers and employees were also raised to bring them into line with wages in comparable kinds of work. At the same time, prices of certain foods were reduced, whereas prices of some other essential goods were raised.

Although the incomes of most Bulgarians have generally kept pace with the rise in the cost of living, a chronic scarcity of consumer goods and services and periodic food shortages have forced a comparatively low standard of living on the population. As in other communist countries, the consumer industry has been neglected in favor of other branches of the economy. Even after the government began to place greater emphasis on the production of consumer goods in the 1960s, rising demand outstripped production capabilities. Even the basic needs of the population often could not be met because of poor planning or the inflexibility of the central planning system, which does not react effectively to changing market conditions. It is not uncommon to have excessive inventories of certain sizes of clothing or footwear while other sizes are in short supply. Retail outlets are either unwilling or unable to replenish their supplies of missing sizes until the overall stock of the item is almost depleted, regardless of consumer demand.

The government has for some time indicated concern over the low standard of living in Bulgaria as compared with other Eastern European countries.

One of the aims of the Sixth Five-Year Plan is to increase production of consumer goods and meet the needs and rising demands of the population.

Limited production capacity, however, and shortages of certain raw materials will seriously restrict the extent of possible improvements.

In December 1972 the Central Committee of the Bulgarian Communist Party held a special plenum on improving the standard of living of the people.

This unprecedented move showed the importance that the leadership was attaching to this subject. In an extensive report to the plenum, party chief Todor Zhivkov presented a far-reaching program of steps to be taken, starting in 1973, to improve the standard of living. To implement the decisions of the plenum over the long run, the Commission on the Living Standard was established under prominent Bulgarian Communist Party (BKP--see Glossary) leadership.

As envisaged by the plenum, the standard of living will be raised by pursuing a three-p.r.o.nged policy: gradually increasing wages; keeping prices stable; and making available an adequate supply of consumer goods and services, including luxury goods and services to satisfy the demand of those who are willing to pay the higher price. In the past, luxury goods and services have been considered superfluous and undesirable in an egalitarian socialist country. Higher incomes and exposure to the living standards in other Eastern European and Western European countries, however, have created pressure for more than just the satisfaction of basic needs. According to some government officials, Bulgarians are no longer satisfied with just any washing machine or electric appliance; they want the latest automatic model and are willing to pay for it.

In the program for increasing wages, special attention will be paid to narrowing the gap between incomes of cooperative peasants and those of workers. In the mid-1950s a cooperative peasant's income was only 60 percent of a worker's income. By 1971 the peasant's income had increased to 85 percent of that of a worker, but this amount was still considered too low by the government. To accelerate the growth of peasants'

incomes, a nontaxable minimum income was to be introduced in 1973, and the same system of income tax was to cover both peasants and workers.

The system of remuneration on cooperative farms was to be made the same as that on state farms, where agricultural workers are cla.s.sed as workers, not as farmers. Fringe benefits, such as pensions and supplements for children, were also to be brought into line with those of workers by 1975.

Consumption

According to official figures, consumption has grown steadily since the early 1960s, in spite of continued shortages of some goods. As incomes rose and consumer goods and services became more readily available, a greater percentage of household budgets was being spent on them. All segments of the population spent a greater share of their income in 1971 on household equipment and on cultural and educational pursuits, which included such durable goods as household appliances and radios and television sets, than they did in 1962. Changes in proportionate expenditures for other nonessentials during the 1960s reflected the income differences and taste preferences of the different social categories as well as their rural or urban residence.

The largest share of consumer expenditures in 1971 went for food, ranging from 42.5 percent of total expenditures for peasants to 38.8 percent of total expenditures for white-collar workers (see table 3).

In calculating expenditures for food, the value of food production for personal consumption was included. The relative share of expenditures on food has been dropping since 1962. At the same time, the quality of the diet for all population groups has improved.

_Table 3. Bulgaria, Percentage Distribution of Household Expenditures by Population Group, 1962 and 1971_

---------------------+---------------+---------------+------------------- Blue Collar White Collar Co-op Farm Member Item +-------+-------+-------+-------+---------+--------- 1962 1971 1962 1971 1962 1971 ---------------------+-------+-------+-------+-------+---------+--------- Food 46.0 42.3 44.6 38.8 46.3 42.5 Alcoholic beverages 2.9 3.4 2.1 2.1 6.3 5.1 Tobacco 2.3 1.7 1.9 1.5 1.3 1.3 Clothing 13.6 11.4 14.7 11.3 13.6 10.3 Housing 9.9 8.7 7.9 11.4 9.6 8.8 Household furnishings 3.5 5.3 4.0 5.3 4.0 5.0 Culture and entertainment 4.3 5.3 6.0 7.8 2.8 5.4 Health and hygiene 1.2 1.8 1.6 2.3 1.0 1.7 Communication and transportation 2.7 2.8 3.3 3.4 1.5 1.7 Taxes and fees 5.4 6.2 6.2 7.0 1.3 2.0 Other 8.2 11.1 7.7 9.1 12.3 16.2 TOTAL 100.0 100.0 100.0 100.0 100.0 100.0 ---------------------+-------+-------+-------+-------+---------+--------- Source: Adapted from _Statistical Yearbook, 1972_, Sofia, 1972, p. 412.

Relative expenditures on clothing were roughly the same for all population groups, although peasants spent a somewhat smaller proportion of their budget than families influenced by urban life-styles. The share of the budget spent on clothing has dropped since 1962.

The relative share of expenditures for housing went down between 1962 and 1971 for the two lower income groups, who spent almost the same proportion of their budget for that purpose. The higher income white-collar group, however, spent over 3 percent more on housing in 1971 than it did in 1962. This group has been investing in its own private housing rather than living in state- or industry-supplied housing. Expenditures for household furnishings and equipment were approximately the same for all segments of the population in 1971. They occupied a greater share of the household budget than in 1962, particularly among blue-collar workers.

In addition to devoting a considerably higher portion of their budget to housing than other social groups, white-collar workers also devote more of their budget to culture and entertainment and to health and hygiene.

This is clearly a reflection of more sophisticated tastes and a higher standard of living. The life-style of this group includes regular attendance at the theater, operas, and concerts; the purchase of books and records; and a higher education for their children. This, also, is the group that prefers to consult a private physician, who sets his own rates, rather than to use the free public clinic.

Relative expenditures for communication and transportation services have remained stable over the years. They vary by population group, consuming a greater portion of the budget as one rises on the social ladder. The proportionately higher expenditures of blue- and white-collar workers are probably due to the expense of commuting to and from a job. The even higher share of such expenditures in the budgets of white-collar workers is attributable to private telephones and travel.

The greatest variation in consumption patterns between the different population groups is evident in the proportion of expenditures devoted to other than the enumerated categories. Although there is no indication in the statistical material as to what kind of expenditures are included, this entry must certainly include expenses incurred in the cultivation of private plots and the raising of animals in the private sector for domestic consumption and expenses incurred in providing private services. Therefore, these expenditures take a high share of the total expenditures of peasants and workers.

Despite expanding consumption, neither the government nor the population is satisfied with the supply and quality of the goods and services available. Some items, such as meat, housewares, furniture, building materials, and various kinds of clothing and knitwear, are in chronic short supply. Other items, such as fruits, vegetables, and dairy products, are subject to periodic shortages. In addition, the quality and selection of many goods do not meet the desired levels. An official doc.u.ment published in 1972 decried the common practice of producing high-quality goods for export and lower quality goods for the domestic market. The same doc.u.ment also called for changing export priorities so that the domestic needs could be met before scarce goods were exported.

Another factor limiting the satisfaction of demands for goods and services has been the small size and inefficiency of the domestic trade network and of the service industry. Retail outlets are state owned and have received very low priority in the allocation of funds. As a result, they are too few in number and are seriously understaffed, making shopping a time-consuming and frustrating activity. Stores are reluctant to stock new styles in response to consumer demands until their old stocks have been almost completely depleted. High-quality and specialty items are usually available only from private craftsmen at very high prices.

Private craftsmen and artisans provide virtually the only service network in the country. The service sector of the economy has been considered as nonessential and therefore has been neglected by the state (see ch. 12). In order to fill the gap thus created, the government started in the mid-1960s to encourage private individuals to provide the needed services. Many of these people are regularly employed artisans and craftsmen in industry who provide specialized services during their spare time. Others are pensioners or unemployed. Because they are in great demand, they can set their own prices, and many are in the highest income groups. The government has attempted to keep their earnings under control through taxes and has restricted their activities by other administrative measures, but it has made no effort to eliminate their services.

In the report issued by the special plenum on living conditions held by the Central Committee in December 1972, a comparison was made of actual consumption in 1970, desired consumption levels during the next decade, and consumption standards developed by government scientific inst.i.tutes.

In most cases the actual levels were far below the standards (see table 4).

_Table 4. Bulgaria, Actual and Desired Annual Consumption Levels_

-----------------+--------------------+----------------------------------- Consumption Levels --------+---------------+---------- Desired Item Measure Actual -------+-------+Scientific 1970 1975 1980 Norms*

-----------------+--------------------+--------+-------+-------+---------- Meat and meat products pounds per capita 91.3 121.3 165.4 176.4 Fish do 12.1 17.6 22.0 22.0 Milk and milk products do 335.4 432.2 551.3 573.3 Vegetable oils do 27.6 30.6 30.9 28.7 Flour and flour products do 376.1 401.3 330.7 221.0 Sugar do 72.5 81.6 79.4 70.6 Vegetables do 196.0 299.9 352.8 396.9 Fruits do 326.8 394.7 442.0 442.0 Eggs number per capita 122.0 159.0 250.0 265.0 Cotton fabrics feet per capita 72.8 81.0 108.2 118.0 Wool fabrics do 12.5 15.4 19.7 23.0 Shoes pairs per capita 1.7 2.1 3.0 4.0 Radio sets per 100 households 100.8 104.0 110.0 130.0 Television sets do 42.0 53.0 80.0 105.0 Telephones do 7.0 9.6 10.0 50.0 Washing machines do 50.0 50.0 60.0 70.0 Refrigerators do 29.0 59.0 90.0 100.0 Automobiles do 6.0 13.5 30.0 40.0 -----------------+--------------------+--------+-------+-------+---------- * As determined by research inst.i.tutes of the Bulgarian Academy of Sciences.

Source: Adapted from U.S. Department of Commerce, Office of Technical Services, Joint Publications Research Service--JPRS (Washington), _Translations on Eastern Europe: Political, Sociological, and Military Affairs_, "Statistics on Rising Living Standard Given," (JPRS 58,480, No. 851, 1973).

HOUSING

In common with other Eastern European countries, Bulgaria has suffered a serious urban housing shortage since World War II, although large reserves have existed in rural housing. Great numbers of workers have left the villages over the years to find employment in the rapidly expanding industrial centers, but housing construction has not kept pace with this migration. During the early years of communist rule, priority in the allocation of scarce building materials and funds was given to the building of new plants and other industrial installations rather than to new housing. In the 1960s only between 3 and 6 percent of the gross national income was invested in housing construction as compared with 20 percent or more in most Western European countries. Bulgaria has had the lowest housing investment among the communist countries of Eastern Europe.

In 1970 the Politburo and the Council of Ministers adopted a special program for the solution of the housing problem within the next ten to fifteen years. The program stated that the aim of the BKP was to enable every family to have its own apartment, and every member of the family his own room. In 1972 there were some 250,000 more urban families than there were housing units.

Aggravating the housing shortage in the early 1970s was an accelerating deterioration of old buildings. Money and materials for maintenance of existing structures have been even scarcer than for new buildings. In addition, many of the postwar apartment buildings were put up hastily, using inferior materials and workmanship, and soon turned into crumbling slums.

In order to spur housing construction without imposing too great a burden on the state budget, the government was forced to abandon its intention of providing low-rent housing for everyone. Instead, it has encouraged the population to invest in its own housing. As a result, special savings accounts for the purchase of private housing have grown at a more rapid rate than regular savings accounts. During the 1968-70 period approximately one-third of the new housing units made available were financed entirely by state funds, another one-third were financed entirely by private funds, and the last one-third were financed by private funds with the aid of loans from state sources. State enterprises are instructed to grant their employees interest-free, fifteen-year mortgages for the purchase of an apartment or house. Up to 4,000 leva can be borrowed for this purpose in urban areas and up to 3,000 leva in rural areas. This, however, covers less than one-half of the cost of a two-room apartment.

Although the increasing reliance on tenant-financed housing is helping to reduce the overall housing shortage, it has meant that most new housing units are built for the higher income groups. Cooperative apartments and private houses require a substantial initial investment and the a.s.sumption of a mortgage, which are beyond the means of most blue-collar and low-income white-collar workers. These groups continue to rely on state-financed or industry-financed low-rent housing, which usually has long waiting lists of prospective tenants. In order to free more of the low-rent housing for those who cannot pay for a private home, persons owning a second home or intending to build one are being asked to vacate their state-supplied housing.

In 1973 the per capita area of usable housing s.p.a.ce was 124 square feet.

New dwelling units constructed under the Sixth Five-Year Plan were to have an average of 857 square feet each; those constructed during the following Seventh Five-Year Plan (1976-80) will have an average of 911 square feet each. Inasmuch as possible, all new housing units constructed before 1975 will be equipped with running water, electricity, sewage disposal facilities, and central heat. After 1976 such amenities will be mandatory. In the mid-1960s, the latest date available, 30.7 percent of all housing units had running water, 94.7 percent had electricity, 32.7 percent had sewage disposal facilities, and 1.5 percent had central heat. The availability of these amenities in housing units varied a great deal among the different social groups of the population (see table 5).

_Table 5. Bulgaria, Percentage of Housing Units Equipped with Various Amenities, December 1965_

----------------------+---------+-------------+------------+--------- Sewage Running Disposal Central Water Electricity Facilities Heat ----------------------+---------+-------------+------------+--------- _Households_: Blue collar 29.0 95.2 32.7 0.8 White collar 72.6 99.3 73.0 4.9 Cooperative farm 6.5 91.6 7.2 0.0 Cooperative artisan 37.1 98.4 40.2 0.2 Other 54.0 96.5 56.7 2.9 ALL HOUSING 30.7 94.7 32.7 1.4 ----------------------+--------- -------------+------------+--------- Source: Adapted from U.S. Department of Commerce, Office of Technical Services, Joint Publications Research Service--JPRS (Washington), _Translations on Eastern Europe: Political, Sociological, and Military Affairs_, "Aspects of Standard of Living a.n.a.lyzed," (JPRS 48,717, No.

126, 1969).