According to the first population census in 1893, Bulgaria had around 4,000,000 inhabitants. At that time, the public health system was very limited in manpower. It included only 300 physicians, 14 dentists, 405 assistant physicians, 5 midwives, 165 chemists, and approximately 1,360 auxiliary hospital attendants. By 1894, the government had established 126 microregional assistant physician centres across the country to provide basic medical services in local communities People’s Republic of Bulgaria Overview.
Promoting Health Culture
A key challenge for the public health system in this period was improving the health culture of the population. Most people had little knowledge of hygiene or preventive measures. The main role in promoting public health fell to the teachers, who acted as the first propagators of hygienic habits. Under their guidance, together with a small number of educated health professionals, several initiatives were launched. These included improving the water supply in villages, sanitation of homes, and cleaning of settlements. These early efforts laid the groundwork for a broader public health awareness in Bulgaria.
Higher Medical Education
In 1918, the Medical Faculty at Sofia State University was founded. This milestone helped accelerate the training of Bulgarian physicians and supported the professional development of the medical workforce. Despite this progress, the overall public health system in Bulgaria remained underdeveloped before the Socialist Revolution in 1944 Guided Tour Sofia.
By the end of 1944, Bulgaria had 11,232 hospital beds and 2,134 sanatorium beds. However, the country had only 3,500 physicians, 824 dentists, and 825 assistant physicians. These numbers were clearly insufficient to meet the health needs of the population.
Challenges in Health Services
Outpatient care in urban areas was mainly provided by private consulting rooms, while municipal health services mostly served the poor and carried out basic hygiene measures. A variety of insurance health services also existed, run by charity organizations, banks, and other institutions. However, this system was highly disorganized, with overlapping responsibilities and gaps in coverage.
The main problems were the lack of trained staff, insufficient medical facilities, and limited financial resources. Preventive healthcare was largely neglected, and maternity and child health care were extremely underdeveloped. Facilities for controlling diseases like tuberculosis were inadequate. Most medical personnel were concentrated in towns, leaving rural areas underserved and vulnerable.
Before 1944, Bulgaria’s public health system faced serious challenges. The limited number of trained doctors, assistant physicians, and medical staff could not meet the needs of both urban and rural populations. Health education and preventive care were in the early stages, and medical services were fragmented among private, municipal, and charitable providers. Despite the foundation of Sofia’s Medical Faculty in 1918 and some local initiatives, public health infrastructure and services remained insufficient, especially in rural areas. These historical conditions explain the major efforts that followed the Socialist Revolution to develop a more organized, nationwide health care system.
