Bulgaria taps EU Recovery Plan to curb record-high stroke mortality

Bulgaria will establish six high-tech stroke treatment centres in the country’s largest cities to reduce its record-high stroke mortality, with the project to be financed through EU funds under the Recovery Plan, the Sofia health ministry told Euractiv.

One of the EU’s poorest member states, Bulgaria, struggled for years to absorb money from the Recovery Plan, which the European Commission had blocked due to delayed reforms. In 2025, Brussels released the funding, and health authorities in Sofia say they are confident that the €110 million stroke-treatment project will be implemented.

In an interview with Euractiv, Associate Professor Dr Rosen Kalpachki, founder and head of the largest specialized stroke treatment centre in Bulgaria, based at Sofia’s St Anna’ hospital and treating nearly 30% of all patients annually, paints a bleak picture of the country’s stroke statistics.

Grim statistics

“Bulgaria has an enormous mortality from stroke, and things are not changing for the better. Four times more people in the country die from stroke compared to the average European level,” Dr Kalpachki said.

He added that in a country of 6.4 million, around 45,000 people suffer a stroke every year. Still, the actual number of cases, including those who never reach a hospital, is unknown, as Bulgaria has no national stroke registry.

The EU-funded project aims to drastically improve rapid access to modern stroke treatment, adhering to the so-called ‘golden hour’ standard. If a patient receives treatment within the first hour, their condition is fully reversible.

Dr Kalpachki noted that Bulgaria has poor stroke prevention, which contributes to the high incidence of the disease. The construction of modern centres and faster access are aimed solely at improving treatment.

“In Bulgaria, only 4% of patients receive modern stroke treatment, compared to at least 15% on average in Europe,” the leading specialist said. He pointed out, however, that even within this grim picture, Bulgaria has seen some progress.

“We still have some good practices. Besides our centre at the St Anna hospital, which over the past ten years has treated almost one-third of all patients – about 30% of Bulgaria – there are now other treatment centres in the country. This has allowed us to reach 4% of patients receiving modern treatment. A few years ago, we started from 0.5%,” he said.

Improving access

According to him, the greatest benefit from the Recovery Plan funding will be for people living outside the capital, who currently lack access to modern and rapid treatment.

“These six centres cannot change the statistics dramatically, but first of all, they will make modern stroke treatment much more accessible and fair for the rest of the Bulgarian population. Providing modern treatment only in Sofia is not enough,” he said.

A second significant benefit is that many doctors outside Sofia will gain access to training and modern equipment. In October 2025, leading specialists in neurosurgery, neurology and psychiatry proposed the creation of a national plan to improve brain health in Bulgaria, with a horizon to 2030.

“The aim of the National Plan for Brain Diseases is prevention, early diagnosis, high-quality and high-tech treatment, and ongoing rehabilitation and support for patients with brain disorders,” said Prof Dr Nikolay Gabrovski, neurosurgeon and chair of the Brain Health Council Foundation.

Implementing the plan’s measures will require an additional €100 million annually, which can only be provided through the state budget. The plan envisions the establishment of hospitals to meet the enormous need for rehabilitation and care for people who have survived strokes, suffered various injuries, or who have severe dementia – facilities that currently do not exist in Bulgaria.

According to recent data, the economic burden of brain diseases in Bulgaria amounts to 2% of GDP, or nearly €2.5 billion.

[VA, BM]