ISSA Member pilots promising Nurse-Family Partnership home visiting program in Bulgaria  

ISSA Member, Trust for Social Achievement (TSA), in Bulgaria aims to help young mothers build parenting skills to ensure a healthy start for their babies.  

TSA is pursuing this aim through the Nurse-Family Partnership (NFP), supported by the America for Bulgaria Foundation, as well as with EU funds. NFP is a home visiting program, which includes intensive home visits for first-time mothers up to the age of 22 years in vulnerable situations. The NFP program is an internationally recognized model of home visiting care developed by Prof. David Old, Professor of Pediatrics and Public Health at the University of Colorado Denver, USA.  

Countries across the globe have adopted this program due to its high return of investment of a child’s first 1,000 days, perceived and assessed national needs, and its long-term benefits. Among them includes fewer cases of child abuse, decreased use of social benefits, and reduced infant mortality rate.  

Implementation in cities in Bulgaria 

In Bulgaria, TSA provides crucial home visits to first-time, low-income mothers from the prenatal period until the child is two years old. Teams of nurses and midwives who go through specialized training, conduct between 50 – 64 home visits to mothers enrolled in the program, to provide ongoing support, care, and necessary information for new parents. The program goals are to support mothers to give birth to healthier babies, improve the early development of children, and increase the economic independence of the parents. 

TSA began piloting the program in 2016 after adapting the material to suit the Bulgarian context while partnering with healthcare institutes and local foundations. Through a collaboration with II SAGBAL "Sheynovo" – a specialized hospital for gynecology – over 160 families in Sofia enrolled in the program and continues to attract applicants. In 2019, the program attracted over 80 families after expanding to Bulgaria’s second largest city, Plovdiv, supported by the local St. George’s University Hospital. While efforts are dedicated to neighborhoods with a high number of young mothers facing economic challenges, the program is available for families throughout the entire city. 

Scaling up NFP program to the national level 

To support quality national implementation, TSA created two local boards in Sofia and Plovdiv and one national advisory board who meet regularly. Key institutional representatives along with local and national experts in maternal and infant health and development meet every four to six months. Additionally, an expert from National Center of Public Health and Analysis (NCPHA) at the Ministry of Health has been working since 2019 to adapt the program’s methodology to suit the Bulgarian healthcare system and social services. 

During the national roundtable held in January 2023, Home visiting care for vulnerable pregnant women and mothers and children up to 2 years: international experience and perspectives for Bulgaria, Associate Professor Krassimira Kostadinova, Head of the Department of Child and Adolescent Health at the NCPHA, highlighted needs for national dissemination of an evidence-based home visiting care service, such as the NFP model, and proposed viable options for incorporation into the Bulgarian health system. Moreover, the Ministry of Health confirmed their commitment to developing a national home visiting care program by the end of 2023, while highlighting maternal and child health policy as the ministry’s top priorities with home visiting care included in the National Strategy for Child and Adolescent Health and Pediatric Care in the Republic of Bulgaria (2021-2030). This is in line with TSA’s goal to complete the pilot phase and advocate for the integration of the NFP program into the national health system. 

Evaluation of the implementation 

The program proves a promising approach for improving the health and development outcomes of young Roma children living in poverty aged zero to two. In 2023, an outcome evaluation by the University of Utrecht demonstrated that the program was closing the gap between Roma and non-Roma children by significantly improving child-development outcomes and parental practices related to the stimulation of early learning and by increasing the duration of breastfeeding.