| Project management: This task includes the coordination and management of administrative, legal and financial matters and providing respective support to all partners. This activity will set the organisational framework to execute the project as foreseen in the implementation plan, will assure the fulfilment of the objectives and if necessary will take corrective measures. Furthermore, the project management will take on an important role in quality assurance of project results.This task will also deal with the identification and monitoring of risks, and the implementation of contingency plans if needed.
The Project Management team will coordinate necessary activities with external stakeholders with regard to the working groups to be established in the 3rd and 4th project years (Activity 7) as well as with regard to the establishment of a common platform with other service providers and partners to work together on the qualitative and sustanable provision of integrated medico-social services and teleassistance.
The team will have the responsibility for organization of PR and visibility activities according to the Project Plan and observing the requirements of the Communication and Design Manual of the EEA and Norway Grants 2014-2021.
The Project Management team is also responsible for the proper organization of all outsourcing procedures according to the Regulation of the EEA Financial Mechanism and observing Bulgarian legislation. |
540 885.40
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536 713.06
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| Restoring the operation of the mobile teams at the four home care centres functional in Vratsa region and establishing three new home care centres in Vidin region and Montana region including mobile units: The four HC Centers in Vratsa region were established in 2012 with the support of the Swiss-Bulgarian Cooperation Programme. They are located in Oryahovo, Krivodol, Byala Slatina and Vratsa covering also patients from 13 villages within the territory of these municipalities. Each of the teams consist of 1 manager who is obligatory a nurse with the necessary qualification, 2-4 nurses depending on the specificities of each of the municipalities and the needs of the beneficiaries and 3-4 home-helpers. After the completion of the Project funded by the Swiss-Bulgarian Cooperation Programme in June 2017, the BRC has ensured the continuity of the services of the four HC Centers mobilizing other donor funds, own resources as well as financial support from the municipalities. Unfortunately, due to the uncertainty, as well as the lack of opportunity to update the salaries of the staff within this period, part of them have left and others have retired. What is important is that the BRC has managed to keep the managers of the four HC Centers and the nurses and even with this decreased number of staff to work in the same capacity paying regular home-visits to their beneficiaries.
The situation described will allow the BRC to immediately restore the activities of the four HC Centers by signing labour contracts with the available staff within the current project. Besides, the beneficiaries of the centers will receive the services they need from the very first day of the project.
Based on the model approbated in Vratsa three new Home Care Centers in Vidin and Montana Districts will be established at the beginning of the second year. One HC Center will be established in the city of Vidin which is the administrative center of Vidin District. Vidin is the greyest province of Bulgaria, with 35 % of its population being over 60 years or older at the end of 2017. There is a big difference between the percentage elderly living in urban and rural areas: in urban areas 21.1% of the population is 65 years or older while that percentage is 42.8% in rural areas.
A second HC Center in the same district will be established in the town of Belogradchik. This municipality has been defined by the BRC in the planning process of the project mainly because of the financial problems of the municipal hospital and the threat to be closed soon. Although the municipality is trying to support the functioning of the hospital with some financial resources, this will not be possible for a long time. At the current moment plenty of medical specialists have left the hospital and only very limited activities are still performed in it. Given the experience the BRC had in the previous project funded by the Swiss-Bulgarian Cooperation Program, one of the Home Care Centers in Vratsa region was established in the municipality of Oryahovo exactly at the time when their hospital was closed. Thus the provision of qualified medical care by the nurses in the HC Center alleviated to some extent the closure of the hospital. Besides, part of the nurses that lost their job in the hospital had the opportunity to continue their professional realization in the HC Center thus preventing them from leaving their home town.
The third HC Center will be established in the city of Montana which is the administrative center of Montana district. 33 % of its inhabitants are over 60 years old and almost 13 %of the population is Roma.
Another important characteristic valid for all of the three regions that was taken in mind in the planning process is the highest rate mortality for the whole country – 20.0 to 22.0 ‰. In rural areas it reaches 38.0 ‰. |
342 826.84
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660 479.99
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| Provision of home care to total 750 elderly individuals with chronic diseases and permanent disabilities in the regions of Vidin, Vratsa and Montana: The HC Centres operate from Monday to Friday from 9.00 am to 5.30 pm. They provide integrated medico-social services to beneficiaries at their homes. The center is managed by a nurse manager who is responsible for the overall organization of the care process, needs assessment, coordination of the services with other service providers and quality monitoring. Medical cares, provided by the nurses, include basic medical services such as blood pressure measurements and blood glucose checks, wound care, injections, control of medicines intake, overall health status monitoring and other medical cares prescribed by family doctors or other medical specialists. Home-helpers provide services such as maintenance of personal and home hygiene, shopping, food preparation, help with administrative procedures and other similar tasks. An important aspect of the activities of Home Care Centres is the support of patients’ capacity for self-care and independence. Nurses provide training to patients and their relatives with the objective of strengthening a patient’s potential for self-care and increasing their motivation to invest in their health. All centres implement the rotation principle of staff, i.e. beneficiaries are visited by different members of the staff. This ensures flexibility in scheduling and optimizing transportation time as each user has his/her own schedule. The average number of home-visits paid by one nurse daily is 8-10, while the home-helpers visit usually up to 5 beneficiaries daily. Medical consumables are also purchased for the needs of the HC Centers - blood pressure devices, glucometers and test bars, gloves, overshoes, disinfectants, bandages, etc.
There is a system in place to document and monitor the quality of services provided. Quality is ensured via several tools: Protocols for actions and handling of users, technical steps for actions, algorithms of actions during defined (crisis) situations, monitoring visits on behalf of the centre manager with family members and users, direct feedback from the users. Home-helpers follow protocols and their work is supervised by the nurses. The Regional Health Inspectorate monitors the safety of devices and work in all centres including disposal of hazardous waste. A software system, for the organization of the services, documentation and reporting was developed in the previous project and is applied in the work of the four centres in Vratsa region. It will also be introduced in the three new HC Centers and all members of the staff will be trained accordingly. The software helps the managers of the HC Centers to analyse and plan the service provision in a more effective way with regard to users’ health condition, the time needed for the services and the transportation time. The software program also provides important statistics for the type of services each patient receives, profile by age, most common diseases, etc. With respect to the data in the software, the information from a particular centre is not directly accessible to the other centres, but the information flows via the BRC Project team in Sofia.
The work of the managers of the HC Centers will be supported by a Chief Nurse Manager with the necessary qualification, monitoring the quality of the services and supporting them in resolving different cases from medical point of view. Periodical exchange meetings will take place among the Home Care Centres three to four times a year. In between meetings, centres will keep in touch via Skype, email and phone. Topics of discussion are primarily user situations and how to best address them.
The integrated medico-social services provided by the BRC should be clearly diferentiated from other forms of social services provision at community level. The demarcation with them is made in a separate document attached to the application form. |
5 378 185.01
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5 007 543.06
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| Establishing and equipping a pilot teleassistance call-centre: The first call-centre of this type will be established in the town of Vratsa in premises provided by the municipality free of charge for the needs of the project. It will have the capacity to provide teleassistance services for all three project regions - Vidin, Vratsa and Montana.
The implementation of this activity includes:
a) Study of the Norwegian experience with regard to the provision of teleassistance services;
b) Needs assessment on the profile of the beneficiaries of the four HC Centers functioning in Vratsa region. The assessment and the development of the model will be made jointly with experts of the Bulgarian project partners - Ministry of Health and Minsitry of Labour and Social Policy. The objective is to define what type of technology solutions would correspond most to the needs of the potential beneficiaries of the teleassistance service and on this basis to make a decision about what type of equipment to be purchased.
c) Renovation of the premises
The call-center will be established in premises provided by the municipality to the BRC free of charge for the needs of the project. The renovation will be organized by an external company following a qualfied assessment (bill of quantities) by relevant experts /architectures, engineers/ and observing of the requirements for accessibility and energy efficiency.
d) Equipment of the call center
The necessary equipment for the provision of this type of service includes:
- Equipment in the call centre:
• Computer network: multi-station network that supports the relevant software; computer equipment and screens displaying details and resources about the patient as well as the signals received.
• Software: developed specifically for the purpose of providing teleassistance services and will be purchased from an external supplier.
- Equipment in the patient’s home:
• Personal devices - depending on the needs of the beneficiaries they will be of different types - fall detectors, medication dispensers, devices to measure blood pressure, temperature, etc. They will have to be compatible with the software program installed in the call-centre.
- Ensuring of connectivity and data transmission between the personal devices and the call-center within the overall provision of the teleassistance services.
Training of all relevant staff in how to use the equipment and the software program will have to be provided by the supplier as well as technical maintenance for the overall duration of the project.
e) Training of trainers in Norway |
594 362.97
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590 159.61
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| Provision of telecare / teleassistance services to 500 individuals in the districts of Vidin, Vratsa and Montana : Teleassistance aims to provide continued contact and support to older and vulnerable people in the community, helping them to remain independent for as long as possible and delay or avoid the need for more complex interventions. The project will deploy a set of technology solutions to deliver coordinated health and social care services to the beneficiaries. These tools will integrate functionalities such as monitoring of patient status, monitoring of treatment adherence, support of healthy lifestyles, etc. These tools will be integrated in the beneeficiaries' daily life providing solutions that are at the same time secure and easy to use.
Through the provision of teleassistance services beneficiaries will be constantly monitored to ensure their health and wellbeing through a minimally intrusive alarm system which will detect the worsening of the physical condition or the occurrence of a health or life threatening situation. Depending on their specific needs, their homes will be equipped with the respective device - fall detectors, medication dispensers, devices to measure psysiological parameters , etc. The signal emitted by the personal is transmitted to the call-center via its SIM card or a transmitter. The microphone embodied in the unit detects the call for assistance, and transmits the signal to the call-centre. In the call-centre, via a specific computer system, the signal is received and a conversation can begin between the dispatcher and the patient. All the information necessary for dealing with the situation is displayed on the computer screen: medical records, doctors, contacts with relatives, etc. If a conversation is not possible, the call-centre operator will organize the most appropriate reaction according to agreed handling protocols.
The call-centre will provide 24-hour service and will maintain constant contact with all HC Centers. Depending on the exact situation to occur in beneficiaries' homes, call-centre operators may contact also other services like emergency aid, medical centres, family doctors as well as relatives.
The teleassistance will complement the services provided by the HC Centers. It will lead to optimization of home-visiting thus allowing the staff of the HC Centers to increase their capacity as well as to provide regular services to beneficiaries in remote and rural areas.
It has to be kept in mind that this type of service is not just deploying “technology” but it is rather related to achieving coordination of health and social services with the support of ICT tools. It supposes new ways of working and organizing health and social services, with the objective to provide effective patient-centred care. |
339 910.22
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316 565.46
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| Improving the qualification of the home care providers (incl.: according the forthcoming Methodology of the Ministry of Health for providing home care to elderly people and people with diseases): The BRC observes a very strict policy with regard to the qualification of the staff employed at the HC Centers. Within the project several types of trainings are planned, both for the nurses and for the home-helpers.
a) Initial training of nurses and home-helpers
An obligatory requirement for employment at the HC Centers is the successful graduation of training courses both for the nurses and for the home-helpers. The course for the home-helpers omprises 120 classes, half of them practice. Some of the main topics include: Care and assistance for the patient at home; Body care; Clothing; Care for disabled people; Safety for the patient at their home; Ethical aspects in the work of the home helper; Nutrition; Desinfection and others. The training program is licensed at the National Agency for Vocational Education and Training.
The training course for nurses comprise 160 classes, again half of them practice. The main topics include: Basic principles in help and care at home; Needs assessment; Planning of cares; Guidance and observation of home helpers; Collaboration with partners in the health sector; Ethical issues; Crisis and death at home and others.
Both training programs have been elaborated by the Bulgarian Red Cross for the needs of the home care services many years ago. As required by the donor, the trainings will be in conformity also with the Methodology for providing home care to elderly people and people with diseases that will be elaborated by the Minsitry of Health.
b) On-the-job trainings
These are practical trainings organized by external experts covering different topics arising from the practice of the Home Care Centers. These could be palliative care; care for people with dementia; wound care; kinesthetics, etc.
c) Training of the staff of the call-centre
Training of the operators to be employed at the call-centre will be performed by the company that will provide the equipment for the teleassistance service. It will include guidance on working with the software program as well as with the personal devices at the homes of the beneficiaries.
Second training for them will be organized by the team of trainers described in Activity 4 regarding protocols of reaction, coordination of activities with the HC Centers as well as with other health and social services at local level.
d) training of the staff of the HC Centers with regard to the teleassistance service.
This training will be organized by the team of trainers as described in Activity 4. Topics will include: e) Needs assessment of the beneficiaries with regard to teleassistance services; elaboration of care plans; documentation of cases; coordination between the home care services and the call-center, etc.
It has to be emphasized that home care services, especially the part of household/social services, which is performed by semi-professional staff (home-helpers) trained in the project, could serve as an employment opportunity for women/men with low educational background and having very little chances to find paid work in a region with high unemployment rate. This is especially relevant for representatives of Roma community and based on the BRC experience in Vratsa region so far we expect that about 20 % of the staff of all seven HC Centers will be Roma. The creation of employment opportunities in the health sector as part of the teams of the HC Centers could also prevent many qualified nurses to emigrate to other countries aiming to find a decent salary. |
49 695.20
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48 062.00
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| Review of the relevant legislation and development of legislative proposals and quality standards for telecare / tele-assistance services: The introduction of this type of innovative service in Bulgaria corresponds to EU policies and strategic documents trying to cope with the challenge of ageing population. The Europe 2020 strategy for a smart, sustainable and inclusive growth emphasises the need to promote active ageing policies. This type of activity is also in conformity with the WHO global strategy on integrated people-centred health services 2016-2026 as well as with European Innovation Partnership on Active and Healthy Ageing. Action Group B3: Integrated Care. The challenge of creating a new health and social care coordinated community-based model, and the use of IT tools such as teleassistance, is one of the goals on these health programs as it is of the current project.
The approbation of this service in our country aims to explore how technology and digital solutions could impact the social and health care sectors thus paving the way towards a new approach and more effective provision of services in terms of allocation of resources. The engagement of a wide range of stakeholders in the project will seek to provide a platform for future development of working practices applied in the care for older people and people with disabilities. Based on the practical experience that will be acquired, the project envisages elaboration of draft legislation proposal as well as standards that would regulate the provision of this type of services in Bulgaria for people with chronic diseases and disabilities thus enabling their development on a larger scale in the future.
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35 887.53
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28 698.87
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| Establishment of teams of volunteers to support the work of the HC Centers and the teleassistance service: Another task of the project will be to develop teams of volunteers to support the activities of the Home Care centers and the teleassistance/telecare services. This includes recruitment of volunteers, elaboration of appropriate training programs based on the Minimum Standards of the International Federation of the Red Cross and establishment of a system of communication and coordination with the staff of the centers. Volunteers will support the centers mainly with regard to household work or social support as well as in terms of preventing social exclusion of the patients. The project foresees that at least 5 volunteers in each HC Center will be trained and mobilized. |
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| Information and publicity activities, including a Communication Plan: The project will set up a comprehensive communication plan, allowing the partners to exchange information in an effective way and to reach all targeted stakeholders. This will include:
• A stakeholder mapping exercise to identify the project’s key stakeholders;
• Identification of the main messages the project would like to communicate;
• A communication plan detailing the tools and channels to be used to communicate with each stakeholder;
• A timetable for communication and dissemination activities.
The Communication plan will also take advantage of partner communication channels with the objective to reach as many as possible stakeholders.
The information and communication activities will focus on several tools:
a) webpage: it will be designed in Bulgarian and English languages and will be the main communication tool for dissemination of project information. Except for general infomation, it will highlight and promote project news, announcements, project events and will be linked to other such as Facebook and LinkedIn to create a joined-up communications environment;
b) Flyers/leaflets to present the project in Bulgarian and English languages; publications in BRC weekly newsletter distributed to a wide range of external stakeholders to share project news; Pressrelease; posters/banners for specific project events; documentation at the HC Centers and the call-centre having the logo of the EEA Financial Mechanism;
c) Social media - Facebook, Linkedin, etc. to increase the timely dissemination and potential impact of project information, facilitate information sharing and expand reach to include broader, more diverse audiences;
d) Publications (in journals, web) - include the outcomes of the project including recommendations, documents drafted during the process/evaluation of results;
e) Meetings, conferences, round tables - dissemination events will be organised as described below with the objective to increase visibility and exposure for the project gathering a wide range of national and local stakeholders;
The Project Promoter will consider the use of local and national television/radio stations and newspaper coverage of the events to ensure maximum communication of the project messages. Project partners will also support dissemination activities by actively seeking presentation opportunities at other events, in order to reach a wider audience. |
68 683.78
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64 283.87
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| Activities in cooperation with donor programme partners: The contribution of the Norwegian partner - KS will focus on three main components of the project:
A)Support for the introduction of a pilot teleassistance/telecare service covering the regions of Vratsa, Vidin and Montana;
B) Support of the work of the experts’ groups to be established in the 3rd and 4th project year with regard to elaboration of standards and draft legislation regulating the functioning and provision of teleassistance/telecare services in the area of community-based medico-social services;
For the fulfilment of these tasks KS will coordinate the process of exchange of expertise and know-how to contribute to the successful introduction of the system in Bulgaria building on the existing home care services. KS will invite the members (municipalities) and other competent Norwegian actors to participate in the implementation of the project.
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316 531.31
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314 097.88
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| Monitoring and evaluation of the project:
Periodical financial audits according to the requirements of the donor will also be performed. |
27 504.98
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20 356.00
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