Resources for health services before the pandemic
IGN (2021): The COVID-19 pandemic in Spain. First wave: from the first cases to the end of June 2020
Monographs from the National Atlas of Spain. New content
This chapter presents the main material and human resources that were available to the health services in Spain before the pandemic. Nevertheless, this is not an easy task: on the one hand, the aim of this publication is not to compile a detailed inventory, so some data have not been included (e.g. data on masks, personal protective equipment, diagnostic determinants, respirators, etc.); on the other hand, the information is dispersed in a large number of sources.
(1) Some hospitals are included in big medical facilities.
Source: Health on Data and National Catalogue of Hospitals 2020. Ministry of Health
Emergency health care also played an important role during the first wave of the pandemic. This service is provided by hospital emergency services, out-of-hospital emergency centres and the coordination of 061 and 112 emergency telephone numbers. The map on Physical resources of out-of-hospital emergency services shows the out-of-hospital emergency centres and the coordination of 061 and 112 emergency telephone numbers.
The first link in the health care chain is the Primary Health Care Centres, which is supported by clinics and health centres. There are 10,080 clinics and 3,051 health centres in total in Spain. This map accurately shows the patterns of the human settlement system: clinics are more present in the Northern Plateau and in mountain areas, as they are ideal for habitats with sparsely populated human settlements, whilst health centres are more present in larger municipalities, i.e. along the Northern coast, along the Mediterranean coast, in the Southern Plateau and in major towns in Aragón and Castile and León (Castilla y León).
There were 837 hospitals in Spain in 2020, which are mapped according to two criteria: Hospitals according to membership and Hospitals according to the purpose of care. According to the membership criterion, 63.2% were public, i.e. they belonged to the National Health System. However, private hospitals had a significant presence in some provinces: around two thirds of hospitals in Cádiz were private, as well as over 50% of them in León, Palencia, Valladolid, Madrid, Málaga, Las Palmas and Santa Cruz de Tenerife. When classifying hospitals according to the purpose of care, acute care hospitals (general and specialised hospitals) were clearly dominant, with an average presence of 70.6% throughout Spain. Medium and long-stay hospitals and mental health and drug addiction treatment hospitals were located in the provinces with the largest amount of population.
Another relevant aspect is the hospital capacity prior to the pandemic. The map on Hospital beds according to membership shows all available beds, including those allotted to intensive care units. The map on ICU beds shows only those in intensive care units (ICU). There were 157,249 hospital beds in Spain towards the beginning of 2020, i.e. a national average of 3.3 beds per thousand inhabitants. The northern half of the country stood out above the national rate, especially the provinces of León, Palencia, Burgos, Gipuzkoa, Saragossa (Zaragoza), Teruel, Lleida, Tarragona and Barcelona. Moreover, the dominance of the public service in the northern half of Spain was clear. 4,915 out of the total amount of hospital beds were allotted to intensive care units (ICU). This means that 3.2% of the total amount of hospital beds were ICU beds at national level. However, it shall be noted that this figure rose to over 4% in the southern half of Spain. 81.5% of the nearly 5,000 ICU beds belonged to public hospitals.
HOSPITAL BED CAPACITY
Hospital beds according to membership 157.249 Hospital beds allotted to ICUs. ICUs with respirator (1) 4.915 Public hospitals 126.801 Public hospitals 4.006 Private hospitals 30.448 Private hospitals 909(1) Not including newbornsSource: National Catalogue of Hospitals and Statistics on Specialised Care Centres. Ministry of Health
With regard to human resources, data from two different sources have been used. On the one hand, the Labour Force Survey from the National Statistics Institute has been used. The Medical Staff and Nursing and Midwifery Staff maps have been drawn up using these data. These maps show the staff by region, making no difference between those working at the National Health System and those working at private health insurances. The National Statistics Institute offers the joint figures for some regions as their disaggregation could have been affected by sampling errors.
(1) Associated doctors and nurses, not including collaborating personnel
(2) Doctors and nurses of 112 and 061 emergency telephone numbers
Source: Statistics portal. Management Intelligence Area. Ministry of Health
On the other hand, statistics from the Ministry of Health on medical and nursing personnel have been used. However, they only include staff working at the National Health System. This data source is not comparable to the above-mentioned National Statistics Institute data source, as it uses a different data collection methodology. Nevertheless, these Ministry of Health statistics do include the different tasks of the professionals: primary care, hospitals and emergency services.
The National Health System medical staff included 131,517 professionals towards the beginning of 2020. 32.5% of these worked in primary care, 65% in hospitals and 2.5% in 112 and 061 emergency telephone number services. The information for this indicator is mapped by region and shows the different rates per thousand inhabitants. The national average is 2.8 doctors per thousand inhabitants. Most of the regions in the northern half of Spain are above the average. Andalusia (Andalucía) and the Canary Islands (Canarias) are the regions with the lowest ratios.
The National Health System nursing staff included 191,452 professionals, distributed unevenly across the above-mentioned three sectors. 78.8% of this personnel worked in hospitals, whilst 19.5% worked in primary care and 1.7% of the staff worked in 112 and 061 emergency telephone number services. The amount of nursing staff follows a very similar spatial pattern to that of doctors: the national average lies by 4.1 per thousand inhabitants, and the regions that exceed this average are in the northern half of Spain.
In addition to human and material resources, another actor that played a crucial role during the first wave of the pandemic shall be mentioned: solidarity. It came from different sources, sometimes driven from above by public and private organisations, sometimes from within society itself, either individually or in groups. It would be preposterous to assess whether the resources that existed prior to the pandemic were proportional to the challenge this new situation presented. It is worth noting that the scale and severity of the impact was very difficult to foresee, so it was necessary to optimise all available resources and to be very diligent in providing new ones in extremely difficult times. It shall be noted that the public authorities and Spanish society in general responded to the challenge of the pandemic with the forces available at the time and with an extraordinary spirit of solidarity.
Co-authorship of the text in Spanish: José Sancho Comíns. See the list of members engaged
Adaptation of the text and translation into English for this international version: Andrés Arístegui Cortijo (Translator in chief)
You can download the complete publication The COVID-19 pandemic in Spain. First wave: from the first cases to the end of June 2020 in Libros Digitales del ANE site.