Guatemala, with a population of 12,755,366 in 2008, had a gross national income per capita of $2680 and is considered a middle-income country by the World Bank (http://data.worldbank.org/indicator/NY.GNP.PCAP.CD, accessed on 1 September 2010). Guatemala is divided into 22 departments, which are further subdivided into 10-29 municipios (similar to counties), made up of multiple communities. The Guatemalan Ministry of Public Health and Social Welfare (MSPAS) provides free healthcare in several different settings, including hospitals, health centers, health posts, and outreach centers. Hospitals and health centers are staffed by physicians and nurses, whereas health posts are staffed by nurses. Outreach centers provide preventive and primary healthcare but are only visited by trained medical staff a few days each month. In addition to the MSPAS facilities, formally-employed workers who contribute to the Guatemalan Institute of Social Security (IGSS) can receive healthcare from IGSS hospitals and health centers, which are concentrated in Guatemala City. Other non-governmental locations where people may seek healthcare are private hospitals and clinics, pharmacies, drug shops, and traditional healers and midwives. Communities in Guatemala vary in their access to healthcare depending on their size and location (e.g., urban vs. rural).