Oversimplifying the Health Crisis
As Bolivia is currently going through a second wave of coronavirus, it is inevitable to hear criticism directed at the already strained Bolivian healthcare system. The problem with much of this criticism is that it is often nothing more than commentary with a clear political bias, attempting to analyze something as complex as a health crisis in an overly simplistic manner. As a result, such criticism fails to offer constructive feedback or real solutions, as it usually focuses on the lack of hospital construction and argues that this alone is the cause of the health crisis.
In every healthcare system, there are first-level hospitals (medical posts), where patient care is limited to essential services, ranging from basic treatments to mild conditions that can be handled by general practitioners. When an illness or condition becomes more complex, patients must turn to second-level hospitals, where medical specialties such as pediatrics, gynecology, traumatology, and others are available, meaning that physicians already have specialized training.
At third-level hospitals, highly specialized diseases are treated. For example, in a children’s hospital there will be a pediatric cardiologist and a pediatric oncologist; in an eye hospital, ophthalmic surgeries will be highly specialized. In this regard, international health organizations and specialists recommend building such infrastructure according to population size, meaning that a third-level hospital should be built for a population of 75,000 inhabitants.
Hospital construction is an issue that involves extensive planning. This includes identifying an optimal construction site, assessing the size of the surrounding population, determining the amount of equipment required, and, most importantly, evaluating the availability of specialists. The pandemic has made this shortage evident. According to standards set by the World Health Organization (WHO), for every 100,000 inhabitants there should be 10 intensive care units (ICUs), which would imply an optimal total of approximately 1,100 ICUs. In 2018, there were 430 ICUs, not including private clinics or the social security system. However, even if the country had 1,100 ICUs, they could not operate properly because there were only 190 intensivists. This situation is not exclusive to intensive care, but extends to most medical specialties and even to general medicine.
Thinking that the solution to the shortcomings of the healthcare system is simply to build hospitals without further consideration is a mistake. There must be comprehensive planning that combines hospital construction with programs for medical specialization and the provision of equipment to existing hospitals. Given the situation we face today, real criticism and concrete proposals are more necessary than ever. The oversimplification of the health crisis by political actors seeking to gain votes in subnational elections must be set aside.
Author: Walter Marañon Quiñones
