HEALTH SINCE 1945: TRANSITION PERIOD, PART 3
In the 50s, already, socialist transformation of health care was marching on a dynamic and rational scale - which, within the frames of the "Second Five-Year Plan" led to a total socialization of state apparatus: cf. Josef Stalin /1879-1953, b. Djugashvili/ and "Stalinism". I turn the pages of an old book, viz. Kolarov P. On socialist transformation of public health care /2nd ed./. Sofia: Nauka i Izkustvo, 1952. The author, Dr. Petar Kolarov /1906-1966/, was architect of socialist reform in health care. Himself, interbrigadier from Spain and U.S.S.R., was appointed minister-of-health on 20 January 1950. Same year, with decree ¹ 2658 from 20 November 1950, was given state jurisdiction to a new nomenclature of health care organisation in the country. The basis of the decision making process, included:
1. Categorization of health care establishments and health care appointments
2. Unification of ambulatory and stationary health care units in academic structures
3. Recreation of Sanitary Epidemiologic Stations /SES/ with prophylactic purpose /N.B. first time, such stations were created during WW I but abolished on a later stage/.
The "Ministry of Public Health", renamed "Ministry of Public Health & Social Care" /MPHSC/ from 29 November 1951, function as a co-ordinating body which organise and run at the head a large network of branch structures - in itself, a replica of the "Directorate of Public Health" before WW II. A "Scientific Medical Council", accredited with ordinance ¹ 911 from 14 April 1950, is the supreme consultative organ of the ministry for planning, research and development. It consist 25 members, all republican specialists in their corresponding working fields, appointed from the minister-of-health and treating different social medical problems with the help of standing committees and commissions.
In the periphery, health care is administered by the local organs of state authority - the public councils. Consequently, with decree ¹ 2822 from 29 November 1951, are established the "Sectors for Public Health" within the district, community and city public councils. The "Sectors …" are responsible for management of hospital and ambulatory care on the territory of the corresponding council, while, some institutions on a national importance are under umbrella jurisdiction of the MPHSC. As a supplement and on a middle level of management are constituent, also, a network of corollary consultative organs with duplicate functions: see example 1.
Now, medical planning has become particularly important characteristic for socialist health care. Planning is inseparable from budget and market extrapolations of any state economy. It consist from parallel lines of development and truncates to the left. Insofar as medicine is concerned - expenditures, for Ministry and Sector health establishments, are planned within the total republican budget and allocated with the help of corollary consultative organs. This seldom leads to discrepancies, but, once a deficit is settled and it can be reimbursed from the state reserve. In a historical perspective - some, 50 years after WW II and the federation of socialist states collapsed under the burden of state deficit. The question is, no making predictions, what could a wholesome world do if a trend on planning continue and this time in an inverse order under capitalist rules?
Next step, nevertheless, comes the reformation of cadres politics in the country. This is an issue of utmost importance and having in mind that Bulgaria could not boast a plethora of medical workers in year 1950, viz. there are 5164 physicians, 1550 dentists, 2034 nurses in practice. We see that health personnel management is not concerned, so much, with a matter of numbers as to their distribution and category level. Ahead, comes an ordinance ¹ 1124 from 6 March 1951 that proclaims the "Institution for Specialization and Unification of Lectors" /ISUL/ - a doublefould organisation: once, to methodically upbring cadres and twice, to nourish a peripheral structures with personnel on a mapping principle /editor note, understand here "geography"/. Socialist reorganization seemed incomplete, without, ISUL and socialist international co-operation. In the long run, socialist countries, joined World Health Organization /WHO/ and International Classification Diseases /ICD/ - fl. year 1960.
/to be continued/