Number and distribution of inpatient beds per 10,000 population
The number of inpatient beds available relative to the total population for the same geographical area. This includes total hospital beds (for long-term and acute care), maternity beds and pediatric beds, but not delivery beds. Data on maternity beds can also be used to calculate the density of maternal beds per 1000 pregnant women per year. Public and private sectors are included.
This indicator is calculated as:
(Number of inpatient beds / Total population for the same geographical area)
The ratio can be adjusted to per 10,000 population by multiplying the numerator and denominator by the same factor required for the denominator to equal 10,000.
This indicator is selected from the list of core indicators in the WHO Health System Strengthening (HSS) Handbook. For more background on the process and criteria used in developing the WHO Handbook of indicators for HSS and for details on this and related indicators, see WHO (2010) USAID (2009); and The Global Fund (2009).
District and national databases can provide the number of beds. Facility censuses may be required to obtain the number of private, non-governmental and community-based facilities, especially if there is no enforced registration system. Where a full-scale census of facilities may not be feasible or in order to validate census findings, a comprehensive facility survey instrument called the Service Provision Assessment (SPA) has been developed by USAID and Macro International Inc. to be used with nationally representative samples of health facilities to provide information on the characteristics of health services, including their quality, infrastructure, utilization and availability. The WHO service availability and readiness assessment (SARA) is specifically designed to assess, map and monitor service availability and readiness. For more details on the SPA and SARA, see WHO (2010) and MEASURE DHS (2011). Data can be disaggregated by type of facility, districts, urban/rural location, and, where data are available, by area income median or quintiles and other demographic and socioeconomic factors.
District and national databases; facility censuses; facility surveys, such as the SPA and SARA
This standardized indicator measures levels of access to hospital inpatient services by the designated populations, can be used to identify underserved areas, and will allow comparisons within and between countries, regions, sectors, and programs. Moreover, data from multiple time points will allow for monitoring progress in scaling-up health services and overall HSS (WHO, 2010). The primary aim of HSS is to improve access, quality, and utilization, and growing evidence shows that health systems capable of delivering services equitably, efficiently, and in a coordinated manner are essential for achieving improved health outcomes. There has been a shift in the global health agenda from focusing on disease-specific approaches to emphasizing HSS to improve the effectiveness of national and district-level health ministries and programs. This indicator can contribute to monitoring progress in the Millennium Development Goals #4. Reduce child mortality; #5. improve maternal health; and #6. combat HIV/AIDs. The usefulness of this indicator, as with all of the indicators in the WHO HSS toolkit, will be enhanced and better understood through continued research and utilization of the information that they generate.
Two closely related inpatient indicators are (WHO, 2010):
1. Average length of stay: an indicator of quality and efficiency of health services.
2. Bed occupancy rate: an indicator of efficiency of services.
The size of hospitals and numbers of inpatient beds may vary considerably making comparisons difficult and, when smaller geographical units such as districts are analyzed, the population may not necessarily use the hospitals in the designated area. Consequently, comparisons of numbers of available inpatient beds between districts and subpopulations need to be done with caution.
Indicators of service availability cannot accurately reflect access to and utilization of services. For example, clients may avoid use of local hospitals or may use ones that lie outside the immediate catchment area because of travel logistics, sociocultural preferences and perceptions of quality. Urban areas present a particular challenge because, although hospitals may be close in proximity, issues of affordability and acceptability become more important obstacles to access (WHO, 2010).
access, health system strengthening (HSS)
The Global Fund, 2009, Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengthening, http://www.hivpolicy.org/Library/HPP000485.pdf
MEASURE DHS. 2011, Service Provision Assessments (SPA) Survey Overview, DHS Website. http://www.measuredhs.com/What-We-Do/Survey-Types/SPA.cfm
USAID, 2009, Measuring the Impact of Health Systems Strengthening, A Review of the Literature, Washington, DC: USAID. https://www.researchgate.net/publication/274064201_Measuring_the_Impact_of_Health_Systems_Strengthening_A_Review_of_the_Literature
WHO, 2010, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies, Geneva: WHO. http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf