The Nicaragua Health Care SystemOctober 28, 2016Paul Treadwell
Sandinista priorities and healthcareJuly 1979 Healthcare was one of 4 main priorities for the Sandinistas after the
revolution Defense of the revolution Price supports for basic commodities Education Health
The Unified National Health System was established on August 8, 1979 MINSA established to manage services across the country Consolidated 23 autonomous bureaucracies
The six principles forming the basis of the health system (1979)1. Health is a right of every individual and a responsibility of the State and
the Popular Organizations.2. Health services ought to be accessible to the entire population,
geographically, economically and culturally. 3. Health services should function to integrate the physical, mental and
social dimensions of health and to address the conditions of work and residence as they affect health.
4. Health care ought to be delivered in a multi- professional team effort. 5. Health activities are to be planned. 6. The community ought to participate in all activities of the health
system .
MINISTRY OF HEALTH (MINSA)
Responsible for both regulation and provision of health care services
A national network of 1059 health facilities
17 departmental SILIAS (Sistemas Locales de Atención Integral de Salud /Local Comprehensive Health Care Systems)
Health system levels
32 public hospitals 21 departmental 11 national reference and specialty
28 health centers (with beds) 144 health centers (without beds) 855 health posts Supplemented by community
based networks Home based facilities Casa Maternas
Hospitals
3 hospitals cover the RAAN and RAAS 55% of the national territory
The national average is one hospital per 212,800 persons
Broad resource variation across hospitals
Exterior Hospital Nuevo Amanecer – Bilwi, Nicaragua
Health centers and health posts
Health centers Provide all primary health care
services Staffed by Doctors or nurses pharmacy, basic laboratory,
immunization, mental health, zoonosis, & environmental health services, and some offer dentistry.
Health posts One or two nurses, possibly a doctor Health promotion and disease
prevention
Health post, El Chile, Nicaragua
Community based networks
Almost 4,400 home-based community clinics
33 maternity homes (Casa Materna)
MINSA trained, independent volunteer network 12,700 brigadistas 6,200 midwives 7,100 voluntary collaborators
Interior, Casa Materna, Bilwi, Nicaragua
MINSA Priorities
Maternal mortality. Infant mortality High fertility and birth rates. Chronic infant malnutrition. High prevalence of acute
respiratory illness and diarrheal disease.
High prevalence of endemic diseases, such as malaria, dengue fever, and TB, and increased prevalence of HIV/AIDS.
Elimination of measles, rubella, malaria, and rabies.
High incidence of occupational accidents.
High prevalence of mental health problems.
High rate of disability. Violence-related injuries, morbidity,
and mortality. Chronic disease morbidity and
mortality. Cancer mortality.
Health care and the Atlantic CoastIndigenous and western medicine in the RAAN
MINSA strategies for the Atlantic Coast Bring health services to
communities in extreme poverty and with difficult access
Strengthen intercultural autonomous health models
Promote the traditional health system
Nicaragua’s General Health Law of 2005 Calls for indigenous peoples within the Atlantic Coast regions to be
enabled to develop health methods that are consistent with their traditions and communities. Specifically, provisions state that the RAAN region may define and implement through regulations models of health care according to their traditions and customs of medicine and designate health authorities by methods they adopt.
Nicaraguan law and indigenous medicine on the Atlantic Coast Nicaraguan Constitution (1987)
Article 5 “the State recognizes the existence of indigenous peoples who enjoy the rights, … and guarantees … their identity and culture, to have their own forms of social organization and administer their local affairs, as well as to preserve the communal forms of land property…”
Article 89 “The communities of the Atlantic Coast have the right to preserve and develop their cultural identities within the national unity, to provide themselves with their own forms of social organization, and to administer their local affairs according to their traditions
Article 180 guarantees the right to “live and develop … under the forms of social organization that correspond to their historic and cultural traditions…Furthermore, it guarantees the preservation of their cultures and languages, religions and customs.”
Nicaraguan law and indigenous medicine on the Atlantic Coast Law No. 759, (Ley de Medicina Tradicional Ancestral ) Law of Traditional
Ancestral Medicine addresses equity and access to traditional and ancestral medicine.
Law No. 774, Law of Natural and Complementary Medicine, Therapies, and Natural Products (Ley No. 774, Ley de Medicina Natural, Terapias, Complementarias Y Productos Naturales En Nicargaua ), establishes provisions to promote access and use of natural medicine that includes traditional medicine practices, products and health services. Additionally, Law 774 declares the right of choice in therapeutic care to the Nicaraguan people and outlines regulatory procedures to oversee health care providers, products, and services [14]
Sources
Carrie, Heather, Tim K. Mackey, and Sloane N. Laird. "Integrating traditional indigenous medicine and western biomedicine into health systems: a review of Nicaraguan health policies and miskitu health services." International journal for equity in health 14.1 (2015): 1.
Donahue, John M. "Planning for primary health care in Nicaragua: a study in revolutionary process." Social Science & Medicine 23.2 (1986): 149-157.
Garfield, Richard M., and Eugenio Taboada. "Health services reforms in revolutionary Nicaragua." American journal of public health 74.10 (1984): 1138-1144.
Nicaraguan Constitution (1987) http://www.parliament.am/library/sahmanadrutyunner/Nicaragua.pdf
Sequeira, M., et al. "The Nicaraguan Health System." Seattle, Washington: PATH (2011).
Contact
Paul Treadwell Adjunct Instructor Tompkins Cortland Community College [email protected]
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