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A training under Programme "Strengthening the National Tuberculosis Programme in Bulgaria", Component 5,  which is coordinated by Amalipe in Veliko Tarnovo took place in September 2012. The Program is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. The goal of the programme  is "Extension of effective treatment for the prevention and control of tuberculosis in the Roma community." Dr. Elena Kabakchieva, long-term consultant under Component 5 conducted the meeting. The trainers were Radostina Antonova - a psychologist and Boyan Vassilev also psychologist. In the different segments of the program participants were Dr. Vladimir Milanov - Medical Coordinator under the Program and Dr. Tonka Varleva - Director of donor programs at the Ministry of Health (MoH).
The workshop was held in Sofia and involved teams of NGOs working in the so-called Program’s Round 8. The aim of the meeting was all organization to share successful practices and difficulties in their work, exchange and build on experience among staff in the field, answering questions related to the technical work as well as to clarify the most troubling question of all whether and when the Program will continue to be funded by the Global Fund.
Various cases encountered by the outreach workers in the field were reviewed and discussed. A few interactive games about how field workers talk about the disease among the community, how to approach the filling of questionnaires and ways to ask questions related to personal information of patients were performed. Other colleagues shared their difficulties with respiratory health facilities and that medical teams that we work with often neglect and underestimate the work of outreach staff, also problems with the various institutions, such as the mayor, who does not allow people from the village to be interviewed about the disease and to talk with them on the topic of tuberculosis.
All participants were gravely concerned by how and whether the TB Program will continue. Dr. Kabakchieva gave a vague answer to this question, and said that the Program will continue but regional centers working on it will be reduced. Out of the 28 districts 15 will remain and the other 13 will be left outside the scope of funding from the Global Fund through the Ministry of Health. Districts that will continue to work with GF resources are to be selected on the basis of epidemiological data from all the 28 districts. “We will continue working where epidemiological data is highest and where the number of patients on chemo-prophylaxis and those with latent tuberculosis are highest”, said Dr. Kabakchieva.
On the last day of the meeting, Dr. Tonka Varleva said the program will continue to support methodologically the organizations that will remain outside financing if they wish to apply for other small grants to work on the tuberculosis control. On behalf of Center Amalipe, Momchil Baev asked Dr. Varleva whether MoH nevertheless has a clear vision for an alternative to the Global Fund, but one that would preserve the centralized structure of networking and would play the role of a national policy on the issue. To that, Baev added that relying on the option where individual NGOs apply for small grants at the local level, will soon lead to disintegration and collapse of slender network of 28 regional teams, established by the MoH with funding from the Global Fund and will be piecework, but not a national policy. The clear answer to these questions for now is not on the table, but Dr. Varleva said talks with local municipalities to support any activities in TB control will be held.
Considering how the municipalities are struggling to support municipal hospital including pulmonary and respiratory specialist hospitals is rather unrealistic to rely on the idea that they will take more financial burden on the control of one of the most common diseases worldwide.
By the end of October 2012 it will become clear which 13 NGOs in various regional cities will drop out of the Program and hence what the future policies in the control of tuberculosis in Bulgaria will be.