Home-visiting nurse Nina becomes a local hero

Five days a week, six family visits a day and more than 1,000 family visits a year: Nina Dimova is a local hero for children and families in Sliven region, in central Bulgaria.

Nina is one of only 12 home-visiting nurses from the Centre for Maternal and Child Health in the region, which has a population of almost 176,000 people. The nurses visit pregnant women and families with young children, and provide an extended package of support to families facing challenges.

Many of the families Nina works with tell her that she makes them feel more comfortable and secure. Margarita, for example, works on a stall at Sliven’s street market. She carries her third child, Maria, in her arms all day while she works, and this was affecting the girl’s motor skills. Since receiving advice from Nina on this, as well as on immunization, nutrition, inclusive breastfeeding, early learning activities and the need to limit Maria’s screen time, Maria’s health and development has improved.

Another mother, Daniela, from the village of Zhelyu Voyvoda in the Sliven region is full of praise for Nina, saying,

"Nina Dimova is part of my family. I thank her for being by our side in the first and most important moments since the birth of our son, Brian. And now she continues to support us in all matters related to his upbringing. She brings us hope in the most difficult moments."

Nina attributes the success of her work to two key principles: providing clear, evidence-based information to every parent at a pace that works for the family and that aligns with their own priorities, and building strong personal attachments. She believes that the bond between parents and their children is crucial, and that every parent needs timely support to ensure the best start in life for every child.

“When you see that you are valuable to others, this makes you feel in a strange way – the tiredness goes away, and I am ready to welcome the next day and visit more homes”, explains Nina.

“When I started working, however, my basic training as a midwife was not enough to conduct open conversations with parents, and gain their trust”, she says.

Nina recently took part in a UNICEF-supported training session where she gained the skills to train other home visiting nurses. Thanks to the programme – funded by CRH, a private sector company – she is now a home-visiting nurse trainer.

“I did not know how to convey understandable messages about the importance of a healthy lifestyle, self-care, the preventive measures, and the significance of parental communication and play. There are still many harmful practices in families – early or improper weaning, and a fear of vaccines. There are also harmful practices like salting the baby [the traditional practice of sprinkling a newborn baby with coarse salt, which can have serious risks] uncontrolled screen time, and lack of engagement with babies and young children.

“It was really difficult for me to provide positive messages to parents in an understandable way and bring a positive perspective when working with families who face multiple risks. These include environments of violence and extreme poverty, where harmful practices are often the most prevalent and the children are the most vulnerable.

“Our country is now discussing the model of home-visiting care and the need for quality basic training, and I am very happy that along with a few university lecturers, my colleague Kalina and I managed to complete the training for trainers. As one of the few practicing nurses, I believe I will be able to connect practice with basic training.”

A group of trained academic lecturers and practicing home visiting nurses, funded through the CRH and UNICEF partnership, is now working to create a national basic training programme for future home visiting nurses.

“I personally know how high the expectations are,” says Nina, “especially in families where there are no other services, and how essential it is to meet these expectations adequately.”

“Thanks to this training, within this year we will work to complete the guide and training programme for my future colleagues. This means that many more families will receive evidence-based advice and more adequate support. They may also gain confidence to eradicate harmful practices, and spend more time with their children.

“As a result of the training in the next five years, I believe that we will support more than 250,000 children and their families to thrive, and to live longer and happier lives.”