Health care unions in Bulgaria have addressed psychosocial risks and violence and harassment at work in agreements dating back to 2013, when the first clauses on psychosocial risks and violence and stress at the workplace were included in the health sectoral collective agreement since 2013, including TPVH. Despite some progress in implementing policies and procedures to prevent TPVH in collective bargaining, unions report that there have been higher levels of violence and harassment. A high-profile national campaign amongst unions and civil society organisations has called for the ratification of C190, including stronger laws and obligations on employers. A sectoral CBA between the Bulgarian national health insurance fund, the Union of Civil Servants and the Federation of Health Care Unions, 14 May 2015, states that the employer shall protect the dignity and honour of the employee during the performance of their duties within the labour contract (Art. 12, para. 5). The employer shall undertake all measures provided by law – inclusive of providing legal protection against moral or physical violation against the employee during the time of performing labour duties as per the labour contract (Art. 6). During the pandemic Bulgarian Federation of Health Services successfully concluded an agreement for a CBA entitling workers to holidays and treatment in a sanatorium after illness. Unions have recommended that the renewal of the 2015 agreement should include new clauses on prevention and psychosocial risks, in response to the worsened conditions faced by health workers and rising levels of TPVH, exhaustion and burnout during the pandemic.