Chile , Mexico , Paraguay , Brazil and Argentina
Q&A

Latin America is 40 years behind in hospital infrastructure

Bnamericas Published: Wednesday, April 22, 2020
Latin America is 40 years behind in hospital infrastructure

With the emergency caused by COVID-19, the governments of several Latin American nations have turned their attention to the construction of hospitals, such as Paraguay, which is now finishing a contingency hospital that took 25 days; Chile, which is accelerating investments of more than US$2bn in this area; Argentina, which is building 12 modular hospitals; and Brazil, which has erected field hospitals.

Against this backdrop, BNamericas spoke to Guillaume Corpart, managing director of consultancy Global Health Intelligence, about the state of the region's hospital infrastructure in the face of this pandemic and other long-term challenges.

BNamericas: How was the response of Latin American hospital infrastructure to previous epidemics such as H1N1 and Zika?

Corpart: During the H1N1 pandemic I was living in Mexico and at that time the entire country was completely paralyzed. The cessation of activity at that time was much faster than the reaction to COVID-19.

Regarding the response of the health system, it should be noted that these are two extremely different situations. In the case of COVID-19, we are demanding a very different level of response, at a level that hospitals and health authorities have never seen before.

Suddenly there's a lot of pressure on installed capacity, and I feel like we're really pushing the limits of our response to that demand.

If we classify countries in terms of response level, Chile appears extremely well positioned or better equipped than others, but Brazil stands out for the number of mechanical ventilators, not only in total numbers, but also in per capita quantities, which is between 20 and 25 for every 1,000 people, while the rest of the region has about half that figure.

It may be that this difference has come about due to Brazil's experience with Zika or other epidemics. In the rest of the region, on the other hand, we have seen that the stock of ventilators has decreased and they haven't invested much.

However, the Brazilian health system has been under a lot of pressure in the last five years due to the country's economic situation.

BNamericas: Amid the COVID-19 emergency, several Latin American countries have built contingency hospitals in a relatively short period of time. Do you think the region should rethink the investment models that it has used to implement hospitals?

Corpart: Before thinking about designing or creating new hospitals, there's a question about how we're using the current infrastructure. What we're seeing today is that communicable diseases of community transmission have grown, and hospitals are designed for the needs we had 40 or 50 years ago; therefore, it's necessary to rethink the needs of the current health system and the needs for the future.

Latin America is one of the regions with the fastest aging population. We're going to have a high proportion of elderly between now and in 10-15 years' time. The health system must be able to respond to those needs for which it isn't prepared at present.

We must ask ourselves how we're structuring the health system to meet the needs of today and tomorrow, and how we can create more intrahospital collaborations. For example, in Mexico there are 14 public health agencies and all of these are groups of public hospitals that don't speak to each other and, apart from this, the private system does whatever it wants, so in emergencies like COVID-19, the big problem is that there's a completely disjointed health system.

BNamericas: If there's a 40-year delay in infrastructure, how much would it cost to close that gap?

Corpart: It's more a matter of mindset. We have the capacity and technology to do it, but it has a fairly high cost of leadership and political capital. We can be much more resource-efficient.

BNamericas: In that sense, Chile is promoting a US$2.5bn program in hospital public-private partnerships. Is this a viable mechanism at a time when infrastructure is urgently required?

Corpart: That type of model is very interesting and in that sense Chile stands out for the type of hospital infrastructure it has, since it's very similar to hospitals that we see in Europe or the US in terms of size and number of medical specialties that they have.

On average they have 100 or 110 beds per hospital, compared to the regional average of 47 per hospital.

That also gives us an indication of the ability of hospitals to develop critical infrastructure. For example, a scanner that costs around US$1mn is very difficult to acquire for a 40-bed hospital; it's not easy to justify that investment. However, a 100-bed hospital may have the necessary patient flow to be able to justify a purchase like that. Many capital investments depend on the flow of patients.

BNamericas: Do you think COVID-19 will mark a before and after in planning investment in hospital infrastructure?

Corpart: I hope so. I hope it helps to change the mindset. It's not just about resources, it takes a mindset for execution. If there's one thing that can be learned from the COVID-19 pandemic, it's precisely this: looking for ways to leverage investments so that they yield and help to correct public health issues in the long term.

BNamericas: There's a lot of talk about investments in large hospitals, how could you be more efficient in investments in medical infrastructure in more isolated communities that don't require such large facilities?

Corpart: In telemedicine, there's a lot of talk about two types of sites: specialty centers and satellite sites. In the latter, it doesn't necessarily have to be a hospital, it may even be a private home that has the technology to connect with the specialty center. It can be from a school to a prison.

Today, telemedicine infrastructure can specifically help more remote communities where a highly complex hospital isn't needed. It's about finding how to leverage these resources and increase the flow of patients without necessarily having more beds.

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