90084  Bulgaria   SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2013      Policy Goals Status 1. Establishing an Enabling Environment TheGovernmentofBulgariahasestablishednationallawsandregulationstoprotect  childrenandtheirfamiliesandpromotetheprovisionofhighqualityearlychildhood development(ECD)services.TheestablishmentoftheNationalCouncilforChild Protection(NCCP)showsthecommitmentofthegovernmenttoeffectivelycoordinate ECDactivitiesacrosssectors.ImprovedcoordinationandcomprehensivemultiͲsectoral ECDpolicyframeworkthatequallyaddresseducation,health,andnutrition,aswellas children’ssocialinclusion,shouldbeputinplacetomeettheholisticdevelopmental needsofyoungchildren.FinancingforECD,whileadequateinsomesectors,couldbe bettercoordinatedwithmeasurestoensuretailoredandsustainablelevelsof investment.WhilethegovernmentmandatestheprovisionofcompulsoryfreepreͲ primarypreparatoryeducationforchildren,municipalitieslackthenecessaryfiscal resourcestoprovidepreͲprimaryeducationfreeofcharge. 2. Implementing Widely BulgariahasestablishedawidescopeofECDprogramsinmostessentialsectorsofECD  addressingtheneedsofalltargetbeneficiaries.Coverageformosthealthprogramsis adequate,butprovisionofcertainessentialnutritionandpreͲprimaryinterventions couldbeexpandedtoreachallyoungchildrenandpregnantmothers.WhilethepreͲ primaryenrollmentratecontinuestoincrease,youngchildrenthatneedearly childhoodcareandeducation(ECCE)mostareexcludedfromthesystem, predominantlydisadvantagedRomachildren.Thegovernmentshouldcarefullyreview thisequitychallengethathasfargreaternegativeimpactslaterinlife.Officialdataare notavailabletocomprehensivelyassessthecoveragelevelbysocioeconomicstatusof childrenandtheirfamilies,butsurveydatashowthatpovertyͲrelatedchallengesof vulnerablefamiliesnegativelyaffectECD.ECDservicedeliveryshouldbeexpandedtoall youngchildrentoensuretheyreachtheirfullpotentialinlife. 3. Monitoring and Assuring Quality AdministrativeandsurveydataexisttodifferentiateaccesstoessentialECD  interventionsinBulgaria,buttheavailabilityofsuchdatacouldbefurtherimproved. WhilequalitystandardsandrequirementsareestablishedforECDserviceprovision, compliancemechanismscouldstillbeenforced.Developingacomprehensivechild developmenttrackingsystemacrosssectorscouldenableinclusiveandresponsive monitoringofchildren’sdevelopment.      BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  This report presents an analysis of the early childhood Bulgaria is ranked 57th in the UNDP Human development (ECD) programs and policies that affect Development Index and has a gross national income young children in Bulgaria and recommendations to of US$ 6,870 per capita (World Bank, 2012). In move forward. This report is part of a series of reports 2011, Bulgaria had 28.4 percent of its young prepared by the World Bank using the SABERͲECD population aged 0Ͳ17 years living below the national framework 1 and includes analysis of early learning, poverty line (Eurostat, 2010). Eurostat further health, nutrition, and social and child protection policies indicates that 51.8 percent of young children aged 0Ͳ and interventions in Bulgaria, along with regional and 17 years, including 49 percent of children less than 6 internationalcomparisons. years old, are at risk of poverty or social exclusion (2011). BulgariaandEarlyChildhoodDevelopment Bulgaria is an upperͲmiddleͲincome country located in The Government of Bulgaria (GoB) recognizes the Southeastern Europe. In 2007, Bulgaria became a critical importance of ECD through the range of member of the European Union (EU) and is Europe's national laws and regulations in place to promote the 14thͲlargest country with a total population of 7.3 provision of adequate early childhood interventions. million and a GDP per capita (PPP) of US$ 7,283 (2011). Responsibilitiesaresharedamongstseveralministries Bulgaria is the poorest EU member state with the and agencies, including: Ministries of Education, highestshareofpopulationinriskofpoverty.Povertyin Health, and Labour and Social Policy, as well as the Bulgaria is disproportionately concentrated in two State Agency for Child Protection. The National ethnic minority groups: Roma and Turkish minority Council for Child Protection (NCCP) has a consultative groups. According to the latest population census, the mandate to oversee the establishment and groups represent the two largest ethnic minorities in implementation of all child development policies. Yet the country. The Turkish minority comprises essential ECD services are still delivered in a approximately 590,000 citizens (or 8.8 percent of all fragmented manner, requiring improved mechanisms people who responded to the question of ethnic selfͲ for effective coordination both at the national and identification). The number of Roma population based servicedeliverylevels. on selfͲidentification is approximately 325,0002(or 4.9  percentofthecitizenswhoansweredtothequestionof The present SABERͲECD analysis is intended to ethnic belonging). But it is known from surveys that identify achievements, as well as gaps, in Bulgarian many Roma identify themselves as Bulgarians and ECD policies and programs in hopes of informing the Turks. According to the Council of Europe estimations3 improvement of the existing ECD system. Table 1 (2010), Bulgaria has up to 800,000 Roma citizens, the presents a comparison of selected ECD indicators in EU‘s largest share of Roma population – approximately BulgariaandselectEuropeancountries. 10percent. Table1:SnapshotofECDindicatorsinBulgariaandotherEuropeancountries Bulgaria Denmark France Hungary Romania InfantMortality(deathsper1,000livebirths,2011) 8.5 3 3 5 11 Below5Mortality(deathsper1,000livebirths,2011) 10 4 4 6 13 GrossPreͲprimaryEnrollmentRate(3Ͳ6years,2012) 85% 100% 100% 87% 77% Source:UNICEFCountryStatistics,2010;UNESCOInstituteforStatistics;NationalStatisticsInstitute.  1 SABERͲECDisonedomainwithintheWorldBankinitiative,SystemsApproachforBetterEducationResults(SABER),whichisdesignedtoprovidecomparableand comprehensiveassessmentsofcountrypolicies. 2 NSI,Census2011,http://censusresults.nsi.bg/Census/Reports/1/2/R7.aspx. 3 TheCommission'sCommunication,AnEUFrameworkforNationalRomaIntegrationStrategies,COM(2011)173final,5.4.2011,p15. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  2 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  SystemsApproachforBetterEducation Box1:AninitialchecklisttoconsiderhowwellECDis Results–EarlyChildhoodDevelopment promotedatthecountrylevel Whatshouldbeinplaceatthecountrylevel topromote (SABERǦECD) coordinatedandintegratedECDinterventionsforyoung SABER–ECD collects, analyzes, and disseminates childrenandtheirfamilies? comprehensive information on ECD policies around the HealthCare world. In each participating country, extensive multiͲ x Standardhealthscreeningsforpregnantwomen sectoral information is collected on ECD policies and x Skilledattendantsatdelivery programs through a desk review of available x Childhoodimmunizations government documents, data and literature, and x WellͲchildvisits interviews with a range of ECD stakeholders, including Nutrition government officials, service providers, civil society, x Breastfeedingpromotion x Saltiodization development partners, and scholars. The SABERͲECD x Ironfortification analytical framework presents a holistic and integrated EarlyLearning assessment of how the overall policy environment in a x Parenting programs (during pregnancy, after delivery, and country affects young children’s development. This throughoutearlychildhood) assessment can be used to identify how countries x Highqualitychildcareforworkingparents address the same policy challenges related to ECD, with x FreepreͲprimaryschool(preferablyatleasttwoyearswith the ultimate goal of designing effective policies for developmentally appropriate curriculum and classrooms, youngchildrenandtheirfamilies. andqualityassurancemechanisms)  SocialProtection Box 1 presents an abbreviated list of interventions and x Servicesfororphansandvulnerablechildren policies that the SABERͲECD approach looks for in x Policiestoprotectrightsofchildrenwithspecialneedsand countries when assessing the level of ECD policy promotetheirparticipation/accesstoECDservices development.Thislist isnotexhaustive,but is meant to x AppropriatehousingconditionsforqualityECDprovision provide an initial checklist for countries to consider the x Financialtransfermechanismsorincomesupportstoreach keypoliciesandinterventionsneededacrosssectors. the most vulnerable families (could include cash transfers, socialwelfare,etc.) Š”‡‡‡›‘Ž‹…› ‘ƒŽ•ˆ‘”ƒ”Ž›Š‹Ž†Š‘‘† ChildProtection ‡˜‡Ž‘’‡– x Mandatedbirthregistration x Jobprotectionandbreastfeedingbreaksfornewmothers SABERͲECD identifies three core policy goals that x Specificprovisionsinjudicialsystemforyoungchildren countries should address to ensure optimal ECD x Guaranteedpaidparentalleaveofleastsixmonths outcomes: Establishing an Enabling Environment, x Domesticviolencelawsandenforcement Implementing Widely, and Monitoring and Assuring x Trackingofchildabuse(especiallyforyoungchildren) Quality.ImprovingECDrequiresanintegratedapproach x Training for law enforcement officers in regards to the to address all three goals. As described in Figure 1, for particularneedsofyoungchildren each policy goal, a series of policy levers are identified, Figure1:ThreecoreECDpolicygoals through which decisionͲmakers can strengthen ECD. Strengthening ECD policies can be viewed as a continuum; as described in Table 2 on the following page, countries can range from a latent to advanced level of development within the different policy levers andgoals.     SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  3 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Table2:ECDpolicygoalsandlevelsofdevelopment LevelofDevelopment ECDPolicy Goal  NonͲexistentlegal Minimallegalframework; Regulationsinsome Developedlegalframework; Establishingan framework;adͲhoc someprogramswith sectors;functioninginterͲ robustinterͲinstitutional Enabling financing;lowinterͲsectoral sustainedfinancing;some sectoralcoordination; coordination;sustained Environment coordination. interͲsectoralcoordination. sustainedfinancing. financing. Coverageexpandingbut Universalcoverage; Lowcoverage;pilot NearͲuniversalcoveragein gapsremain;programs comprehensivestrategies Implementingprogramsinsomesectors; somesectors;established establishedinafewsectors; acrosssectors;integrated Widely highinequalityinaccess programsinmostsectors; inequalityinaccessand servicesforall,some andoutcomes. lowinequalityinaccess. outcomes. tailoredandtargeted. Informationonoutcomesat Informationonoutcomes Informationonoutcomesat national,regionalandlocal Minimalsurveydata fromnationaltoindividual Monitoring nationallevel;standardsfor levels;standardsfor available;limitedstandards levels;standardsexistforall andAssuring servicesexistinsome servicesexistformost forprovisionofECD sectors;systeminplaceto Quality sectors;nosystemto sectors;systeminplaceto services;noenforcement. regularlymonitorand monitorcompliance. regularlymonitor enforcecompliance. compliance.      Policy Goal 1: Establishing an Enabling sector.TheActfurthermandatestheprovisionofatwoͲ year compulsory free preͲprimary preparatory Environment educationforchildrenof5Ͳ7yearsofageinpreparation ¾PolicyLevers:LegalFramework• forformalschooling. InterǦsectoralCoordination•Finance The scope of this law includes not only early learning An Enabling Environment is the foundation for the opportunities for young children, but also health and design and implementation of effective ECD policies.4 protection of children. The Act commits to create An enabling environment consists of the following: the conditions for proper physical and mental development existence of an adequate legal and regulatory of young children. According to the Health Act (2005), framework to support ECD; coordination within sectors the state and the municipalities work in close andacrossinstitutionstodeliverserviceseffectively;and collaboration with the Ministry of Health (MoH) to sufficient fiscal resources with transparent and efficient create conditions for healthy living environment and allocationmechanisms. normal physical and psychic development of children. Medical specialists and others implement Policy Lever 1.1: complementary services to support the upbringing, LegalFramework stimulation, education, and healthy feeding of young The legal framework comprises all of the laws and childrenupto3yearsofage. regulations which can affect the development of young childreninacountry.Thelawsandregulationsthatimpact PreͲprimary education in Bulgaria caters to children ECDarediverseduetothearrayofsectorsinfluencingECD aged3Ͳ7andisprovidedinstate,municipal,andprivate andbecauseofthedifferentconstituenciesthatECDpolicy kindergartens. PreͲprimary education aims to 1) can and should target, including pregnant women, young develop children’s skills and motivation to learn, 2) children,parents,andcaregivers. ensureasmoothtransitionintotheprimaryeducational process, and 3) prepare them for lifelong learning by National laws and regulations in Bulgaria promote developingtheirfullpotential. equitable preschool education. The Public Education Act (1991) registers preͲprimary education as the first For children up to 3 years of age, dayͲcare nursery levelofpreparatoryeducation.Earlychildhoodcareand services are provided. The purpose of this education (ECCE) services are provided by the public establishmentistosupportfamiliesinbringinguptheir  4 Brinkerhoff,2009;Britto,Yoshikawa&Boller,2011;VargasͲBaron,2005. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  4 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  children and ensure a healthy living environment for Under the National Framework Agreement (NFA) for young children’s physical and mental development. It is Medical Services (2012) and the related legislation, 7 regulated that the dayͲcare nursery provides organized health services8for pregnant women, women in childͲ educational services through a comprehensive regime birth,andchildrenareguaranteed.Uninsuredexpecting and activities defined according to the specific age of mothers, particularly from vulnerable groups, also thechildren.However,nurseriesarenotpartofthepreͲ benefit from guaranteed minimum prenatal visits and primary education system in Bulgaria. They are skilled delivery in accordance with Ordinance ζ 26 regulated by the MoH and the services are provided by (2007). The standard health screenings for HIV and medical professionals like nurses. Nursery groups may sexually transmitted diseases (STDs) for pregnant existinkindergartens. women are free, and standard followͲup and referral procedures are provided. In accordance to Article 87 of The government endeavors to ensure access to the Health Act (2005), medical activities are performed education and improve the quality of education for only after informed consent from the patient. A young children and pupils from vulnerable ethnic pregnant woman who refuses an HIV test is constantly communities. The strategy adopted to reduce the share offeredtheopportunityfortesting. of early school leavers (2013Ͳ2020) states that kindergartens and schools should implement policies to Under the framework of activities guaranteed by the overcome separation by ethnicity of children and pupils NHIF budget, other key health services provided free of in groups and classes, provide orientation training to charge to young children and pregnant women include: facilitate work in a multicultural group and class, while growth monitoring and promotion; diarrhea treatment; improving intercultural competence of all stakeholders upper respiratory tract infection treatment; antibiotic intheeducationservicedeliverychain. treatment for pneumonia; 9 treatment to prevent motherͲtoͲchild transmission of HIV/AIDS; antiͲ National laws and regulations in Bulgaria promote retroviral treatment for HIV/AIDS; and tuberculosis health care for young children and pregnant women. treatment. The Health Act (2005) guarantees the provision of free public health services for young children and pregnant National laws and regulations promote dietary women. In addition, Ordinance ζ 40 determines the consumption by pregnant women and young children, basic package of health services guaranteed by the but this effort could be further improved. Bulgaria NationalHealthInsuranceFund(NHIF).Ordinanceζ38 does not fully comply with the International Code of further specifies the list of diseases for home treatment Marketing of Breast Milk Substitutes – an international of which the NHIF pays drugs, medical devices, and health policy framework for breastfeeding promotion dietary foods for special medical purposes wholly or adopted by the World Health Organization (WHO) – partially. Under the Ordinance for Immunizations in which serves as a minimum requirement for all Bulgaria (Ordinance ζ 15, 2005), young children are countries to protect infants and young children. The required to receive a complete course of Code aims to ensure that parents receive evidenceͲ immunizations.5Similarly, Ordinance ζ 39 (2004) for based information and regulates the marketing of preventive examinations and dispensary activities breast milk substitutes and feeding supplies. On the regulatestheconductofregular6checkͲupsforchildren. basis of this international code, the government has The ordinance regulates also the type and frequency of adopted the Global Strategy for Infant and Young Child the preventive checkͲups for pregnant women for Feeding and the related Ten Steps to Successful normal course of pregnancy and for atͲrisk pregnancy. Breastfeeding, based on the UNICEF/WHO BabyͲ Referral systems are in place to direct young children Friendly Hospital Initiative (BFHI). Nutrition activities andparentstoadditionalservicesasnecessary.   7 Ordinanceζ 39 for preventive examinations and dispensary activities and 5 The Expanded Program on Immunization (EPI) complete course of Ordinanceζ40forbasicpackageofhealthservices. 8 immunizations targets nine vaccineͲpreventable diseases: tuberculosis, The NFA provides health services for hospital and out of hospital care, diphtheria, pertussis, tetanus, poliomyelitis, measles, hepatitis B, including preventive examinations, dispensary activities, laboratory Haemophilusinfluenzatypeb,andyellowfever. examinations and consultancy in the specialist outpatient care, hospital care 6 Ordinanceζ39(2004)requiresperiodicwellͲchildvisitsinaccordancewith where hospitalization is needed, medicines for home treatment for children a wellͲestablished visit plan as follows: one visit within the first 24 hours of with chronic diseases, Children’s Health Program, Maternal Health Program, discharge from the maternity hospital, monthly preventive checkͲups during andNationalProgramFundforChildTreatment. 9 thefirstyear,fourtimesayear(everythreemonths)duringthesecondyear, Health services for diarrhea treatment, upper respiratory tract infection twice a year (every six months) for children aged 2Ͳ7 years, and once a year treatment,andantibiotictreatment forpneumoniaareonlyprovidedfreeof forchildren7Ͳ18yearsold. chargeifhospitalizationisneeded. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  5 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  targeting breastfeedingsupportand promotionare part with a monthly cash benefit determined by the Law on ofthehealthactivitiesperformedbythemedicalstaffin theBudgetoftheStateSocialSecurity. maternal wards and general practices. Yet formula is Fathersarealsoguaranteedpaidpaternityleave.Article still used widely to support mothers in the maternity 50 of the Social Security Code stipulates that fathers, hospital. includingadoptingfathers,areentitledtoacashbenefit The MoH has recognized the need for increased for their childbirth and for 410 calendar days after the emphasis on optimal infant and young child feeding child turns 6 months old. The financing compensation practices. TheGoB hasestablished the NationalPlanfor amountisdeterminedinaccordancewithArticle48and Food and Nutrition 2005Ͳ2010 to lead activities 49ofthesamecode. promoting breastfeeding practices and effective The GoB encourages feeding practices in ECCE centers. nutrition interventions in the country. While the As a result of surveys held in Bulgaria in the last 10 National Plan focuses on breastfeeding promotion, years, national programs for healthy nutrition practices followed by the creation of the National Breastfeeding were introduced by law. In 2011, the GoB adopted Committee, breast milk substitutes and formula are Ordinanceζ 6 to promote healthy nutrition of children widely promoted in the maternity hospitals, general aged 3 to 7 years in child care centers. The Ordinance is practices, and by pediatricians. The National targetedtowardschildrenattendingorganizedchildren’s Breastfeeding Committee closely collaborates with groups; municipal, state, and private institutions; and UNICEF to continue to promote the Baby Friendly preparatory preschools. The policy is currently under Hospitals Initiative. The next phase of the National Plan implementation, closely monitored by the regional for Food and Nutrition (2011Ͳ2016) was not launched structures of the MoH and the NCPHA. Most recently due to lack of resources. In 2013, a National Program the government adopted similar Ordinanceζ 2 (2013) for Prevention of Chronic NonͲcommunicable Diseases for healthy nutrition of children aged from 0 to 3 years (2014Ͳ2020) was adopted by Decision of the Council of inchildcarecentersandchildren'skitchens. Ministers ζ 538, which included breastfeeding promotion activities. Under the Decree for Salt Bulgaria has ratified the ILO Maternity Protection Iodization (1994), the GoB mandates iodization of salt Convention. The Labor Code includes special protection for human consumption. Regulations are not yet in for women, and more specifically for pregnant and new place to encourage iron fortification of food staples in mothers. The Code requires employers to provide Bulgaria. Although there have been preliminary breaks for nursing mothers (Article 166) and discussions based on dialogue with world producers of appropriate facilities for breastfeeding (Article 308) in iron fortification staples, policies have not been cases where more than 20 women are hired in the established. respective entity. In addition, the Code protects against discriminatorydismissalofpregnantwomen(Article328 Policies guarantee job protection for pregnant women and330); employersarerequired togiveemployeesthe and opportunities for new parents to care for infants samejobwhentheyreturnfrommaternityleave(Article in their early years of life. The Social Security Code 309). (2000) guarantees 48 weeks of maternity leave for biological or adopting mothers. Compensation for Table 3 provides a sample of leave policies from other pregnancy and childbirth (Article 49) include: daily cash Eastern European countries. Compared to Bulgaria and benefitat90percentofaveragedailygrosssalaryorthe other countriesintheregion,highperforming countries average daily income. The Code further guarantees like Sweden, offer greater protection for parental leave support for selfͲemployed mothers, and contributions and focus on enhanced economic and social planning. include financial assistance provided for sickness and Sweden’s approach, detailed in Box 2, is an advanced, maternity leave for the period of 18 calendar months flexiblepolicytoensureadequatecareofthechild. preceding the month of occurrence of temporary disability due to pregnancy and childbirth. Leave is paid by the employer and the National Social Security Institute. In addition, supplementary paid leave is provided after the expiration of the benefit for pregnancy and childbirth (Article 53 of the Social Security Code): childͲraising mothers are compensated SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  6 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Table 3: Comparison of maternity and paternity leave Acts of Civil Status. The Register of Population contains policiesinselectedcountriesinEasternEurope information about every person – name, registration United number, address, civil status data, and information Bulgaria Russia Sweden Kingdom about close relatives. The Register of Acts of Civil Status 48weeks contains information about birth, marriage, and death 140daysbirthand maternity,at 480days(60days 90percentof pregnancyleaveat exclusivelyfor 273days(30 of the population. The Act states that official 100percentwage; daysat90 representatives of medical entities (maternity ward, or wage,paidby motherand60 parentalleaveupto percentwage, theemployer 36months(40 daysforfather, remainderat state official in case the delivery was not in a health andthe remainder percentofwageuntil fixedrate);14 establishment) are required to report a child’s birth in government. discretionary)at 18monthsofage, dayspaternity writingwithinfivedaystolocalregistrars. Limitedpaid 80percentof fixedamountfor leave paternity wage leave. remaining18months) The Civil Registration policy is implemented at local level by a specialized department in the municipality to Source:SABERͲECDPolicyInstrument;ILO,2012. maintain a Unified System for Civil Registration and Administrative Service of the Population (USCRASP, Box2:RelevantlessonsfromSweden:TheSwedish Article 100 of the Civil Registration Act) – a national ParentalInsuranceBenefit system for civil registration of individuals living in Summary: The Swedish Parental Insurance Benefit is Bulgaria. Every maternity ward maintains an the international exemplar for parental leave policy. information system containing data on each delivery Parental insurance in Sweden is designed to benefit and the actual distribution of newborns by regions both men and women. In total, the leave includes 480 throughout the country in accordance with Ordinance daysofpaidleave,60daysofwhichareearmarkedfor 32 (2008). The information system is maintained by the the mother, 60 days for the father, and the remainder MoH. While the government’s efforts to promote the to be divided as the couple chooses. It commences up registrationofnewbornsarecommendable,itshouldbe to seven weeks prior to the expected birth, and also is noted that there is yet not an effective policy available for parents adopting a child. The established for the registration of children born outside compensation rate can vary; as a minimum, however, 80percentoftheemployee’ssalaryisprovidedduring maternityhospitals. leave. In addition, each parent is legally entitled to The GoB promotes the reduction of family violence take unpaid leave until a child is 18 months old. across relevant sectors. Bulgaria’s Law on Protection Additional benefits include: temporary parental leave, from Domestic Violence (2009) and the Child Protection which entitles a parent to 120 days of parental leave Act (2000) guarantee young children’s protection from annually to care for children under the age of 12 with illness or delay (child requires a doctor’s certificate); a anyactofviolence.Article11oftheChildProtectionAct pregnancy benefit, payable for a maximum of 50 days defines violence as any act of physical, psychological, or toexpectantmotherswhoareunabletoworkbecause sexualabuse,neglect,commercial,orotherexploitation of the physically demanding nature of their jobs; and, atfamily,school,orsocialenvironment,whichharmsor pension rights for child care years, which partially brings potential harm to the child’s health, life, and compensate the loss of future income during the development.TheStateAgencyforChildProtection,the periodwhentheparentisathomewiththechild. government entity primarily responsible for Bulgaria’s KeyconsiderationsforBulgaria: child protection system, has established a range of 9 Mandatedparentalleaveforfathers national programs and services to prevent violence 9 Improvedadequateandsustainablefinancial against young children (discussed in detail under the supporttosupportfamiliesduringearlystageof Policy Goal 2 section). Every year, funds are allocated child’slife from the state budget through the Ministry of Justice 9 Additionalbenefitsforfamilieswithchildrenwho (MoJ) in order to finance projects for the development havespecialneeds and implementation of violence prevention activities. In addition, several key interventions are in place to Child protection policies and services, including birth protect children, including training for professionals of registration and protection from violence, are the justice system (judges, lawyers, and law establishedinBulgaria.TheCivilRegistrationAct(1999) enforcementofficers)onchildren’srights. requires that each municipality maintains two sets of register: (i) Register of Population, and (ii) Register of SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  7 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Policies are established in Bulgaria to enable the childhood programs. One of the major expected provision of specialized services for disadvantaged outcomes of the project is to improve the school young children. The GoB has established Ordinanceζ readiness of vulnerable children from low income 1 (2009) under the Public Education Act to meet the familiesandchildrenwithdisabilities. needsofchildrenwithspecialeducationalneedsand/or As a part of the government’s ongoing efforts to with chronic diseases. Special needs are defined as ensuring quality care and development services for its various disabilities – sensory, physical, and mental; youngest citizens, the government adopted a national multiple disabilities; speechͲlanguage disorders; and strategy entitled “Vision for deinstitutionalization of learning difficulties. A range of programs and services children in Bulgaria" (2010Ͳ2025). The strategy aims at are established to meet the special needs of some creating new opportunities for family support and vulnerable children but adequate services are still not communityͲbased services, and providing support for providedtoallchildreninneed. the establishment of ECD programs and services. As The National Child Strategy (2008Ͳ2018), the Public described in Article 36 of the regulation on the Education Act (1991), and the Law on Integration of implementation of the Social Assistance Act, the People with Disabilities (Ordinanceζ 1, 2009) promote strategy aims at promoting the following types of inclusive education for children with disabilities. The communityͲbased social services and specialized MoE has the mandate to create learning opportunities institutions that can be used by children and their for children who have special educational needs who families:familytypeaccommodationcenter/smallgroup are not integrated into the mainstream preͲprimary homes; "mother and baby” unit; shelters for homeless educationsystem.Baseduponanassessmentofachild, children; transitional home; temporary placement families are offered with possible education services center;andobservedhouse.According todatafrom the targeting children with special needs. Special education Third Monitoring Report of the National Strategy (July servicescouldbeprovidedinspecialenvironmentssuch 2012–June 2013), 35 new communityͲbased services as special kindergartens, special schools, or special targeting vulnerable children were established between health kindergartens for children with chronic disease June 2012 and June 2013.The report further indicates only after opportunities for inclusive education are that the GoB is facing challenges in effectively mainstreamed.An expert committeeofthe MoEshould implementingtheDeͲinstitutionalizationStrategy. approve every case of a child’s enrollment in special environment. Article 36 of the Social Assistance Act promotes the socialinclusionofchildrenwithdisabilities.CommunityͲ basedservicesincludingsocialrehabilitationandspecial day care centers are established to integrate children with disabilities. These centers are expected to provide arangeofcomplexsocialservices–rehabilitation,social and legal counseling, educational and vocational training and guidance, preparation and implementation of individual programs for social inclusion, and other services. According to independent monitoring reports, access and coverage of such services are insufficient. In most cases, children whose families live outside the administrative center have to travel to the municipal centers where most of the service providers are located. Furthermore, there is a lack of system to ensureadequatequalityofserviceprovisionindifferent regions. A social inclusion project10is currently under implementation – aiming to prevent social exclusion and reduce child poverty through investments in early  10 TheMinistryofLabourandSocialPolicyisthemanagingauthorityofthe project,underaspecialagreementbetweentheWorldBankandtheGoB. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  8 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Box3:KeyLawsandRegulationsGoverningECDin relevant government institutions engaged in policy Bulgaria making do not yet fully recognize the concept of the ‡›ƒ™• ‘˜‡”‹‰‹—Ž‰ƒ”‹ƒ needforacomprehensiveandintegratedECDsystem.It x PublicEducationAct(1991) is also reported that there is currently no unified x HealthAct(2005) understanding of what ECD entails and what effective x CivilRegistrationAct(1999) strategiesshouldbeputinplacetoensuretheprovision x ChildProtectionAct(2000) of integrated ECD services to enable all young children x HealthInsuranceAct(1999) develop to their full potential. Although various x SocialSecurityCode(2000) ministries and institutions provide a range of services x LaborCode(1987) targeting young children’s development, the approach x LawonProtectionfromDomesticViolence(2009) is rather fragmented. As described in earlier section, several laws and regulations have been developed –Š‡”‡‰—Žƒ–‹‘•”‘–‡…–‹‰‘‡ƬŠ‹Ž†”‡ including: the Health Act, the Public Education Act, the x LawonIntegrationofPeoplewithDisabilities(2005) Law on Child Protection, among others. The current x SocialAssistanceAct(1999) legal framework for ECD is not specifically tailored to x Nationalstrategy–“Visionfordeinstitutionalization ECD aged children, but rather to the age group 0 to 18 ofchildreninBulgaria"(2010Ͳ2025) years. x FamilyAllowancesAct(2002) A National Child Strategy (2008Ͳ2018) was developed in x NationalChildStrategy(2008Ͳ2018) consultation with the various ECD stakeholders. –‡”ƒ–‹‘ƒŽ‘˜‡–‹‘•‘‘‡ƬŠ‹Ž†”‡ Although the strategy refers to children 0Ͳ7 years of x TheUNConventionontheRightsoftheChild(1989) age, the strategy does not address the specific ECD x TheUNConventionfortheProtectionofHuman activities related to this critical period of a child’s RightsandFundamentalFreedoms(1950) development. As part of the GoB’s efforts to improve x ILOMaternityProtectionConvention(2002) the ECD system in Bulgaria, the Government is highly x TheUNProtocolontheSaleofChildrenandChild encouragedtoreviewtheongoingnationalstrategyand ProstitutionandonInvolvementofChildrenin develop an explicitly stated comprehensive multiͲ ArmedConflict(2002) sectoral ECD policy, complemented by a costed x TheILO182ndConventiononChildLabor(1999) implementation plan. Box 5 provides relevant examples x TheHagueConventiononInterͲCountryAdoption from Chile on the benefits of multiͲsectoral design and (2008) implementationofECDpolicy.   ECD policy development could be better coordinated PolicyLever1.2: toensuretheestablishmentofacomprehensivepolicy InterǦsectoralCoordination and improved coordination amongst the relevant government entities. The central government is Development in early childhood is a multiͲdimensional responsible to create all the necessary conditions for process. 11 In order to meet children’s diverse needs the protection of the rights of children. Child during the early years, government coordination is development policies are developed at the national essential, both horizontally across different sectors as level by different ministries and agencies, including: the well as vertically from the local to national levels. In StateAgencyforChildProtection,theMinistryofLabour many countries, nonͲstate actors (either domestic or and Social Policy (MLSP), the Ministry of Education and international)participateinECDservicedelivery;forthis Science (MoES), and the MoH. Several initiatives have reason,mechanismstocoordinatewithnonͲstateactors been undertaken to consolidate the various efforts arealsoessential. madeinECDpolicydesign.In2012,theStateAgencyfor The GoB has not yet developed an explicitly stated ChildProtectionproposedanewChildLawwiththeaim comprehensive multiͲsectoral ECD strategy. A child’s to consolidate the legislation around young children in development requires a safe, stimulating environment, Bulgaria. The proposed new law was developed and withaccesstoamultitudeofinterventionsineducation, presented by an interagency working group chaired by health, nutrition, and social and child protection that the Minister of Labour and Social Policy and with the are delivered at different stages of development. The participation of all ECD stakeholders – relevant  ministries, agencies, the National Association of 11 Naudeauetal.,2011;UNESCOͲOREALC,2004;Neuman,2007. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  9 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Municipalities,andalargenumberofnonͲgovernmental Figure2,theNCCPisdesignedwithrepresentationfrom organizations. Its approval and consideration in all relevant sectors. However, the latter has mainly parliament were delayed due to the dissatisfaction of consultative functions and coordination mechanisms parents and community organizations on its content. withstakeholdersarenotclearlyestablished. Similarly, the MLSP has included initiatives for ECD The GoB is encouraged to further improve the ECD policy for social inclusion. Most recently, in 2013, the coordination mechanisms and strengthen the role of MoES proposed a draft law to regulate the provision of the NCCP to serve as a national crossͲsectoral ECD compulsorypreͲprimaryeducationstartingintheschool institutional anchor to streamline ECD activities across yearforchildrenoftheageof4years. relevantsectors. While the various efforts by the responsible bodies are Box 4 presents valuable examples from Australia on a highly commendable, the design of ECD policy could be participatory approach to achieve universal preͲprimary improved through enhanced coordination amongst the educationanddevelopECDstrategy. different ECD stakeholders and the development of one holistic multiͲsectoral ECD policy to cater the Box4:RelevantlessonsfromAustralia:participatory comprehensive developmental needs of all young approachtoachieveuniversalpreͲprimaryeducation childreninBulgaria. anddevelopECDstrategy. The National Council for Child Protection (NCCP) is an Summary: Early childhood development is embedded in ECD consultative body serving as an institutional a strong legal framework in Australia. The Council of anchor; however, improved crossͲsectoral Australian Governments (COAG) created the National collaboration platforms need to be established to Partnership Agreement on Early Childhood Education, effectively coordinate ECD interventions across which commits the Commonwealth and State and sectors. The GoB has not yet established a crossͲ Territory Governments to ensure that all children have sectoral institutional anchor to coordinate ECD access to a quality early childhood education programin activities, nor does a specialized ECD department, the year preceding formal schooling by 2013. The program is required to be delivered by a fourͲyear ministry, or agency exist yet. The State Agency for Child universityͲtrained early childhood teacher and be Protection is the responsible body for developing provided for a minimum of 15 hours a week, 40 weeks mainly child protection policies. It assists the relevant peryear. ministries, together with the European Union (EU), in the formulation and implementation of child protection Developed under the auspices of the COAG in 2009, Investing in the Early Years – A National Early Childhood policies, including: health, education and science, Development Strategy is a joint effort to ensure that by justice, foreign affairs, culture, and finance. In addition, 2020 all children have the best start in life to create a the Chairperson of the Agency works jointly with the betterfutureforthemandforthenation.Thestrategyis Governor of the National Insurance Institute, the a comprehensive approach to ECD that focuses on a Secretary of the Central Commission for combating child’s life cycle, across the four interrelated dimensions juveniledelinquencyofminors,theCouncilofMinisters, ofECD,fromtheprenatalperiodtoage8. and the National Association of Municipalities of the An important factor for emphasis in Australia’s Republic of Bulgaria to establish state policies on child establishment of a comprehensive ECD system has been protection. These ongoing collaboration efforts the effective participation, cooperation and policy reiterate the inevitable needs for greater collaboration development across all levels of government. The between relevant sectors for improved design and strategy acknowledges that families, community, implementation of holistic ECD policies. The State organizations,workplace,andgovernmentallplaycritical Agency for Child Protection has further established a roles in shaping children’s development, and thus multiͲsectoral consultative body – the NCCP – leading requires an effective ECD system with sufficient capacity the establishment and implementation of any early andstakeholdersynergy. childhood related policies. Operating under the State  Agency for Child Protection, the NCCP is responsible for  the formulation, planning, and implementation of any  possible joint activities and policy actions that could arisefromtheEUpartnershipinitiatives.Asdisplayedin   SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  10 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Mechanisms are in place for collaboration with nonͲ further expand the existing communityͲbased social state stakeholders. As displayed in Figure 2, services – such as the Foster Care Programs – for representatives from 12 nonͲstate ECD service placement of young children who cannot be providers have guaranteed seats at the NCCP on a reintegrated in their families. The National Children’s rotational basis. The NCCP holds biannual coordination Strategy (2008Ͳ2018) puts forth measures and actions meetings involving all members of the national council for improving children’s welfare in Bulgaria. It sets out a and the existing three working groups – “Coordination number of key areas in which actions should be taken, of Activities and Policies," “Prevention of Violence and including: family environment, living standards and Abuse of Children," and "Improvement of Care and social support, alternative services, health care and Services for Children and Families." The working groups nutrition, education, leisure and development of skills, meet on a more regular basis. In addition, activity and child participation. The Strategy recommends the feedback hotlines are established for nonͲstate adoption of standards for ECD and requires the providers (including phone or email communication). adoption of measures for the prevention of child Every year, nonͲstate service providers are required to abandonment, as well as ensuring provision of submit a report capturing the activities carried out to appropriate communityͲbased social services. Another populateimplementationdata. key document worth noting is the new draft of the Child’s Law (2011). This law is still in the process of ECDgoalshavebeenestablishedinallrelevantsectors; public debate, but is expected to bring a considerable howeveranintegratedcommonplanofactionisyetto improvement to the existing Child Protection Law and be established. Each sector has put forth its own will assist with the implementation of the deͲ specific ECD goals. In the education sector, in the institutionalization process. The law specifically 2010/2011 school year a compulsory twoͲyear stipulatestheprovisionofearlyinterventionservicesfor preparation before entering first grade was introduced children with disabilities. It also legislates against for 5ͲyearͲold children. According to Article 20 of the abandonmentofchildrenandtheplacementofchildren Public Education Act (2010) preschool preparation of 0Ͳ3inspecializedinstitutions. children two years before they enter into first grade is mandatory, but not earlier than the year in which the While the efforts of the different sectors in establishing child turns 5 years old. Its introduction aims to provide sectoral ECD goals are commendable, the GoB should a fair start for every child, contributing to the developanintegratedECD policyanda commonplan of development of skills required for entry into the first action to effectively respond to the comprehensive grade of primary school. This measure is a preventive needs of young children. The National Child’s Strategy step to decrease the number of children not reached could serve as a basis to take further actions in this and early school leavers. The implementation of the area. measure will help to achieve the national goal of  reducing the share of early school leavers to under 11 Figure 2: Composition of the National Council for Child percent by 2020. In addition, the MoES is a leading Protection institution in the “priority education” initiative ensuring equal access to education through the implementation of measures of the National Strategy for Roma Integration in the Republic of Bulgaria (2012Ͳ2020). In the child and social protection sector, the recently adopted National Strategy "Vision for deinstitutionalization of children in Bulgaria" (2010) mainly focuses on preventing child abandonment and  supporting families in raising their children in a childͲ friendly, family environment. An ordinance has been adopted for the terms and conditions for implementation of measures to prevent abandonment and placement of children in institutions and for their reintegration. Based on a needs assessment, an action plan has been developed to SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  11 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Box5:TheChileanexperience:benefitsofmultiͲsectoral PolicyLever1.3: policydesignandimplementation Finance Summary: A multiͲsectoral ECD policy is a comprehensive While legal frameworks and interͲsectoral coordination document that articulates the services provided to children are crucial to establishing an enabling environment for and key stakeholders involved, including responsibilities of ECD,adequatefinancialinvestmentiskeytoensurethat service providers and policy makers. The policy should also resources are available to implement policies and present the legal and regulatory framework in a country and achieve service provision goals. Investments in ECD can address any possible gaps. Typically, a policy can include a yield high public returns, but are often undersupplied set of goals or objectives and an implementation plan that outlines how they will be achieved. The benefits of doing so without government support. Investments during the are manifold. The preparation process requires all early years can yield greater returns than equivalent stakeholders to contribute, which in turn promotes a more investments made later in a child’s life cycle and can holistic, synergetic approach to ECD and identifies possible lead to longͲlasting intergenerational benefits. 12 Not duplication of objectives by individual stakeholders. Another onlydoinvestmentsinECDgeneratehighandpersistent benefit is that the policy framework clarifies the boundaries returns,theycanalsoenhancetheeffectivenessofother within which all stakeholders are to operate and can create social investments and help governments address accountabilitymechanisms. multipleprioritieswithsingleinvestments. One such example is Chile Crece Contigo (“Chile Grows With In all relevant sectors, explicit criteria are used to You,” CCC), an interͲsectoral policy introduced in 2005. The allocate ECD funding. In the education sector, multidisciplinary approach is designed to achieve high quality ECD by protecting children from conception with allocation is based on specific criteria, including the relevant and timely services that provide opportunities for number of children enrolled, attendance level, number early stimulation and development. A core element of the of staff positions, and geographical location, as well as system is that it provides differentiated support and children’s characteristics, such as gender, guarantees children from the poorest 40 percent of socioeconomic status, and special needs. Similarly, in householdskeyservices,includingfreeaccesstopreͲprimary the health sector, allocation of health funding for early school.Furthermore,theCCCmandatesprovisionofservices childhood is based on criteria, including the number of for orphans and vulnerable children and children with childrenatthesubͲnationallevel,geographicallocation, special needs. The creation and implementation of the CCC usage, and children’s characteristics. In the nutrition has been accomplished through a multiͲsectoral, highly and child and social protection sectors, a similar set of synergistic approach at all levels of government. At the central level, the Presidential Council is responsible for the criteria are used to allocate funding, including the development, planning, and budgeting of the program. At numberofchildrencoveredinthesubͲregion,children’s each of the national, regional, provincial, and local levels, characteristics,andhistoricalprecedent. there are institutional bodies tasked with supervision and National laws and regulations have not established a support, operative action, as well as development, planning, minimum level of public funding for ECD services and budgeting for each respective level. The Chile Crece ContigoLaw(ζ20.379)wascreatedin2009. across sectors. The planning and determination of budget for ECD activities are not coordinated across KeyconsiderationsforBulgaria: sectors. There is no separate budget for ECD and 9 Highly synergetic approach to service delivery, financing for ECD services takes place in a fragmented focusing on multiͲsectoral nature of children’s waywithineachofthesectors,underthesupervisionof needs: Given the multidimensional nature of national ministries and agencies. Currently, there is no children’s development needs, a cohesive approach officialpolicyinstitutingsomelevelofminimumfunding in ECD service delivery is highly beneficial. It is for ECD services to ensure sustainable investments of important to establish a scheme for comprehensive ECD in Bulgaria. Every year, the Council of Ministers ECD services that should be delivered to all young determines the basic standards and financing for public children, leveraging the respective competencies of each sector with a focus on achieving holistic child services according to the Law on Annual National development. Budget based on the types of services provided. Bulgaria could learn valuable lessons from OECD 9 Guaranteed support to the poorest, most in need countries, such as Australia, which ensure sustainable childrenandtheirfamilies.   12 Valerio&Garcia,2012;WHO,2005;Hanushek&Kimko,2000;Hanushek& Luque,2003. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  12 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  ECD financing with a more streamlined system. Box 6  explains Australia’s system to ensure sustainable Table4:Regionalcomparisonofselecteducation financingforECD.13 expenditureindicators,2010  Bulgaria Denmark France Hungary Romania Box6:RelevantlessonsfromAustralia:sustainable Shareofpublic financialinvestmentsinECD education 11.5% 11.7% 9.6% 22% 14.6% expenditureon (2009) (2009) (2009) Summary: In 2008, through the Council of Australian preͲprimary Governments, all state and territory governments in PreͲprimary 0.9% 0.7% 0.4% Australia jointly agreed to the National Partnership expenditureas 0.8% 0.7% (2009) (2009) (2009) Agreement on Early Childhood Education. Prior to the percentageofGDP Source:UNESCOInstituteofStatistics,2010. National Partnership, Australia’s investment in ECD was only 0.1 percent of GDP, which ranked 30th out of the 32 The burden of finance for ECCE is distributed across OECD countries. To achieve quality, universal coverage, all various segments of society. State and municipal levels of government agreed to increased, sustained budgetscovertheessentialcostsofECCEprovision.The financial investment, which was partially aided though state is primarily responsible for costs of staff salaries, additional funding of $970 million (AUD) by the CommonwealthofAustraliaoverafiveͲyearperiod. training, medical prevention, and safe and healthy  working conditions.  The municipality covers the The Australian strategy calls for streamlined mechanism for additional costs for maintenance of heating, lighting management and finance at all levels. It requires effective and other supplies, major repairs, medical care, and accountability mechanisms, with clearly defined roles and partlyforchildren’sfood.Whilenationallawguarantees responsibilities at each respective level. The Best Start free preͲprimary education, there is a chronic shortage Program in the State of Victoria is an example of a of places in kindergartens, particularly in big cities comprehensive ECD program with sustainable financing including the capital city. In addition, state and local mechanisms. The program uses a decentralized approach authorities expect parents who can afford to contribute and is coͲfinanced by local governments and regional financially for the provision of quality ECCE services to stakeholders. The program’s multiͲpronged funding approach is effective largely due to strategic mapping, preschoolͲaged children. Each municipality constant monitoring, and extensive evaluation methods at autonomously determines and regulates the amount of thelocallevel. fees collected from parents or legal guardians of children who attend kindergartens or nursery schools, KeyconsiderationsforBulgaria: based upon the type of services14provided. Parents do 9 Accountability measures for financing and allocating funding across sectors and between sectors and the notpaytuitionfees,butsomeofthemhavesignificantly nationalandprovincialgovernments. high contributions, despite having to partially cover the 9 Improved availability of expenditure data and a unified daily needs of their children, including food and information system to monitor the NSP across ECD educational materials. According to the World Bank indicatorsinordertotrackandsustainadequatefinancing. regional study on “Closing the Early Learning Gap”  (2012), the average Roma parent with a child in preschool reports spending 15.4 euros per month on The level of public sector financial commitment to ECE preschool related fees; a very substantial amount for is adequate. Approximately 11 percent of total poor Roma families. In comparison, Hungarian Roma government expenditures go towards education in report spending only 1.3 euros on average. These outͲ Bulgaria(representingapproximately4percentofGDP). ofͲpocket expenses and huge variations in the costs for Of the entire education budget, 22 percent is allocated kindergartens are an important barrier to accessing to preͲprimary education (UNESCO, 2010). Table 4 preschools, which brings in the issue of why the compares Bulgaria’s distribution of preͲprimary Government is not considering universalizing free spending with select countries in Europe. As of 2009, access to ECCE, as in Hungary for example, because of Bulgaria had the highest proportion of its education the inability of local governments to fully comply with spendingallocatedtowardspreͲprimaryeducation.  14 For example, in the Municipality of Sofia, parents contribute the following  fees established according to the type of service: 72,00 lv per month for 13 Formoreinformation,seeAustralia’sNationalPartnershipAgreementon weekly use of nurseries and kindergartens; 60,00 lv per month for the whole EarlyChildhood day programs; 23,00 lv per month for the half day programs (with feeding Education:http://www.deewr.gov.au/Earlychildhood/Policy_Agenda/ECUA/P services); and 15,00 lv per month for half day programs (excluding feeding ages/EarlyChildhoodEducationNationalPartnership.aspx. services). SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  13 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  the mandate for free access to kindergartens. The medical services, specific treatments for diarrhea and Hungarian experience shows that free kindergartens, pneumonia are officially free (last two are free if with a priority access to vulnerable children when hospitalization is needed). Yet patients are required to places are insufficient, may lead to better alleviation of pay a certain amount for each medical visit, as defined differences in cognitive outcomes—for example, by a Decree of the Council of Ministers, with exceptions between ethnic Hungarian children and ethnic Roma guaranteedtovulnerablegroups,including:peoplewith childreninHungary. diseases; minors and those underage; unemployed members of a family; war veterans; and military In addition, it is worth noting that the GoB’s disabled officials. The Health Insurance Act further expenditure streams ease the burden of finance for allowsalargegroupofpeopletohaveaccesstomedical some vulnerable children and their families. ECCE care without payment of health insurance services are provided free of charge for orphans and contributions. All young children and youth under 18 vulnerable children (OVCs), children with parents with years of age and all persons up to 26 years of age who disabilities, children with severe chronic diseases, and are fullͲtime students, citizens who are eligible for foreverythirdchildandaboveinasinglehousehold. receiving social assistance, parents who take care for The new Draft Law for Preschool and School Education persons with disabilities, and persons receiving introducestheideaofcompulsorypreschoolenrollment unemploymentbenefitsareguaranteedfreehealthcare of children aged 4. Since the academic year 2012/2013, services. Table 5 displays select health expenditure the preͲprimary education of children aged 5Ͳ7 years is indicators in Bulgaria in comparison with other compulsory. Furthermore, with the amendment of the countriesintheregion. Law for Family Allowances for children, the right to Table5:Regionalcomparisonofselecthealth family benefits is bound by the mandatory enrollment expenditureindicators,2011 of the child in preͲprimary school. In order to  Bulgaria Denmark France Hungary Romania implement this measure successfully, the GoB should Totalhealth consider making ECCE services free of charge for all 8% 6% expenditureasa 11% 12% 8% eligible children. Additional policy measures related to (2010) (2010) percentageofGDP social benefit services could ensure that vulnerable OutͲofͲpocket children enroll in kindergarten—such as developing expenditure15as 97% 98% 89% 32% 74% percentageofprivate (2010) (2010) someconditionalitybindingtheaccesstosocialbenefits healthexpenditure (as income replacement in case of unemployment) with Generalgovernment enrollment of children in preschools. Such actions expenditureonhealth US$ US$ US$ US$ US$ would motivate those parents to enroll their children at percapita(adjusted 589 3,886 3,135 1,081 708 least for the period of the social benefit programs, but forpurchasingpower (2010) parity) attention should be given to vulnerable children in RoutineEPIvaccines families that are outside of the labor market and social No No financedby 100% 100% 100% data Data benefit system. A significant number of Roma children government liveinsuchfamilies. Source: WHO Global Health Expenditure Database, 2011; UNICEF, 2011; Bulgaria’s NationalImmunizationCalendar. In the health sector, public sector financial At the household level, outͲofͲpocket health commitmentcoversfreehealthcareforyoungchildren expenditures 16 account for 97 percent of all private and mothers. The health care system in Bulgaria health expenditures in Bulgaria. As demonstrated in requires each citizen to have personal compulsory Table 6, Bulgaria’s outͲofͲpocket expenditures are health insurance managed by the NHIF. It guarantees significantly higher than other select European basic package of public health services as defined in countries.Eventhoughdataarenotspecific totheECDͲ Article 4 of the Health Insurance Act. These public services are provided by the health establishments  under the delegation and supervision of the states. The   16 MoH does not report ECDͲspecific expenditures. An outͲofͲpocket expenditure is any direct outlay by households, including gratuities and inͲkind payments, to health practitioners and suppliers of However, all ECD health services, including prenatal pharmaceuticals, therapeutic appliances, and other goods and services checkͲups, labor and delivery, immunizations, growthͲ whose primary intent is to contribute to the restoration or enhancement of thehealthstatusofindividualsorpopulationgroups.Theseexpendituresare monitoring and promotion, wellͲchild visits, emergency notECDͲspecific.  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  14 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  aged population, this figure illustrates that despite the 327 (2012), community health workers are paid an legislatively wellͲestablished health care policy annual salary of BGN 3788,00 per year by the guaranteeing free access to health services, government, funded by the national government beneficiaries continue to bear major costs to receive through delegated budget for state activities to be these services. The share of general government performedbythemunicipalities. spending on health care is one of the lowest in the region (US$ 589) with 8 percent of GDP allocated for PolicyOptionstoStrengthentheEnabling governmentexpenditureonhealth. EnvironmentforECDinBulgaria TheGoBcompensatespublicECCEprofessionalsonthe samesalaryscaleasprimaryschoolteachers.Bulgarian ‡‰ƒŽˆ”ƒ‡™‘”ǣ legislation has introduced the concept of minimum ¾ Consider strengthening the legal framework for wage. The Labor Code (1987) requires the Council of ECD. The GoB has made great progress in adopting Ministers to establish a regularly updated standardized national laws and regulations and in ratifying pay scale for the remuneration of the employees of the international conventions and protocols to promote education system. Early childhood practitioners 17 ECD. Yet, the current legal framework for ECD is not receiveamonthlysalaryofminimumBGN500basedon specifically tailored to ECDͲaged children but rather to the same salary scale as primary school teachers. the age group 0 to 18 years. It is also reported that Salaries are determined by qualifications and positions there is currently no unified understanding of what ECD heldandrangefromminimumBGN500toBGN660per entails and what effective strategies should be put in month.Inaddition,communityͲbasedchildcareworkers place to ensure the provision of integrated ECD services are compensated by the government and fall under the to enable all young children develop to their full category of pedagogical specialists in the nomenclature potential. The crucial next step will be the development of the government payroll system. Table 6 displays the of a comprehensive ECD policy addressing the holistic established minimum basic salary for ECCE needsofyoungchildren. professionals as of January 1, 2013. As highlighted in the SABERͲTeacher report, the overall level of ¾ Create innovative mechanisms to promote remuneration for teaching staff in Bulgaria is not adequate and sustainable nutritional policies in the conducive to attracting young and talented teaching country. The WHO recommends food fortification with professionals. iron including folic acid, zinc, vitamin B12, and Vitamin A. In Bulgaria, regulations are not yet in place to Table6:EstablishedminimumsalaryforECCE encourage iron fortification of food staples. Although professionals(2013) there have been preliminary discussions based on Minimum dialogue with world producers of iron fortification Position MonthlySalary staples, policies have not been established. The GoB is (lv) encouraged to continue in this dialogue and establish Schoolprincipal,kindergartenserviceprovisionunits 660 mechanisms to promote iron fortification of food DeputyͲprincipal 610 staples. In addition, the GoB should build upon existing Headteacher,headeducator 570 efforts and ensure sustainable policies and improved Senioreducator,Seniorteacher 535 implementation of programs that address nutrition, Pedagogicalspecialists:speechtherapist,psychologist, pedagogicalcounselor,accompanist,choreographer, 500 particularlybreastfeedingpromotion. pedagogue,resourceteacher,teacher,andeducator. Source:MoES.  –‡”Ǧ•‡…–‘”ƒŽ‘‘”†‹ƒ–‹‘ǣ The GoB compensates community health workers; ¾ Ensure the development of an explicitly stated however, the level of remuneration could be multiͲsectoral ECD strategy. Currently, the relevant improved. Community health mediators work in government institutions engaged in policy making do vulnerable communities (mainly Roma communities) not yet fully recognize the concept of the need for a and are appointed by the local municipal council. In comprehensive and integrated ECD system. Bulgaria accordance with Decision of the Council of Ministers ζ should transform its ECD system from a single sector to  a multiͲsectoral approach, by converging interventions 17 Teachingstaffinnurseriesandkindergartensinclude:principal,assistant director,teachingandpedagogicalstaff,speechtherapist,psychologist,and counselor. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  15 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  in education, health, nutrition, care stimulation, and ¾ EnsurethelevelofECEfinanceisadequatetomeet protection. The establishment of a comprehensive the needs of the population. The OECD recommends multiͲsectoral ECD policy, with clear roles and that a public investment of 1 percent of GDP is the responsibilities assigned to each relevant government minimum required to ensure provision of quality early body, is a first step in designing an improved ECD childhood care and education services. 18 Bulgaria system. The multiͲsectoral policy should further be currently spends 0.8 percent of its GDP on preschool19 complemented by a costed implementation plan and and could consider a higher level of ECD financing to the development of solid ECD information system that ensuretheneedsofyoungchildrenaremet. is capable of tracking beneficiaries, their needs, and the services provided to them across the different sectors ¾ Ensure that lowͲincome and vulnerable children and vertically (central authorities – local governments – have access to key health and nutrition interventions. service provision units) throughout the ECD age span, Overall, outͲofͲpocket expenditure as a percentage of starting from pregnancy through completion of totalhealthexpendituresishighinBulgaria.Itshouldbe preschoolandtransitiontoprimary. a priority for the government to provide sufficient funding for the basic services, particularly targeting the ¾ Establish a common plan of action for ECD service poorandmostvulnerable. delivery at the state level. Given that essential ECD services are provided across multiple sectors, it is ¾ Ensure sustainable and adequate commitment to important to establish a common plan of action for ECD spending. It will be important for public effective service delivery. An important first step is to institutions, both at the national, state, and municipal develop an agreed list of essential services that will levels, to commit to sustained financial support of the translateintoacommonplanofaction.Clearguidelines effectiveimplementationofECDservicesacrosssectors. for leading roles, joint planning, resource mobilization, Box 6 provides an example from Australia, where all implementationandmonitoringofservicesarerequired state and territorial governments have agreed to by all intervening sectors.  Mechanisms to coordinate maintain sustainable financial investment in the ECD service provision at the delivery level will be preprimary education sector. The GoB should consider essential to guarantee that every child has access to all working across sectors and all levels to streamline of the essential services. Coordination between the Bulgaria’s financial system for sustained and education, health, nutrition, and child protection coordinated ECD financing. This will require improved sectors in state governments and municipalities will be accountability measures and clear and available crucial. This coordination could include sharing expendituredataacrosssectors. coverage data and collaborating to identify differentiated needs of young children and gaps in PolicyGoal2:ImplementingWidely servicedelivery. ¾PolicyLevers:ScopeofPrograms• Coverage•Equity ‹ƒ…‡ǣ Implementing Widely refers to the scope of ECD ¾ Strengthen ECD budget coordination mechanisms programs available, the extent of coverage (as a share between the different sectors involved. Although the of the eligible population) and the degree of equity multiͲsectoral nature of ECD makes it difficult to clearly within ECD service provision. By definition, a focus on disaggregate public financing of ECD, effective ECD involves (at a minimum) interventions in health, implementation of integrated ECD policy will nutrition,education,andsocialandchildprotection,and necessitate a jointly coordinated budget planning should target pregnant women, young children, and process across ministries. The development of a their parents and caregivers. A robust ECD policy should common plan of action would lead towards more includeprogramsinallessentialsectors,whileproviding coordination and adequate levels of financial support comparable coverage and equitable access across necessary to effectively and efficiently implement the regions and socioeconomic status – especially reaching potential multiͲsectoral policy. At the planning stage of the most disadvantaged young children and their this policy, a sustainable financial plan should be families. elaboratedtosecureitsfullͲfledgedimplementation.  18 OECD,2011. 19 UNESCO,2010. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  16 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  PolicyLever2.1: educational needs of young children through nurseries ScopeofPrograms (for children up to 3 years old) and kindergartens (for children ages 3Ͳ6). In the health sector, expectant Effective ECD systems have programs established in all mothers and young children are provided with essential essential sectors and ensure that every child and maternal and childhood health services including expectant mothers have guaranteed access to the prenatal visits, skilled delivery, maternal depression essential services and interventions they need to live screening, immunizations, and childhood wellness and healthfully. The scope of programs assesses the extent growth monitoring. In the nutrition sector, to which ECD programs across key sectors reach all breastfeeding and school feeding programs exist or are relevant beneficiaries. Figure 3 presents a summary of planned to be developed, as well as food and the key interventions needed to support young children micronutrient supplementation activities as part of the and their families via different sectors at different overall services provided by general practices for stagesinachild’slife. pregnant women and young children. Finally, in child Programs are established across all relevant sectors and social protection, a wide scope of tailored and cover a wide range of beneficiary groups. ECD interventions exists to meet the specific needs of Interventions exist in the education, health, nutrition, children with special needs and orphans and vulnerable and child and social protection sectors and target a children. range of beneficiary groups in Bulgaria. Figure 4 While Figure 4 displays some of the major ECD presents select ECD interventions that exist in the programs in Bulgaria, it does not portray the scale of country.Thedifferentiatedinterventionstargetnotonly programs. Table 7 shows that a range of ECD programs infants and young children, but also pregnant women are established across sectors, including education, and caregivers; these programs are designed to meet health, nutrition, parenting, and special needs and themultiͲsectoralneedsofyoungchildren. displays the scale of coverage of these select ECD For each sector, a series of specific interventions are programs in the country. While mostly all 28 districts in essential to support young children’s holistic the country are covered, levels of access are not developmental needs. As displayed in Figure 4, a wide available consistently across sectors. Levels of coverage range of interventions are available in the education willbefurtherdiscussedinSection2.2. sector: subsidized early childhood care and  development programs are established to cater to the Figure3:Essentialinterventionsduringdifferentperiodsofyoungchildren'sdevelopment  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  17 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013   Figure4:ScopeofECDinterventionsinBulgariabytargetpopulationandsector    SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  18 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Table7:ECDprogramsandcoverageinBulgaria Scale Coverage NumberofRegions ECDIntervention (numberof Covered beneficiaries (outof28districts) reached) Education Governmentsubsidizedearlychildhoodcareandeducation 28 232,658 (nurseriesandkindergartens) Privatelyprovidedearlychildhoodeducation 28 2,357 CommunityͲbasedearlychildhoodeducation 28 235,015 Health Prenatalheathcareforexpectantmothers 28 95,918 NationalProgramforMaternalHealth(NHIF) NationalProgrammeforPreventionofDentalDiseaseAmongChildren (NHIF) Notavailable Notavailable Children’sTreatmentFundCenter(NHIF) Notavailable Notavailable Childhoodwellnessandgrowthmonitoring(NHIF) 28 493,389 Immunizations 28 1,181,556 NationalImmunizationsProgram(NHIF) MaternalDepressionscreeningprogram(NHIF) 28 Notavailable Nutrition Micronutrientsupportforpregnantwomen 28 Notavailable Foodsupplementsforpregnantwomen 28 Notavailable Micronutrientsupportforyoungchildren 28 Notavailable Foodsupplementsforyoungchildren 28 Notavailable Breastfeedingpromotionprograms NationalProgrammeforMaternalHealthandBabyͲFriendlyHospitalInitiative 28 Notavailable NationalProgramforpreventionofChronicNonͲcommunicableDiseases FeedingprogramsinpreͲprimaryschools 28 Notavailable Parenting Parentingintegratedintohealthandcommunityprograms 24 Notavailable Homevisitingprogramstoprovideparentingandhealthmessages  ͲDeinstitutionalizationProgram(PilotProgram) 8 7,150 ͲParentingmessagesthroughhealthmediators’activities 24 Notavailable SpecialNeeds ProgramsforOVCs  ͲRestructuringofHomesforMedicalandSocialCareofChildrenages0Ͳ3 28 1,833 Ͳ‘IHaveaFamilyToo’FosterCareDevelopmentProgram 28 2,330 ͲHomesforChildrenDeprivedFromParentalCare 28 3,852 Interventionsforchildrenwithspecialneeds ͲͲChildhoodforEveryoneProjectforDeinstitunalizationofChildrenwithDisabilities 28 1,654 ͲHomesforChildrenwithPhysicalandMentalDisabilities 24 1,185 ProgramsforHIV/AIDSPrevention Notavailable AntiͲpoverty/IntegratedPrograms SocialInclusionProjecttoreducechildpovertythroughECDInterventions 69 municipalitiesin 100,000 selectdistricts (target) Source:SABERͲECDProgramandPolicyInstruments.        SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  19 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013   PolicyLever2.2: Figure5:Grossenrollmentrate(ages3Ͳ6)inselected Coverage EastEuropeancountries 140 A robust ECD policy should establish programs in all 120 EnrollmentRatio(%) essential sectors, ensure high degrees of coverage and Belarus PreprimaryGross 100 reach the entire population equitably – especially the Bulgaria 80 mostdisadvantagedyoungchildren–sothateverychild Hungary 60 and expectant mother have guaranteed access to 40 Romania essentialECDservices. 20 Denmark Early childhood education coverage in Bulgaria is 0 gradually expanding. Figure 5 displays the most France 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 recently reported gross preͲprimary enrollment ratios Year for selected East European countries (UNESCO). In  Source:UNESCOInstituteofStatistics,NationalStatisticsInstitute. 2010,thegrosspreͲprimaryenrollment ratioinBulgaria for children ages 3Ͳ6 years old was 83 percent. These The GoB has recognized the need to reach out to all data reflect the number of children enrolled in preͲ eligible children with ECCE services. Figure 6 reveals primary (regardless of age) as a percent of the total that level of coverage for ECCE by age group. As ECCE age population. During the period 2007Ͳ2014, the demonstrated in Figure 6, the enrollment rates in ECCE percentage of all children ages 3Ͳ6 enrolled in for children ages 3 to 6 years old are the highest. Yet, kindergartens increased from 73 to 83.6 percent. government efforts should further focus on targeting Despite continuing to increase its enrollment rate, childrenages1Ͳ3. Bulgaria still falls behind in providing early childhood Figure6:EnrollmentinECCEbyage(2012/13) education compared to some European countries. In addition, in the Bulgarian context young children that arenotenrolledinkindergartensareactuallythosethat need ECCE most, predominantly young Roma children. Survey data suggest that only about 40 percent of the Roma children ages 3Ͳ6 are enrolled in kindergartens20. The GoB is encouraged to learn from countries in the subͲregion and highͲperforming EU member countries that have reached universal access and should consider developing strategies to ensure universal coverage of quality preͲprimary education. Compared with regional and international countries, the level of enrollment in  preschool is low in Bulgaria. Although Bulgaria has Source:NationalStatisticalInstituteofBulgaria. experienced improvements in enrollment over the past Figure 7 displays the proportion of children covered by decade (see Figure 5), this level trails other countries. the different types of ECCE services offered to all BelarusandHungaryareamongstthetopperformersin eligible young children. Amongst the young children the subͲregion, with enrollment of 99 percent and 85 benefiting from preschool education, the majority of percent, respectively. Internationally, countries such as them attend full day kindergartens. The existing Denmark, France, and Sweden achieve near universal differentiated types of ECCE services demonstrate the coverage. GoB’s efforts to respond to the tailored needs of young  children and their families. The GoB also reports that  only approximately 1 percent of these services are  providedbyprivateserviceproviders.        20 UNDP/WB/EuropeanCommissionregionalRomasurvey,2011. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  20 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Figure7:CoverageofECCEbytypeofservices Figure8:Levelsofcoverageforchildrenunder3versus (2012/13) childrenages3Ͳ6inBulgaria(2012/13)  Source:NationalStatisticalInstituteofBulgaria. Policies and measures to prevent dropping out of  Source:NationalStatisticalInstituteofBulgaria. school and early school leaving should also focus on Bulgarian mothers have adequate access to some ECD earlychildhoodcareandeducation.In2013,astrategy health interventions, but it is unclear whether they wasadopted toreduce theshareofearlyschoolleavers have adequate access to all essential interventions. (2013Ͳ2020). Policies and key measures were Table 8 displays selected indicators for heath introduced to prevent early school leaving and a interventionsforpregnantwomeninBulgariaandother coordination mechanism has been put in place to European countries. UNICEF country statistics reveal improve control of all sectoral policies related to the that pregnant women in Bulgaria have universal access provision of adequate access and retention of pupils in to skilled delivery during birth of their child. The MoH school until school completion. In pursuance of the reports that, in 2011, 95,918 expecting mothers have objectives of the strategy, it is expected to achieve benefitted from prenatal health care services. While resultssuchas:increasedcoverageinkindergartensand coverage data are not available, maternal depression schools by encouraging enrollment and regular screening services are provided by general practices attendance, offering interͲsectoral services for under the Maternal Health program in all 28 districts educational and social support, improved learning around the country. According to a UNICEF and NCPHP outcomes, and improved provision of appropriate Survey on breastfeeding and nutrition of children and educational support for the development of every child mothers (2009), 29 percent of mothers of young andpupil. children ages 0Ͳ6 months are anemic. The prevalence is The GoB provides ECCE services to children younger higherforRomamothers:amediumandsevereformof than 3 years old; however coverage level for this anemia is over 6 percent, which is more than two times specific age group could be further improved. Figure 8 higher than the average for the country (2.8 percent). compares the level of coverage for children younger The MoH is encouraged to continue in its efforts to than 3 with that for children ages 3Ͳ6. As displayed provide universal access to essential health below, while children 3 years and older have adequate interventionsaroundthecountry. access to ECCE, only 20 percent of children younger Table8:Regionalcomparisonoflevelofaccessto than 3 have access to early childhood care. As the essentialhealthinterventionsforpregnantwomen majority of Bulgaria’s youngest children do not have  Bulgaria Denmark France Hungary Romania access to ECCE interventions, government efforts Skilledattendantat shouldfurtherfocusontargetingchildrenages1Ͳ3. birth 99% 98.5% 98% 99% 99%  Source: WHO Countries Statistics, 2013; WHO Global Database on Anemia; UNICEFandNCPHPSurvey,2009.   Young children in Bulgaria have adequate access to  health interventions. Table 9 displays UNICEF country  statistics21of selected indicators for access to essential  health interventions for young children. Access to    21 UNICEF,StateoftheWorld’sChildren,2013. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  21 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  comprehensive immunization is 95 percent in Bulgaria. are available), 31 percent of young children ages 6 The MoH reports a wide coverage for essential health months to 4 years were anemic. Stunting affects 7 interventions, including growth monitoring and percent of children ages 0Ͳ5 and 12 percent of children childhood wellness, and specific illnesses requiring ages 0Ͳ6 months. In addition, as shown in Table 10, adequate medical attention, such as diarrhea, Bulgaria has the highest percentage of infants with low respiratory tract infection, and pneumonia. While birth weight compared to other countries. The GoB is available data show adequate access to health encouraged to properly monitor access to essential interventions, Bulgaria’s health care system faces a nutrition interventions and expand the provision of challenge: while the National Health Insurance Law adequate essential nutrition interventions, as well as requires every citizen to participate in NHIF, health the promotion of exclusive breastfeeding and anemia services delivered through the NHIF are underfunded. preventionandtreatmentprograms. The financial instability of the national fund negatively Table 10: Regional comparison of level access to affects the coverage and quality of health care services essentialnutritioninterventionsforECDͲagechildren provided.Vulnerablechildren’saccesstotheseessential health services should be carefully studied. The MoH is  Bulgaria Denmark Hungary Romania Childrenbelow5with encouraged to develop new strategies to ensure that 22 moderateorsevere 7%  Nodata Nodata 13% NHIF provides universal access to essential health care stunting andmaintainthequalityofservicesprovided. 13.3%(0Ͳ2 months) Infantsexclusively Table9:Regionalcomparisonoflevelaccesstoessential breastfeduntil6 6%(2Ͳ3 Nodata Nodata 16% months) healthinterventionsforECDͲagedchildren monthsofage 2%(4Ͳ5  Bulgaria Denmark France Hungary Romania months) 1ͲyearͲoldchildren Infantswithlowbirth immunizedagainst 9% 5% 9% 8% 95% 91% 99% 99% 89% weight DPT(corresponding vaccines:DPT3ß) Percentageof Source:UNICEFCountryStatistics,2007Ͳ2012. householdsconsuming 100% Nodata Nodata 74% iodizedsalt The level of access to essential nutrition interventions Source:UNICEFCountryStatistics,2007Ͳ2012. for young children could be better expanded. Table 10 The MoH effectively maintains a birth registration presents a regional comparison of selected nutrition information system. Each delivery is captured through indicators for young children. National legislation an information system, available at every maternity mandates salt iodization resulting in universal ward. The MoH reports that the birth registration rate consumption of iodized salt in Bulgaria. Breast milk is inthecountryisnearlyuniversal. considered to be the best method to ensure an infant’s intake of all the nutrients and calories for proper PolicyLever2.3: growth and development. Yet, while the MoH reports Equity the provision of breastfeeding support activities in the Based on the robust evidence of the positive effects ECD maternalhospitalsacrossthecountry,dataoncoverage interventions can have for children from disadvantaged level for exclusive breastfeeding are not available. backgrounds, every government should pay special Fragmented services for breastfeeding support and attentiontoequitableprovisionofECDservices.23Oneof promotion are provided by several NGOs and maternity the fundamental goals of any ECD policy should be to wards, but the state doesn’t collect information about provide equitable opportunities to all young children those activities. The national funding for breastfeeding andtheirfamilies. promotionisnotadequateandsustainable. ECCEservicesare equitablyprovided toyoungchildren Data on the coverage of general nutrition interventions regardless of their gender. Figure 9 below displays the provided by General Practitioner (GP) in all 28 districts number of children enrolled in ECCE by age group and in the country, including adequate micronutrients and gender. Girls and boys have equitable access to preͲ food supplements for young children’s proper primary education throughout the ECD age range, with development, are not reported. A UNICEF and NCPHP marginally more males than females enrolled. Yet, data Survey on breastfeeding and nutrition of children and mothers (2007) reported that in 2007 (latest year for  22 which data 23 Thispercentageismuchhigher(11.6percent)forRomachildrenages0Ͳ5. Engleetal,2011;Naudeauetal.,2011. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  22 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  are not available to show if there are major differences PreschoolenrollmentgapinBulgariaishighlylinkedto in enrollment rates by wealth quintile. The GoB is issues of affordability, preference for home care, and encouraged to collect further information on the lack of knowledge on the importance of preschool for socioeconomic status of young children to be able to subsequent education outcomes. According to the provide universal access to all children, especially the World Bank regional study on “Closing the Early mostvulnerablechildrenfromlowerͲincomefamilies. Learning Gap” (2012), outͲofͲpocket expenses is an important barrier for many poor households in Figure9:AccesstoECCEservicesbyageandgender expanding access to preschool. The study also indicates that a preference for home care is an important reason for not enrolling children in preͲschool. Figure 11 highlights selfͲreported parental reasons in Bulgaria for not enrolling a child into preschool.25These responses indicatetheneedtoeducateparentsontheimportance of early learning opportunities and perhaps consider compulsory preschool which may eventually increase enrollment rates among children whose parents currently express a preference to keep their children at home.  Figure 11: Reason for not sending child (aged 3Ͳ6) to Source:NationalStatisticalInstituteofBulgaria,2012. preschool(Bulgaria) Preschool enrollment among Roma children is low, ChildisillͲtreated 1% andmuchlowerthan theoverallpopulation.Asshown Onthewaitinglist 1% in Figure 10, among Roma children ages 3Ͳ6, 38 percent of girls and 42 percent of boys are reported to be Noplace 3% enrolledinpreschool,comparedwithanoverallaverage Toofar 4% of 75 percent for the general population. These Childshouldstayhome 8% enrollment rates compare favorably with Roma in the Childistooyoung 28% Czech Republic (21.8 percent), Slovakia (17.8 percent), Noneed(havehome… 29% and Romania (32.2 percent). Only Hungary is a notable Tooexpensive 40% exception, with 66 percent of Roma in this age group 0% 10% 20% 30% 40% 50% enrolledinpreschool.24  Source:UNDP/WB/ECregionalRomasurvey,2011. Figure10:AccesstoECCEservicesbyageandgender 100% Access to ECCE varies across the regions. Figure 12 75% displays the net enrollment rates in ECCE by statistical 80% regions in the country. Access to ECCE varies across the 60% regions. While the North Central region (Severen 38% 42% 40% 40% tsentralen) has the highest net enrollment rate of 86.6 percent, young children living in the South East region 20% (Yugoiztochen) have only a 78 percent net enrollment 0% ratio. As discussed in earlier sections, data are not Roma Roma Roma National available to differentiate access by children’s girls boys average average socioeconomic status. Thus, it is difficult to assess (2011) (2009Ͳ10) whether poor children have the same opportunities to  Source:UNDP/WB/ECregionalRomasurvey,2011.Tomakecomparisonwith early learning and other essential health and nutrition national data, authors relied on UNICEF's TransMONEE database, 2011. The interventions as children from the richer families. The agegroupforbothdatasetsis3Ͳ6years. GoB is highly encouraged to monitor access data based  on socioeconomic status of young children and their families.   24 25 UNDP/WB/EuropeanCommissionregionalRomasurvey,2011. UNDP/WB/EuropeanCommissionregionalRomasurvey,2011. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  23 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Figure 12: ECCE Net enrollment rate26by statistical of ECCE to ensure that children younger than 3 years region(agegroup3Ͳ6years) old have also adequate opportunities for early stimulationandlearning. Whileguaranteeingthehealth of children (under the leadership and responsibility of the MoH), the role of the educational entities (under the responsibility of the MoES) and more specifically, the early learning practices in Bulgaria, should be strengthened. A possible step is renewing the mission and functions of nurseries as institutions that set clear educational and developmental goals for children’s early childhood, including through the appointment of pedagogical specialists in each nursery group. Furthermore, internationally recognized research from  Jamaica has revealed that home visits and better Source:NationalStatisticalInstituteofBulgaria,2014. parenting programs are both feasible and have the PolicyOptionstoImplementECDWidelyin potential to impact the development of the youngest Bulgaria age cohort. Bulgaria should place increased emphasis on continuing to scale up ECD interventions for parents ‘˜‡”ƒ‰‡ andtheirchildrenfrom0to2yearsofage. ¾ Establish sustainable mechanisms to promote, “—‹–› expand,andreporttheprovisionofadequatenutrition interventions to young children and expectant ¾ Ensure that essential ECD interventions are mothers. Exclusive breastfeeding until 6 months can provided to poor children and to those who are hard reduce infant mortality and promote healthy to reach, mostly in the rural areas. Data are not development.ThenewNationalProgramforPrevention available to assess ECD provision in relation to of Chronic and NonͲcommunicable Diseases envisages children’s socioeconomic status. Evidence suggests that breastfeeding promotion. The MoH is encouraged to lack of appropriate early learning and access to establish mechanisms to ensure the provision of essential health and nutrition interventions place poor adequate nutrition interventions during this critical age children at a disadvantage before they start school. The of a child’s development. As discussed in previous GoB should ensure access to education for all children sections, the GoB should promote iron fortification of regardless of ethnicity, gender and religion, economic food staples. Reducing anemia prevalence in pregnant status, or place of residence. According to Article 26 of women can prevent intellectual and physical the Public Education Act, children and pupils who are impairment in children. It will also be essential to seek subject to mandatory training for school and out updated data on anemia in pregnant women and compulsory education in a settlement where there is preschoolͲage children to determine whether women not a kindergarten or a school, performing a preschool and young children have adequate access to foods preparation in the relevant preparatory group or enrichedwithiron. learning in the relevant grade, free transportation shall be provided to a kindergarten or school in the nearest ¾ Consider providing additional early childhood care settlement in the territory of the municipality or of a opportunities for children younger than 3 years. neighboring municipality. The GoB should further Evidence suggests that the strongest cognitive benefits ensure expanded access to essential ECD services for centerͲbased ECD programs are experienced by targeted at lowͲincome and vulnerable children, as well younger children (ranging from 9 months to <3 years).27 as those in hardͲtoͲreach areas. An effective strategy While nursery services are in place for children under 3, could be to enhance the capacity of local authorities to access level is limited compared to the age range 3Ͳ7. identify existing gaps and address the needs of the The GoBisencouragedtofurtherimprovetheprovision disadvantaged population. As discussed above, coordinating interventions at the point of service  26 The rate is calculated as percentage of number of enrollments in preͲ delivery is an effective strategy to track individual primary education for the age group 3Ͳ6 years within the total number of child’sneedsandtoensurethatacomprehensivescope populationinthesameagegroup. 27 Loebetal,2007;Armecinetal,2006;NICHD,2003. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  24 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  of services is delivered. While national frameworks can MICS data is also a great source of information promote increased coverage, efforts at the local and enriching the data set available regarding young municipality levels are crucial. Municipal authorities will children and mothers. The GoB is highly encouraged to need to take an active role in expanding ECD coverage participate in MICS and further improve the data intheirrespectiveareas. collection system. Box 7 highlights some valuable lessons from Chile on a comprehensive child Policy Goal 3: Monitoring and Assuring developmenttrackingsystem. Quality Table11:AvailabilityofdatatomonitorECDinBulgaria ¾PolicyLevers:DataAvailability•Quality AdministrativeData: Standards•CompliancewithStandards Indicator Tracked Monitoring and Assuring Quality refers to the existence ECCEenrollmentbyregion 9 of information systems to monitor access to ECD ChildrenenrolledinECCEbysubͲnationalregion(#) 9 services and outcomes across children, standards for ChildrenenrolledinECCEbysocioeconomicstatus(%) X ECD services and systems to monitor and enforce SpecialneedschildrenenrolledinECCE(#) X compliance with those standards. Ensuring the quality ChildrenattendingwellͲchildvisits(#)28 X ofECDinterventionsisvitalbecauseevidencehasshown Childrenbenefittingfrompublicnutritioninterventions(#) X that unless programs are of high quality, the impact on Womenreceivingprenatalnutritioninterventions(#) 9 childrencanbenegligible,orevendetrimental. AverageperstudentͲtoͲteacherratioinpublicECCE 9 IsECCEspendingdifferentiatedwithineducationbudget? 9 PolicyLever3.1: IsECDspendingdifferentiatedwithinhealthbudget?29 X DataAvailability SurveyData Indicator Tracked Accurate, comprehensive and timely data collection can promote more effective policy making. WellͲdeveloped Populationconsumingiodizedsalt(%) 9 information systems can improve decisionͲmaking. In VitaminASupplementationrateforchildren6Ͳ59mo.(%) 930 Anemiaprevalenceamongstpregnantwomen(%) 9 particular, data can inform policy choices regarding the volume and allocation of public financing, staff AnemiaprevalenceamongstpreschoolͲagedchildren(%) 9 recruitmentandtraining,programquality,adherenceto Childrenbelowtheageof5registeredatbirth(%) 9 standards,andeffortstotargetchildrenmostinneed. ChildrenimmunizedagainstDPT3atage12months(%) 9 Pregnantwomenwhoattendfourantenatalvisits(%) X Data are available to differentiate access to essential ECD interventions for special groups; however Childdevelopmentoutcomeindicatorsarecollectedto Bulgaria’s availability of relevant administrative and measure child development. During a child’s early survey data could be further improved. Table 11 years, new capacities emerge continuously and displays Bulgaria’s availability of common ECD sequentially –developmentinonedomainoftenaffects indicators. The National Statistical Institute (NSI) of development in another. For example, children who are Bulgaria and other relevant government bodies collect slow in one domain (i.e., language development) may data on differentiated access by the following special have limited capacity to show the skills that they groups: gender; subͲnational division; and rural and possess in other domains (i.e., cognitive tasks that urban location. However, the data collection system require language skills). Therefore, development in does not track access by socioeconomic status nor young children should be assessed as comprehensively capture children who do not attend early childhood aspossible.Whenmeasuringachild’sdevelopment,itis education. These two indicators are particularly also important to look closely at which indicators are important in light of the growing inequality of families expectedtochangeasaresultofaspecificintervention. and the high number of children from lowerͲincome  families not attending early childhood education. Also, while efficient data are collected on service delivery, informationisnotdisaggregatedandpresentedtoshow  28 TheMoHplanstocollectthisfor2012Ͳ2013(Servicelevelagreement the holistic development of the ECD age group. UNICEF indicator). 29 TheMoHdidnotprovideintheSABERͲECDPolicyInstrument. 30 Dataisonlyavailableforchildrenagedupto24monthsͲaccordingtoa UNICEFandNCPHPSurveyonbreastfeedingandnutritionofchildrenand mothers(2009). SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  25 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Box 7: Relevant Lessons from International children ages 25 to 36 months. However, the data ExperiencesinMonitoringandAssuringQuality collection tools need to be updated. The use of child development data for the purposes of analysis, Example from Chile: Online Registration, development, and implementation of local and national Monitoring,andReferralSystem early childhood development policies should be The “Chile Grows with You” initiativeͲCCCͲ(Chile improved. Furthermore, the information collected on Crece Contigo) is a comprehensive child protection early learning achievements of children enrolled in system to prove interͲsectoral support to children nursery are not sufficiently used to ensure optimal from 0 to 4 years. One innovative component of continuitybetweennurseryandkindergarten. CCC is an online monitoring system that follows  each child through the CCC system. The system PolicyLever3.2: tracks each child’s eligibility for and receipt of QualityStandards services, as well as his or her developmental outcomes. It allows service providers and Ensuring quality ECD service provision is essential. A policymakers to monitor the delivery of benefits, as focus on access – without a commensurate focus on wellasevaluateprogramimpact. ensuring quality – jeopardizes the very benefits that KeyconsiderationsforBulgaria policymakers hope children will gain through ECD 9 This system could support better monitoring of interventions. The quality of ECD programs is directly compliance with standards, as it tracks which related to better cognitive and social development in childrenreceivespecificbenefitsandservices. children.31 9 This tracking system is particularly beneficial for Clear learning standards are established for ECCE in improved interͲsectoral coordination at the Bulgaria. AgeͲappropriate learning standards are point of delivery, as it provides an accessible established for the provision of ECCE services. The platform for health, education, and child Ministry of Education and the Ministry of Health have protection service providers to be on the same jointly developed evidenceͲbased learning framework pageaboutchild’sneedsandreceiptofservices. for the provision of ECCE. The framework is mainly 9 An improved online system could improve designed for young children ages 24Ͳ83 months. The targetingandtriggersforatͲriskchildren. Bulgarian Academy of Science and UNICEF are currently  developing development and learning standards for the Such data enable the full assessing of the efficacy of youngest children attending nurseries (0Ͳ24 months). In service delivery and investments. Bulgaria’s preschool accordance with the cultural and educational areas education curriculum has established specific ageͲ under Article 10 of the Law on the Level of Education, appropriate learning outcomes for each educational the General Education Minimum and Curriculum, the field. Children attending kindergartens are expected to content of the preschool education comprises feasible acquire a certain level of knowledge, skills, and, knowledge,skills,andattitudesto beacquiredbyyoung attitudes. In order to assess the achievement of these children. The learning framework includes a range of expected learning milestones, specific child important topics for the effective cognitive development outcome indicators are collected to development of a child including: Bulgarian language capture the developmental competencies and and literature; mathematics; social world; nature; art; readiness,forchildrenages3Ͳ7years. physical culture; music; constructive industrial and householdactivities;andgameculture.ʤwiderangeof Child development indicators are also collected to programs exist to be used by the professionals in ECCE capture the development of children ages 0 to 36 centersincluding:programfortheeducationofchildren months attending nursery schools. Caregivers collect from 2 to 7 years old (ʿ̨̬̬̥̐̌̌ ̌̚ ̛̛̻̪̯̦̖̏̌̚ ̦̌ data to monitor individual child development, including ̨̖̯̖̯̔ ̨̯ ̖̔̏ ̨̔ ̨̛̭̖̖̥̹̦̔̐̔̌ ̻̬̭̯̏̌̚, 1993); mental, motor, sensory, emotional, linguistic, and social the activity of a child in kindergarten (ʤ̡̨̛̯̦̭̯̯̏̌ development. Detailed data are recorded in individual ̦̌ ̨̖̯̖̯̔ ̏ ̡̖̯̭̯̔̌̌ ̛̬̦̐̌̔̌, 1993); program for medical record card in accordance with a wellͲ children of preschool age and their families Ͳ "Program established data collection schedule: monthly data Step by Step" (ʿ̨̬̬̥̐̌̌ ̌̚ ̶̖̯̔̌̌ ̨̯ collection for children ages 0 to 12 months; every three monthsforchildren13to24months;andbiannuallyfor  31 Taylor&Bennett,2008;Bryceetal,2003;Naudeauetal,2011V;Victoriaet al,2003. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  26 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  ̸̛̛̪̬̖̱̣̺̦̔̌ ̻̬̭̯̏̌̚ ̛ ̵̛̯̖̦̯̖ ̭̖̥̖̜̭̯̏̌ – children; methods of teaching preͲliteracy and preͲ ˇ̶̨̛̦̔̌́ ˁ̡̯̻̪̌ ̨̪ ̡̭̯̻̪̌”); "Hand in Hand" numeracy skills; and methods of remediation for (ʿ̨̬̬̥̦̐̌̌ ̛̭̭̯̖̥̌ “ˀ̡̻̌ ̌̚ ̡̬̻̌, 2003); Program learners at risk of failing in the early grades. In addition, "Friends" (ʿ̨̛̬̬̥̦̭̭̯̖̥̐̌̌̌ "ʿ̛̛̬̯̖̣́", 2002); "I students studying to become teachers are required to am in kindergarten" (ʿ̨̬̬̥̦̐̌̌ ̛̭̭̯̖̥̌ “ʤ̚ ̭̻̥ ̏ complete a mandatory fieldwork practicum as part of ̡̖̯̭̯̔̌̌ ̛̬̦̐̌̔̌”, 2004); teaching aids "Molivko" their education in the university.  The requirements (ʪ̸̡̛̛̯̦̔̌̌ ̛̭̭̯̖̥̌ "ʺ̨̡̨̛̣̏", 2003); "Fairy include minimum hours of practical training as follows: paths" (ʿ̨̬̬̥̦̐̌̌ ̛̭̭̯̖̥̌, 2009); program of 60 hours of learning by attending teaching lessons in upbringing for children up to 3 years old called “Impact ECCE centers – to carefully observe the lessons through interaction" (ʿ̨̬̬̥̐̌̌ ̌̚ ̛̻̪̯̯̖̣̦̏̌̌̚ delivered and other forms of the teaching process; 60 ̶̨̨̬̯̭̖̌̍̌̔̌̔ 3Ͳ̨̛̹̦̻̬̭̯̐̔̌̏̌̚ “ʦ̛̻̖̜̭̯̖̔̏̚ hours of educational practice, including participation in ̸̨̛̛̬̖̥̖̜̭̯̖̏̌̔̏̚̚”,1995);and“I'minthenursery" the organization of educational process under the (“ʤ̚ ̭̻̥ ̏ ̡̖̯̭̯̔̌̌ ̭̣́̌”, 2004). Most of these supervision of a professor from the university; and 100 modern programs are based on a childͲcentered hours of internship training in teaching, which provides conceptual model approach to child development and theopportunityforstudentstoindependentlytake part pedagogical interaction as the main essential feature of in the educational process under direct guidance of a the educational process in the kindergartens and school teacher and lecturer at the university. Practical nurseries. In order to ensure coherence and continuum trainings are organized by the universities in agreement of the curriculum into primary education, the learning withstateormunicipalschoolsorkindergartens. framework for ECCE is designed to prepare young In Bulgaria, nurseries are regulated by the MoH and the children for formal school (especially the curricula for main staff members in the nurseries are nurses with the mandatory oneͲyear preschool education before verylimitedpedagogicalstaff.Whilethespecialtraining enteringprimaryschool. in areas of ECD for pedagogical staff is clearly defined, ECCE professionals are required to meet wellͲ additional focus should be given to curriculum for established preͲservice minimum training standards. nurses that are going to be ECCE professionals. The Under the Decree ζ 125 of the Council of Ministers training currently provided to nurses is predominantly (2002), the GoB has established wellͲdefined preͲ concentrated on ECD milestones from a medical point service requirements for the occupation of teaching of view and focuses on treatment approaches. positions in ECCE. ECCE professionals are required to Education and pedagogical training is lacking or limited. acquire the necessary educational and professional According to kindergarten principals that have nursery qualifications and competences. Teaching positions in groups (1Ͳ2), the nurses need additional training and ECCE are qualified as "Junior Teacher", "Teacher," skills to address the learning goals of ECD. The “Senior Teacher,” "Head Teacher," and "TeacherͲ appropriate next step would be to introduce a Mentor." “Qualified” teachers are required to possess a legislative regulation to include obligatory training in teaching certificate issued by a recognized tertiary nursing curriculum that provides psychoͲpedagogical education institution, as determined by state knowledge and skills in the field of early childhood educational requirements for teacher certification and development. As a result, the nurses will hold qualifications. Kindergarten and nursery teachers (from pedagogical degrees (license in Bulgarian) and junior to head teacher) are qualified to occupy these qualificationforpedagogicalpractice. positions only after acquiring the proper education, Professional development opportunities for ECCE training, and higher education bachelor or master providers could be further strengthened. InͲservice degrees in the following domains: Education; Preschool training is not officially regulated through established Education and Foreign language; and Preschool and standards and requirements. However, the Law on Primary School Education in universities that train Public Education states that schools and kindergartens students in these disciplines. The positions of “Senior are mandated to create conditions for continuous Teacher,” "Head Teacher," and "TeacherͲMentor” professional development opportunities in an organized requireadditionalworkexperience. form of learning and selfͲstudy. Qualification PreͲservicetrainingstandardsrequirethatstudentsthat enhancement relates to continuous training aiming to are going to be ECCE professionals receive special improve service delivery, and could be realized in three training in the areas of developmental stages of young stages: at the school level, district level, and national SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  27 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  level. Qualification activities at the school level aim to and playgrounds. ECCE facilities are further required to improve professional skills of the teaching staff and to have functional hygienic facilities, a potable water develop their professional values. The principal of the source, roof, floor, structural soundness, windows, school facility could organize activities for rising buildingmaterials,andconnectiontoelectricity. qualification of the teaching staff. Qualification enhancement activities could also be implemented with Table12:NumberofchildrenrequiredbytypeofECCE the support of universities or specialized training service institutions. In Bulgaria, the financial responsibility of  Requirednumberofchildreninclass/group such inͲservice training programs falls under the Typeofservices Minimum Maximum Wholeday,halfaday institutionwhodemandstrainingforitsstaff. andseasonal 12 22 ECCE service delivery standards are well established. kindergartens NurserygroupsͲwhole Regulations for the implementation of the Law on 8 18 dayservices Public Education require that ECCE institutions operate WeeklyservicesͲ for60hoursaweek(i.e.,atotalof12workinghoursfor 12 18 kindergartens the teaching staff). Established standards outline Specialkindergartens rotational work schedule to the teaching staff – Forchildrenwithspecial 8 11 teachersareexpectedtoworkingroupsofchildrenand educationneeds Forchildrenwith by alternating shifts. In addition, the required daily stammer  32 8 10 working hours of a teacher in a group of children aged Forchildrenwith from 3 to 7 years are minimum six hours. To complete alalia33,rinolalia34,and 6 8 the required minimum of an 8Ͳhour working day, disartria35 teaching staff are encouraged to undertake additional Forchildrenwith 3 5 multipledisabilities activities including: selfͲstudy, preparation of teaching Forchildrenwith materials and resources for different forms of   chronicdiseases   pedagogical interaction, participation in new forms of ͲRemedialkindergarten 12 16 training in the workplace, participation in pedagogical ͲChildrenundermedical 8 10 treatment council’s activities, and communication and Source:Ordinanceζ.7,2000. consultationwithparents. Registration and accreditation procedures exist for The GoB has further established acceptable guidelines ECCE centers. An annual accreditation process is for teacherͲtoͲchild ratios (Ordinance ζ. 7, 2000) in established to ensure the quality of ECCE services. At accordancewiththetypeofservicedelivered.Nurseries the beginning of each new school calendar year, the are served by at least two nurses and two babysitters; director of the kindergarten presents and defends Form and child care is provided by at least one nurse and a ζ 2 to the municipal education departments and all babysitter per shift. Table 12 displays the required relevant government institutions (MoES and Regional number of children in a classroom by type of ECCE Educational Inspectorates). Form ζ 2 contains upͲtoͲ service. dateanddetailedinformationonallkeyparametersand Infrastructure standards for ECCE facilities are activitiesofthekindergartenincluding:enrollmentdata, established. The Regulations provide specific guidelines groups and staff, curricula, programs and manuals in to ensure that ECCE facilities have adequate use, physical condition of the buildings, yard and infrastructure and play areas for young children. As grounds, staff qualifications, and the number of staff. stated in Ordinance ζ 3 (2007) for healthy The successful presentation and defense of the requirements for kindergartens, standards for physical kindergarten’s current operating structure and the level space per child are application for all ECCE facilities in of quality standards met form the basis for obtaining the country. Kindergartens and nurseries are required to have minimum area per child and to accommodate  the premises for sleep and study. Kindergartens and 32 Aspeechdisorderinwhichthepersonrepeatsorprolongswords,syllables, orphrases. nurseriesarealsorequiredtohavealandscapedgarden 33 Impairmentorlossoftheabilitytotalk. 34 Adisorderthatcausesabnormalresonanceinahuman'svoicedueto increasedairflowthroughthenoseduringspeech. 35 Amotorspeechdisorderresultingfromneurologicalinjuryand characterizedbypoorarticulationofphonemes. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  28 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  legally regulated subsidies from state and municipal ECCE professionals comply with preͲservice training structures. standards. The NSI reports that almost all ECCE practitioners comply with the required preͲservice. Infrastructure and service delivery standards in the Table 14 displays the reported number of qualified health sector ensure quality healthcare. Medical teachers by level of qualification. More than 70 percent standards for General Medicine, Pediatrics, of teachers have a specialized tertiary degree in ECD, Neonatology, Obstetrics, and Gynecology are and approximately 27 percent have vocational degrees established to regulate the terms and conditions for in ECD. Yet it would be useful to gather information on carrying out medical activities in order to ensure the what proportion of teachers with specialized degrees provisionofqualitymedicalservices.Inaccordancewith are “Junior Teacher” and “Teacher” versus “Head Ordinanceζ 49 (2010) for the principal requirements Teacher,”“SeniorTeacher”and“TeacherͲMentor.” for the construction, activity, and internal rules of the medical establishment, the system requires that health Table14:ECCEteachersbylevelofqualification posts, health centers, and hospitals meet the NumberofECCE establishedinfrastructurestandardstoensurequalityof Levelofqualification professionals health care services. In addition, health care UpperͲsecondaryschoolcompletion 158 professionals (specifically doctors, nurses, and ISCED4AwithvocationaltraininginECD 5330 midwives) are required to complete training on ECD. SpecializedtertiarydegreeinECD 14241 Thecurriculumforundergraduateandgraduatemedical Totalnumberofpublic students includes special modules addressing child 19729 ECCEprofessionals development but only focusing on medical care, Source:NationalStatisticsInstituteofBulgaria,2012. knowledge, and skills. Students are required to acquire The quality assurance system is not transparent; the necessary knowledge and skills on childhood compliance with ECCE service provision standards developmental milestones, the factors and criteria for could be better monitored. Despite established clear physical and mental development, disorders, and standards for ECCE service provision, the level of relatedtreatmentofchildrenwithhealthproblems. compliancewiththesestandardsisnotclearlyreported. PolicyLever3.3: While unannounced inspection visits are reported to CompliancewithStandards take place, no rules and regulations are in place to establish the terms and frequency of inspections. Most Establishing standards is essential to providing quality centers are irregularly inspected for compliance with ECD services and to promoting the healthy development registration standards. Yet available data show that all of children. Once standards have been established, it is existingcentersmeetinfrastructureandservicedelivery critical that mechanisms are put in place to ensure standards and that all ECCE service providers are compliancewithstandards. qualified. Thus, it is difficult to reflect the existing ECCE institutions comply with established standard for situation at the point of service delivery. The GoB is childͲtoͲteacher ratios. Table 13 displays average childͲ encouraged to strengthen the monitoring and analysis toͲteacherratiosandaveragegroupsize,asreportedby system to ensure compliance with established the National Statistics Institute of Bulgaria. The average standards. ECCE center has one teacher for every 11 children, which meets the international standards for best   practice. Table13:AverageteacherͲtoͲchildratiosandgroupsize inECCEcenters  AverageteacherͲtoͲchildratio AveragechildͲtoͲteacherratio 1:11 Averagegroupsize/classsize 24 Numberofcentersthatmeet 2112 constructionstandards Source:NationalStatisticsInstituteofBulgaria,2012.  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  29 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  PolicyOptionstoMonitorandAssureECD modalitiesofECCEcenterstoensurethatallestablished standards are actually met. Increasing the capacity of QualityinBulgaria local inspectorates to regularly monitor standards ƒ–ƒƒ˜ƒ‹Žƒ„‹Ž‹–› compliance is advisable to ensure that all existing ECCE centers are delivering quality learning opportunities to ¾ Enhance coordination of sectors involved in data youngchildreninBulgaria. collection for ECD services. Given the decentralized institutional arrangement in Bulgaria and recognizing ComparingOfficialPolicieswithOutcomes that essential ECD data come from a variety of sources, mechanisms to connect this information are essential. The existence of laws and policies alone do not always Comprehensive data collection can promote effective guarantee a correlation with desired ECD outcomes. In policyͲmaking, allowing for improved decisionͲmaking. many countries, policies on paper and the reality of Ensuring coordination and consistency of data from all access and service delivery on the ground are not sectors is crucial if the GoB is to measure the impact of aligned.Table15comparesECDpoliciesinBulgariawith its investments and guarantee that all children are ECD outcomes. Some policies reflect the reality for provided with the essential and/or targeted services someECDinterventions,suchaspreͲprimaryeducation, they need. In addition, data are not available to assess immunizations, and birth registration. On the other access by children’s socioͲeconomic status. Survey data hand,thelowrateofexclusivebreastfeedingandaccess are not also available consistently. The GoB could to completely free preͲprimary education do not seem consider the establishment of an improved integrated toalignwiththerespectivepolicies. monitoring and evaluation system that would help Table15:ComparingselectECDpolicieswithoutcomesin guarantee that eligible beneficiaries receive the Bulgaria appropriate services. Box 7 provides an example from ECDPolicies  Outcomes Chile, where a comprehensive information system has  GrosspreͲprimary alreadyproveneffective. Policyguaranteestheprovisionof schoolenrollment: preͲprimaryeducation 83% —ƒŽ‹–›–ƒ†ƒ”†•Ƭ‘’Ž‹ƒ…‡™‹–Š–ƒ†ƒ”†•   Youngchildrenarerequiredto ChildrenwithDPT3(12Ͳ ¾ Improve qualifications of ECD caregivers for receiveacompletecourseof 23months): children ages 0Ͳ3 in nurseries. Staff working in childhoodimmunizations 95%  nurseries should have basic training on ECD milestones  Completenessofbirth and pedagogy as a precondition to be enrolled for the Policymandatestheregistration registration: position. The university training for nurses who are the ofchildrenatbirthinBulgaria Almostuniversal(n/a) predominant staff in 0Ͳ3 ECCE is not covering key  aspects of child development, and the inͲservice training that is offered is insufficient to fill the PreliminaryBenchmarkingandInternational knowledge gaps. In the context of serious health ComparisonofECDinBulgaria professional/nurse human resource outflows, Bulgarian On the following page, Table 16 presents the nurseriesshouldopentowelcomepedagogicalstaffand classificationofECDpolicyinBulgariawithineachofthe the early learning and stimulation principles in addition nine policy levers and three policy goals. The SABERͲ tocare. ECD classification system does not rank countries accordingtoanyoverallscoring;rather,itisintendedto ¾ Strengthen quality assurance mechanisms. While share information on how different ECD systems minimum standards and requirements for quality address the same policy challenges. Table 17 presents assurance in health and education sectors are well the status of ECD policy development in Bulgaria developed in Bulgaria, it is highly recommended that alongside a selection of OECD countries. Sweden is monitoring and compliance mechanisms be home to one of the world’s most comprehensive and strengthened. While unannounced inspection visits are developed ECD policies and achieves a benchmarking of reported to take place, no rules and regulations are in “Advanced”inallninepolicylevers. place to establish the terms and frequency of inspections. The GoB should regulate the inspection   SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  30 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Table16:BenchmarkingEarlyChildhoodDevelopmentPolicyinBulgaria   Levelof  ECDPolicyGoal LevelofDevelopment PolicyLever Development  LegalFramework   EstablishinganEnabling InterͲsectoralCoordination   Environment  Emerging  Finance   ScopeofPrograms   ImplementingWidely  Coverage  Emerging  Equity   DataAvailability  MonitoringandAssuring   QualityStandards  Quality Emerging   CompliancewithStandards   Latent Emerging Established Advanced Legend:         Table17:InternationalClassificationandComparisonofECDSystems  LevelofDevelopment ECDPolicyGoal PolicyLever Bulgaria Australia Chile Colombia Sweden Turkey LegalFramework   Establishingan     Enabling Coordination       Environment Finance       Scopeof   Programs     Implementing Widely Coverage       Equity       DataAvailability       Monitoringand Assuring QualityStandards       Quality Compliancewith   Standards     Latent Emerging Established Advanced Legend:  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  31 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013   Conclusion  The SABERͲECD initiative is designed to enable ECD levers are examined in detail and some policy options policy makers and development partners to identify areidentifiedtostrengthenECDareoffered. opportunities for further development of effective ECD Table18summarizesthekeypolicyoptionsidentifiedto systems. This country report presents a framework to inform policy dialogue and improve the provision of compare Bulgaria’s ECD system with other countries in essentialECDservicesinBulgaria. theregionandinternationally.Eachoftheninepolicy Table18:SummaryofpolicyoptionstoimproveECDinBulgaria Policy PolicyOptionsandRecommendations Dimension x ConsiderestablishinganexplicitlystatedcomprehensivemultiͲsectoralECD Policy. x Createinnovativemechanismstopromoteironfortificationoffoodstaples. Establishingan x EstablishacommonplanofactionforECDservicedeliveryatthestatelevel. Enabling x StrengthenECDbudgetcoordinationmechanismsbetweenrelevantsectors Environment involved. x EnsurethelevelofECDfinanceisadequatetomeettheneedsofallchildren andguaranteefreecompulsorypreschooleducation. x Establishmechanismstopromoteandexpandtheprovisionofadequate nutritioninterventionstoyoungchildrenandexpectantmothers. x Considerexpandingearlychildhoodcareopportunitiesforchildrenyounger Implementing than3years. Widely x EnsurethatessentialECDinterventionsareequitableprovidedtopoor children. x FocusingonECD,earlystimulation,andlearninginnurseries. x EnhancecoordinationofsectorsinvolvedindatacollectionforECDservices. Monitoringand AssuringQuality x ImprovequalificationsofECDcaregiversforchildrenages0Ͳ3. x Strengthenqualityassurancemechanisms.     SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  32 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Acknowledgements References This country report was prepared by the SABERͲECD team at the World Bank headquarters in Washington, SABERͲECDPolicyInstrument,Bulgaria2013. D.C. The report presents country data collected using SABERͲECDProgramInstrument,Bulgaria2013. the SABERͲECD policy and program data collection instruments and data from external sources. The report Black, M., S. Walker, T. Wachs, N. Ulkuer, J. Gardner, S. was prepared in consultation with the World Bank GranthamͲMcGregor, B. Lozoff, P. Engle, and M. de HumanDevelopmentEuropeandCentralAsiateamand Mello. 2008. “Policies to Reduce Undernutrition the Government of Bulgaria. For technical questions or IncludeChildDevelopment.”Lancet371:454Ͳ55. comments about this report, please contact the SABERͲ Heymann, J., K. McNeill. 2012. Families at Work: What ECDteam(helpdeskecd@worldbank.org). We Know About Conditions Globally. Policy Brief  prepared for the UN Department of Economic and SocialAffairs.UN,NewYork. Acronyms Loeb, S., M. Bridges, D. Bassok, B. Fuller, and R.W. ECE  EarlyChildhoodEducation Rumberger. 2007. “How Much Is Too Much? The ECCEEarlyChildhoodCareandEducation Influence of Preschool Centres on Children’s Social and Cognitive Development.” Economics of ECD  EarlyChildhoodDevelopment EducationReview26(1):52–66. EUEuropeanUnion Neuman, M. J. 2007. “Good Governance of Early CCCChileCreceContigo(“ChileGrowswithyou”) Childhood Care and Education: Lessons from the 2007 Education for All Global Monitoring Report.” GDPGrossDomesticProduct UNESCO Policy Briefs on Early Childhood.  United GoBGovernmentofBulgaria Nations Educational, Scientific and Cultural ILOInternationalLaborOrganization Organization,NewYork. MoES  MinistryofEducationandScience Neuman, M. & Devercelli, A. 2013. "What Matters Most for Early Childhood Development: A Framework MoF  MinistryofFinance Paper."SABER,WorldBank,WashingtonD.C. MoH  MinistryofHealth Naudeau, S, N. Kataoka, A. Valerio, M. J. Neuman, L. K. MoJ MinistryofJustice Elder. 2011.  Investing in Young Children: An Early MoLSPMinistryofLabourandSocialPolicy Childhood Development Guide for Policy Dialogue and Project Preparation. World Bank, Washington, NCCPNationalCouncilforChildProtection D.C. NHIFNationalHealthInsuranceFund OECD (Organisation for Economic CoͲoperation and NSINationalStatisticalInstitute Development. 2006. “Starting Strong II:  Early OVCOrphansandVulnerableChildren Childhood Education and Care.” OECD Publications, Paris. STDSexuallyͲtransmittedDisease OECD. 2011. “Starting Strong III: A Quality Toolbox for UNESCO        United Nations Educational, Scientific, and Early Childhood Education and Care.” OECD CulturalOrganization Publications,Paris. UNICEFUnitedNationsChildren’sFund World Bank, 2013. SABERͲECD Colombia Country Report. WHO WorldHealthOrganization Available online: http://siteresources.worldbank.org/EDUCATION/Res ources/278200Ͳ1221666119663/saber.html. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  33 BULGARIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013   www.worldbank.org/education/saber  TheSystemsApproachforBetterEducationResults(SABER)initiative producescomparativedataandknowledgeoneducationpoliciesand institutions,withtheaimofhelpingcountriessystematicallystrengthen theireducationsystems.SABERevaluatesthequalityofeducation policiesagainstevidenceͲbasedglobalstandards,usingnewdiagnostic toolsanddetailedpolicydata.TheSABERcountryreportsgiveall partieswithastakeineducationalresults—fromadministrators, teachers,andparentstopolicymakersandbusinesspeople—an accessible,objectivesnapshotshowinghowwellthepoliciesoftheir country'seducationsystemareorientedtowardensuringthatall childrenandyouthlearn.  Thisreportfocusesspecifically on policies in the area of Early ChildhoodDevelopment. ThisworkisaproductofthestaffofTheWorldBankwithexternalcontributions.Thefindings,interpretations,andconclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the partofTheWorldBankconcerningthelegalstatusofanyterritoryortheendorsementoracceptanceofsuchboundaries. THEWORLDBANK SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  33