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Bulgaria Health Sector Labor Adjustment Strategy

Emerging Markets practice


Deloitte provided human capital consulting services to an agency in the Government of Bulgaria that was charged with providing free health services to its citizens. Project activities focused on a situational analysis, a labor adjustment strategy for excess staff in the health sector, and building capacity to plan and evaluate human resource needs in the health sector.

The Challenge

Bulgaria spent 45 years as a socialist economy, making a number of public sector reforms after the fall of the Berlin Wall. Health care reforms began in 2000 but led to declining employment conditions for health care workers. Through a World Bank project, Deloitte was tasked with assisting the Government of Bulgaria in creating a Health Sector Labor Adjustment Strategy both to address maladjustments in Bulgaria's health workforce and to build capacity of Bulgarian institutions to properly plan and evaluate the need for human resources in the health sector.

How We Helped

Deloitte worked closely with the client to conduct the following activities in support of Bulgaria's Health Sector Labor Adjustment strategy:

  • Conducted a careful review of legislative and normative arrangements regarding human resources
  • Completed an analysis of human resources available for the health sector based on data from the National Institute of Statistics as well as offices within the Ministry of Health
  • Developed a pivot-table based model to simulate reallocations of health sector professionals by region and by specialty going forward ten years
  • Reviewed the experience of selected East European and EU countries concerning human resource reforms in the health sector to provide the basis for indicators/benchmarks used in the model
  • Trained staff at the Ministry of Health and the National Center for Health Statistics to use the model to simulate staff early retirements, retraining programs, and increases in the number of training slots for nurses
  • Convened workshops for leaders in the provider community to gain their insight into health human resource requirements and strategies for addressing projected needs
  • Recommended short and long term planning considerations for medical and nursing schools given the projected needs of the health sector


Deloitte provided a final report with recommendations for human resource training programs and for improving the distribution of health professionals to achieve more equitable access to care and to reduce the provision of redundant services. Furthermore, Deloitte's model and capacity-building activities left the Government of Bulgaria better prepared to plan and evaluate their human resources needs in the health sector long after the project team left.

As used in this document, ‘Deloitte’ means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.

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