Reducing infant mortality inequities through Integrated Digital Child Health Model: early evidence

Background

Infant mortality rates (IMRs) are key indicators of health equity. Bulgaria’s Southeast Region (SER) has long recorded the highest IMRs in the EU, alongside marked urban–rural disparities in paediatric access. To address these inequalities, an EU-funded territorial investment (BG16FFPR003-2.001-012) launched an Integrated Child Health Model in 2024. This abstract presents early implementation results and initial lessons from the first year of operation.

Description of the intervention

The project spans the four SER districts and combines digital infrastructure with service redesign. In 2025, 5G connectivity was deployed across 34 remote settlements, complemented by 5G-equipped mobile units and ambulances enabling real-time consultations. Ten stationary health centres were established, alongside a 24/7 hotline linked to the new regional children’s hospital opened in 2026. Multidisciplinary teams received targeted training to support integrated care delivery. The governance framework brings together municipalities, regional health authorities, educational institutions, NGOs and the Ministry of Health.

Results

A regional monitoring framework tracks utilization, referrals, emergency response and preventive coverage. In the first 6–12 months, paediatric consultations in targeted rural areas rose by 25–30%, avoidable tertiary transfers fell by ∼15%, and referral times decreased by nearly 20%. Preventive visit coverage increased by over 10% in underserved settlements.

These early findings suggest reduced geographical disparities in access to child health services. Longer follow-up is needed to assess impact on IMR.

Conclusions and lessons learned

Implementation is ongoing and further lessons will emerge. One conclusion is clear – digital infrastructure alone does not produce equity gains unless combined with workforce capacity-building and coherent territorial governance. The model is scalable to other EU regions through adaptive, data-informed governance.

Key messages

• This presentation shares first-year implementation evidence from the innovative integrated child health model in Southeast Bulgaria, highlighting early equity impacts and lessons learned.

• Digital infrastructure advances equity only when paired with workforce capacity and coherent territorial governance; this integrated model is scalable across EU regions.