Nicaraguan Surgical and Anesthesia Infrastructure: Survey of Ministry of Health Hospitals

Abstract

Background

Developing countries have surgical and anesthesia needs that are unique and disparate compared to those of developed countries. However, the extent of these disparities and the specific country-based needs are, for the most part, unknown. The goal of this study was to assess the surgical capacity of Nicaragua’s public hospitals as part of a multinational study.

Methods

A survey adapted from the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical care was used to study 28 primary, departmental, regional, and national referral hospitals within the Ministry of Health system. Data were obtained at the national and hospital levels via interviews with administrators and surgical and anesthesia chiefs of services.

Results

There are 580 obstetrician/gynecologists (OB/GYN), 1,040 non-OB/GYN surgeons, and 250 anesthesiologists in Nicaragua. Primary, departmental, regional, and national referral hospitals perform an annual average of 374, 4,610, 7,270, and 7,776 surgeries, respectively. All but six primary hospitals were able to perform surgeries. Four hospitals reported routine water shortages. Routine medication shortages were reported in 11 hospitals. Eight primary hospitals lacked blood banks on site. Of 28 hospitals, 22 reported visits from short-term surgical brigades within the past 2 years. Measurement of surgical outcomes was inconsistent across hospitals.

Conclusions

Surgical capacity varies by hospital type, with primary hospitals having the least surgical capacity and surgical volume. Departmental, regional, and national referral hospitals have adequate surgical capacity. Surgical subspecialty care appears to be insufficient, as evidenced by the large presence of NGOs and other surgical brigade teams filling this gap.

Appendices

Appendix 1

Appendix 2: Hospital Definitions

The hospitals in Nicaragua may be defined as follows [27].

• Primary hospitals: Health establishments that function as health centers in addition to providing inpatient services in pediatrics, OB/GYN, with an observation service for adults in internal medicine and general surgery. They are typically found in municipalities with primarily rural populations. They usually have 15–40 beds. They provide inpatient and ambulatory services. They provide specialized care in pediatrics and OB/GYN. They usually have general practitioners, a pediatrician, an OB/GYN, dentist, nurses, laboratory technicians, and other health professionals. Sometimes a general surgeon is available if the right conditions and needs are present to perform surgery.

• Departmental hospitals: They have inpatient services with four basic specialties: internal medicine, general surgery, pediatrics (includes neonatology, OB/GYN), and orthopedics. They tend to have more technology and human resources than primary hospitals. They can be qualified to train medical students or nursing students as well as other health professionals.

• Regional hospitals: They have all the capabilities that departmental hospitals have. However, they also provide other medical and surgical specialty services, such as nephrology, dermatology, ENT, ophthalmology, pediatric surgery, intensive care unit, emergency department, and radiology department, among others. They have teaching capabilities and serve as referral centers for departmental hospitals.

• National referral hospitals: They have all the capabilities that regional hospitals have. Additionally, they provide specialty services such as urology, plastic surgery, maxillofacial surgery, orthopedic surgery, neurosurgery, and cardiovascular surgery, among others. They provide definitive surgical care. These hospitals support multiple residency programs.