The job position of the Health Mediator is the bridge between the Roma communities and the health and social services. This measure is innovative for Bulgaria, but it has been successfully introduces and has proven its efficiency in many European countries for the improved access of Roma to health and social services and for overcoming of discriminative attitudes towards them. In Spain and France, the health mediator programme has twenty years long history. In Finland, they are called intercultural mediators, in The Netherlands – ethnic health educators, in Romania and Moldova – sanitary mediators, in Slovakia – health mediators, in Serbia – field health workers. 

The experience of the Romanian Roma non-government organization “Romani Christ” and the Romanian Ministry of Health, presented at a working meeting on the Roma health issues that took place in Sinaia, Romania has been used for the development of the health mediators’ model in Bulgaria, as well as the experience of the Dutch Institute of Public Health. The Romanian MH for more than ten years now has been increasingly successfully developing the health mediators programme and already more than 500 mediators have been appointed by the government to work all over the country. 

In Bulgaria, the health mediator model was launched in 2001 by the team of “Ethnic Minorities Health Problems Foundation”. At that time, the pilot project “Introduction of a system of Roma mediators – an efficient model for the improvement of the access of Roma to health and social services” was implemented in the Iztok Quarter in the town of Kyustendil and the first five health mediators were trained. During 2002/2003, “Open Society” Foundation supported the projects of various Roma non-government organizations (Foundation “Nevi Cherhen” – Kyustendil, Foundation “Integro” – Senovo, Foundation “Integro” – Ognianovo, Foundation “Neve Drome” – Shoumen, Foundation “Pirin-2000” – Sandanski, which, jointly with the team of EMHP Foundation trained health mediators and developed the mediator programme in Bulgaria. The main objectives of the programme are: a) To overcome the cultural barriers in the communications between the Roma communities and the medical staff locally; b) To overcome the existing discrimination attitudes in the field of health services for the Roma locally; c) To optimize the implementation of prevention programmes among the Roma population; d) Health education of the Roma and active social work in the community; e) Active social work with vulnerable Roma groups. 

The Bulgarian experience with the health mediators was presented at the 30^th Congress on social wellbeing in Rotterdam in 2002. 

In December 2003, a Consortium of four organizations: The “Open Society” Institute, “Ethnic Minorities Health Problems Foundation”, the “Bulgarian Association for Family Planning and Sexual Health” and the Balkan Foundation for International Understanding “Diversity”, began the implementation of the project “Ensuring Minorities Access to Health Care” under the “PHARE 2001” Programme of the Ministry of Health. Within this project, fifty-one health mediators, thirty general practitioner doctors, and thirty nurses were trained from fifteen towns in Bulgaria with concentration of Roma population. Regretfully, the majority of the health mediators, who have completed their training in 2004, were not appointed at work by the respective institutions, others practice this profession by working on different projects, financed by international donors.  

In 2005, sixteen health mediators were trained under the project “Access to Health Care for Romani Women and Children in Rural Areas”. The trained mediators are from five districts: Blagoevgrad, Montana, Yambol, Rousse and Razgrad. The project has been implemented by a consortium including CARE – The Netherlands, “ECIP” Foundation (successor of “CARE International – Bulgaria”) and “Ethnic Minorities Health Problems Foundation”. The project is financed by the MATRA Programme of the Ministry of Foreign Affairs of the Kingdom of The Netherlands. Thanks to this project, for the first time the experience of the health mediators has been transferred in the rural areas of the country as well. During 2007, additional 17 health mediators were trained from Varna, Sliven, Sofia and Stara Zagora under a project of Foundation “Initiative for Health” and Foundation “Roma Health”.  

On 08.09.2005, the Government of the Republic of Bulgaria adopted Health Strategy for Disadvantaged Persons Belonging to Ethnic Minorities (www.mh.government.bg). The new profession – this of the health mediator – finds significant place in the Strategy, and one of the indicators for its successful implementation is the number of health mediators employed by the government. In late 2005, the Ministry of Labour and Social Policy (MLSP) showed interest in the mediator position and a team of experts from OSI-Sofia, EMHPF and BAFP again conducted a number of discussions with representatives of MLSP and MH. In 2005, only the trained health mediators from the town of Dupnitsa and the town of Dobrich were appointed under the Programme “From social allowance towards employment”, and in 2006 another thirteen health mediators were appointed under the same programme. 

In 2005, an international meeting took place in Bucharest, dedicated to the health mediator programmes in the different countries. The Romanian, Bulgarian and Finnish health mediators’ experience was presented. A comparative analysis was made and the future challenges and perspectives of the profession were discussed. 

In 2006/2007, forty-five health mediators have been trained under the programme PHARE 2003 of the MH “Educational and medical integration of vulnerable minority groups with special focus on the Roma”. The trained mediators are from five districts: Sofia, Vratsa, Yambol and Pazardjik. The project has been implemented by the Centre for Social Practices. A new training programme with a curriculum of 150 academic hours has been developed, of which 130 hours in auditorium and 20 hours of individual work, nine modules in five sessions. Two medical colleges for training of health mediators have been licensed, in the town of Vratsa and in the town of Plovdiv. 

In 2007, thanks to the efforts of the Ministry of Health, the Ministry of Labour and Social Policy, the Ethnic and Demographic Issues Directorate at the Council of Ministers and last but not least of the non-government organizations, working in this sphere, fifty-seven health mediators were appointed at work in thirty municipalities with delegated budget. The intention for the institutionalizing of the new profession “health mediator” is clearly defined national policy. It has been included in the National Classification of Professions, and the job description of the health mediator has been adopted as well. 

The National Network of Health Mediators was founded in 2007 within the framework of the project “Preparation for introduction into the profession Health Mediator: Health mediators’ capacity building and network building” with the support of the Programme MATRA CAP of the Ministry of Foreign Affairs of the Kingdom of The Netherlands. The Network’s members are more than one hundred and twenty persons – health mediators, lecturers-specialists, general practitioner doctors and nurses, health mediator trainers, experts on ethnic and demographic issues, experts and specialists in the field of public health care, stakeholders and citizens, supporting the introduction of the figure of the health mediator as part of the public health care system in this country. 

In 2008, 111 health mediators were appointed in 55 municipalities through delegated budgets to the municipalities. Nineteen health mediators were trained in the Medical College in Plovdiv from municipalities where thus far there have not been any trained health mediators, as the mayors of these municipalities have covered the costs for the health mediators training.