Intensive Care

Virtually every country has a private health sector, which is often divided into charitable facilities (usually faith based) and for-profit facilities.

Virtually every country has a private health sector, which is often divided into charitable facilities (usually faith based) and for-profit facilities. In much of Latin America and the Caribbean, multiple systems work in parallel: a public system for the poorest; a system serving those with insurance usually derived from salaried employment; and a private sector for the more affluent segment of the population (Lebrun and others 2012; Solis and others 2013).

In India, where the private sector accounts for 78 percent of health expenditure (Kumar and others 2011), the supply of medical school graduates is large, and in some places, excessive. In Sub-Saharan Africa the private health sector is much smaller but is growing rapidly, as is the supply of graduate doctors. In both South Asia and Sub-Saharan Africa, no matter how large the supply of doctors, persuading physicians, especially specialists, to work in rural areas or to serve the poor majority in the cities has been difficult. In Latin America and the Caribbean, the number of physicians is much higher, and many first-level hospitals, even in lower-middle-income countries such as Bolivia and Nicaragua, have specialists (Lebrun and others 2012; Solis and others 2013).

In many Sub-Saharan African countries, mission hospitals (faith-based) can offer to serve as the district (first-level) hospital for a specified area. In Tanzania, for example, if accepted as a “designated district hospital,” these faith-based hospitals receive government support for salaries and supplies, and the government does not provide another first-level hospital for that area.

Everywhere, almost all of the second- and third-level hospitals act as first-level hospitals for local emergencies.

Table 12.3 presents the surgical volume and procedures in the same hospitals described in table 12.2. The detailed information presented in these tables is not available on a national scale for any of these countries, but the selected hospitals are probably typical for Latin America and the Caribbean, South Asia, and Sub-Saharan Africa. In Tanzania, private (usually faith-based) hospitals that have become designated district hospitals often have several surgical specialists on staff, and some of them have a larger number of nurses. Second-level hospitals are meant to be referral hospitals, but many in Sub-Saharan Africa have few or no surgical specialists and primarily function as larger first-level hospitals (Sanders and others 1998; Siddiqi and others 2001). South Asia has more physicians and specialists for a given population than Sub-Saharan Africa and Latin America and the Caribbean countries usually have many more than other LMIC regions. In Latin America and the Caribbean, this larger professional force is reflected in adequate (even excessive) numbers of physicians and specialists in small first-level hospitals (Lebrun and others 2012; Solis and others 2013).