Case Study of Nicaragua - Medical Devices and Biomaterials for the Developing World - page 42

Table 3.8 Population served by Nicaragua's health facilities

% of health
care facilities

Density
(per 100 k) Facility Total Population served a

Health post 890 80.47 15.4977 6,000

Health center 158 14.29 2.7513 36,000

District hospital 26 2.35 0.4527 221,000

Provincial hospital 26 2.35 0.4527 221,000

Regional hospital 6 0.54 0.1045 957,000

a Rounded to the nearest 1,000 people

referral level hospital is described as a “hospital at a district level,” or a facility that
serves 50,000-500,000 people. The densities of the five facility types in Nicaragua
are reproduced in Table 3.8 for emphasis.
Based on the population served by health facilities in Nicaragua, health posts
correspond to the UNICEF “primary health care center.” District hospitals and pro-
vincial hospitals fall squarely in the population range for the first level referral hos-
pital. For simplicity, we will include health centers in this category as well (they
have significantly more equipment than rural health posts). Because more than 99%
of Nicaraguan health facilities (according to Table 3.8 ) can be classified as one of
the two facilities defined by UNICEF, the UNICEF planning guidelines serve as an
appropriate source for the ideal inventory of the Nicaraguan hospitals under study.
The MTS calculation method outlined in Chap. 2 can be applied here.
For the purpose of demonstration, a hospital that could be classified as a district/
provincial hospital would serve as the optimal model. Of the 22 general (non-
specialty) facilities listed in Table 3.7 , 5 are classified locally as regional hospitals
(MINSA), and 5 have been excluded from our analysis. The remaining 12 hospitals
are somewhat diverse with regard to geographic location, private/public status, and
level of inventory detail. Given the regional disparities discussed above between
health facilities on the Pacific Coast and those on the less populous Caribbean Coast,
a comparison of two facilities in close proximity to one another is more equitable
and will yield more meaningful results. For this example, two such hospitals are
considered: Hospital Alemán Nicaragüense (230 beds) and Hospital Roberto
Calderon (250 beds), which are both public hospitals located in Managua (Wheeler
et al. 2001; SODI 2011). They will hereafter be referred to as HAN and HRC,
respectively. A more expansive version of the MTS model faces the challenge of
accounting for geographic and demographic differences among a much larger and
more varied set of facilities.
For the two hospitals chosen, the electro-medical portion of the inventory was
first translated. Each item was assigned its GMDN number using the WHO “Medical
Devices by Health Care Facility” document. Several of the devices in both invento-
ries were not listed in the WHO document, and their GMDN codes are omitted in
Table 3.9 .