We translated this report from our friends of the collective Konflikt from Bulgaria, who told us about recent protests in front of the hospital.
February 4, 2026
In Varna, we started the new year with the announcement that our city is losing its pediatric surgery department in the most important hospital in the city and the region—St. Anna Regional Hospital. Since the beginning of the year, nurses, doctors, and paramedics have had their salaries cut, with their pay falling below even the minimum wage for the country. The medical staff responded with a protest in front of the hospital on the 15th of January, in which almost all workers of the medical facility took part. This prompted media reactions from the hospital director and the management of the National Health Insurance Fund (NHIF), from whom we learned that, once again, no one was to blame. The director blamed the NHIF, saying there was no money for salaries because the hospital’s excess activity had not been paid for. The NHIF claims that it has paid everything. Lawsuits are pending, and in the meantime, there are no salaries. This is not a precedent. The hospital, like most state hospitals in the country, has been collapsing for years. Salaries are humiliating, the material base is crumbling, there is no money for basic consumables, and suppliers refuse to work with the hospital. St. Anna lacks basic amenities, with staff buying dishes for patients with their own money, and the only income for improvements coming from charity campaigns, Norwegian foundations, and individual donors.
The theft of the already meager salaries of the medical staff was simply the last straw. This led to the 2nd of February, when the doctors and nurses from the pediatric surgery department at St. Anna Hospital collectively resigned and the department closed its doors to young patients. The medical staff, some of whom had been working in the public hospital for more than 30 years, were immediately hired by a private hospital in Burgas, and Varna lost its pediatric surgery department. What’s more, this is not the first department we have lost – three departments have been closed in recent years, including vascular surgery and internal medicine.
As we wrote above, what is happening now is not an accident, but another episode in an ongoing tragedy in which the victims are both the doctors and all the residents of Varna and the region. We must stop the collapse of our public hospital – all working people contribute part of their salaries to the maintenance of this hospital every month and we and our children need it. After decades of decline, it is clear to all of us that the solutions will not come from hospital directors or the Ministry of Health. The solutions can only come from those directly interested in saving public healthcare in Varna – the hospital staff and all of us, the patients. However, in order to develop solutions, we need to know exactly what is happening with our hospital. There are many problems, and they overlap. Let’s start with the aforementioned financial relations.
Hospitals are financed by our health contributions through the clinical pathway system (specific amounts for specific activities, “money follows the patient”) allocated by the National Health Insurance Fund. They were introduced as part of the market reform of Bulgarian healthcare, which turned hospitals into commercial companies competing for money from the fund. This system created the conditions for massive corruption and opened the door to the massive draining of the health fund by hospital directors and part of the medical elite, many of whom have become multimillionaires in recent decades, while their hospitals are falling apart, doctors live in poverty, and patients pay not only with their health insurance contributions, but also with their lives and health. This is how hospital limits were introduced. Their stated goal was to curb theft by placing limits on each individual hospital based on its previous activity. Thus, regardless of its activity and the number of patients it has treated, a hospital cannot exceed the limit set by the NHIF. This is exactly the case with St. Anna Hospital in Varna. The NHIF sets a limit, say 5 million leva, and the hospital treats patients for 6 million leva. This generates a debt of 1 million leva for the hospital, which, in the long term, puts the hospital in serious debt and makes it unable to pay salaries and suppliers. However, this scheme directly contradicts the hospital’s obligation to treat all emergency patients, not only from Varna, but also from the region. This is a right guaranteed to patients by the Constitution. Thus, the limits set by the NHIF leave the hospital unable to fulfill its basic obligations without generating more and more debt. And this is no exception; it is happening in many state hospitals throughout the country. At the same time, private hospitals are raking in money from the most profitable clinical pathways, while the entire social function is left to public hospitals. Privatization of profits – socialization of losses.
This paradox is, in fact, the way our healthcare system currently “works.”
But let’s get back to the District Hospital. The hospital is headed by Krasimir Petrov, hospital director and former MP of the GERB (‘Citizens for European Development of Bulgaria’ – a centre-right political party), who has been in charge of the hospital for nearly 20 years. While the hospital is falling apart and medical staff salaries are shrinking, Petrov is amassing a fortune and, in the meantime, has managed to indulge in aggressive tourism, receiving an award for being the first Bulgarian to visit all UN member states. But the problem here is not the individual, but the system that concentrates power in his hands. A key element of the aforementioned market reform in healthcare was giving the director absolute power over the distribution of salaries in the hospital. Thus, although operating with public funds and in the public interest, hospitals are managed as private companies, and the director is given full ownership powers. Concentrating enormous financial resources in the hands of one person is naturally a recipe for corruption, and we see its effects in all state hospitals—millionaire directors and miserable salaries for medical staff. At the same time, workers have no control over their remuneration and are left entirely at the mercy of the director. Even the formal mechanisms at the state level do not function. No national collective labor agreement in the healthcare sector has been signed since 2022. Due to pressure from protests by young doctors and nurses, the government was forced to accept an increase in basic salaries, with the minimum set at €1,550 for nurses and €1,860 for young doctors. Due to the lack of a working mechanism for setting minimum wages in the sector, such as a collective labor agreement, the government included these minimum rates in an unusual place in the fall of 2025 – the National Health Insurance Fund budget law. In any case, where exactly the wage increases were included is irrelevant, as following protests by the PPDB (‘We Continue the Change’ – electoral coalition) and industrial capital, the budget was withdrawn, and with it the planned wage increases. As a result, healthcare workers were left without any salary regulations – no collective bargaining agreement, no budget. In practice, this means that the director can easily keep healthcare professionals on the minimum wage, as we are already seeing happen not only in Varna.
So, faced with a collapsing healthcare system and without any institutional protections, what can workers like Anna do, and what can we all do as patients to save what remains of our public healthcare system?
The problems in the healthcare system are fundamental and require urgent and radical reform – abolishing the commercial status of hospitals and protecting their social function. Our hospitals are not businesses, our health is not a commodity! Abolish the corrupt system of clinical pathways and guarantee fixed and decent wages for healthcare workers. Doctors should not be forced to rely on schemes or handouts from corrupt directors. Nurses should not be forced to work three jobs. Limit the sole power of the director. Healthcare professionals must have a say in the management of the hospital and the allocation of funds. But in order to exercise this right, healthcare workers must be organized. We see that traditional unions are useless for this purpose. Medical professionals face the challenge of creating their own organization, in a way that suits their conditions, which is capable of changing the balance of power in the hospital and effectively representing their interests. Individually, each worker is weak. When united, they are an unstoppable force.
Redirecting all public resources to public healthcare. We must stop financing the profits of private hospital owners with our salaries.
This list could go on. Of course, this reform is far beyond the power of the workers at the district hospital and the residents of Varna who support them. But there are measures that are within our power and that we must insist on – now! First – an increase in the minimum salaries of young doctors and nurses at the District Hospital to the minimum provided for in the NHIF budget – €1,550 for nurses and €1,860 for doctors. There are now rumors in the hospital that nurses’ salaries will be increased to… €1,000. This is grossly insufficient and will in no way stop the exodus of staff from the hospital. We also hear the same mantra from the leadership of the Bulgarian Medical Association (BMA) and the director of the District Hospital that the solution to all problems is… to increase the prices of clinical pathways. Every time the disaster in Bulgarian healthcare hits the news, the same healthcare lobbyists come out with the same prescription: give us more money. But in fact, there is no guarantee that the money for clinical pathways will reach where it is most needed – for the salaries of doctors and nurses. Much of this money will sink into the pockets of those who have the sole power to distribute it – the directors.
It is precisely the distribution of money from clinical pathways that is at the heart of the corruption model in Bulgarian healthcare, and pouring more money into this mill will lead to the same results as before. Therefore, the only way to address the problems is with a fixed increase in the basic salaries of medical professionals. Everything else is just smoke and mirrors for workers and bonuses for healthcare profiteers.
Second – organizing medical professionals at St. Anna Hospital. And here we are not talking about dysfunctional state-controlled unions, but an organization of all hospital workers, beyond professional and union divisions. Only with such an organization will hospital workers be able to effectively defend their interests, which coincide with the interests of all residents of Varna—to have a regional hospital where medical workers receive decent salaries and working conditions.
Due to public and media interest, it is very likely that the state or the municipality will provide a financial injection to the hospital. The inclusion of worker representatives in the distribution of funds is the only guarantee that these funds will not be yet another patch used to temporarily appease discontent until the next crisis. Neither social assistance from the ministry or the municipality, nor an increase in clinical pathways, can contribute to solving the problem. These “more of the same” measures only serve to perpetuate the corrupt model of Bulgarian healthcare and benefit lobbyists from the Bulgarian Medical Association and hospital directors. We should not believe the promises of politicians who are currently in the election race and are more than generous with their promises. They do not want to change the model because some of them benefit from it. They cannot change it because they are dependent on the healthcare lobbies. But they also do not know how, because they are incompetent. And above all because they are all united by the market ideology that society should be run like a business. The only ones who can initiate real change in healthcare are the same ones who can and will save the district hospital, namely the doctors, nurses, and orderlies who work there, with the support of the patients who finance the hospital—the residents of Varna. The time is now.
