The Federation of Trade Unions – Health Services (FTU-HS-CITUB) was founded 30 years ago and is Bulgaria's largest trade union federation in the healthcare sector. Throughout its existence, the federation has successfully overcome many challenges and has become an active partner whose voice is heard by governments, employers and NGOs alike. FTU-HS continues to defend the social and labour rights and interests of all healthcare sector employees – be they medical specialists (doctors, nurses, midwives) or administrative and assistance personnel. The federation works with regional councils around the country to ensure health sector workers all over Bulgaria benefit from labour protection, guarantees on the right to work, decent wages and better quality of life and social status.

The first collective bargaining agreement was signed in 1991 after FTU-HS-CITUB helped develop the collective bargaining process in the Bulgarian health sector. Since then, the federation has continued to consistently promote the cause of workers in the health sector, with adroit use of the collective bargaining mechanism.

Its most recent collective bargaining agreement (CBA) was in 2018. This included an increase of 45-50% for initial salaries in the medical sector (1,500BGN for doctors, 950BGN for nurses*), together with occupational health and safety provisions, specific social acquisitions and qualification brackets, with the aim of providing a better sense of security at work, leading to better quality healthcare.

The CBA also includes provisions for preventing all forms of discrimination and of physical or psycho-social violence in the workplace and as well guarantees in the working conditions to prevent chronic stress and physical or psychological injuries at work.

The federation has applied the collective bargaining agreement as a principal tool to defend healthcare workers' interests and labour rights when faced with difficult and controversial healthcare reform. Over the years, FTU-HS  has constantly insisted on the need for reform in the healthcare sector and for noticeable improvements in public healthcare provision in Bulgaria. As an active member of the sectoral legislative committee in Parliament, the federation frequently introduces initiatives and amendments.

However, the ongoing healthcare reform in Bulgaria, especially when compared with  development trends of healthcare systems in Western Europe, makes health workers wonder if the government aims to align the Bulgarian health service with countries with well-functioning healthcare systems or whether it is following the dictates of a "global market in social services".

Answering that question poses a serious challenge to Bulgarian society as a whole and to the political class in particular. Despite the complex political and financial environment in the healthcare sector, FTU-HS-CITUB  strives to preserve the moral dignity of the medical profession and to foster trust in the health workers' daily battle against disease.

It is the Bulgarian State - and not the patient - that ought to be indebted to the medical professionals. We must, therefore, demand rules and conditions of government that are designed to retain our medical specialists here in the country. Through their active work, FTU-HS and its members provide a counterpart to market pressures in the name of solidarity and the health and well-being of the Bulgarian people.

* Note: 1 BGN = 1,955 EUR

Bulgarian Federation of Health Workers organised a joint protest in 2018 with the Nurses’ Association against nurses’ low wages, their working conditions, increasing migration of nurses and the consequent lack of qualified nurses in hospitals, all of which have a detrimental effect on the quality of health services. The action was successful and resulted in the signature of new collective bargaining agreements and wage rises.