The document summarizes the Nicaraguan health care system. It describes how health care was a top priority after the 1979 revolution and how the Unified National Health System was established. The system is based on six principles including health as a right and community participation. The Ministry of Health manages over 1000 facilities across different levels including hospitals, health centers, posts, and community networks. The system focuses on reducing mortality and addressing endemic diseases, with tailored strategies for indigenous communities on the Atlantic Coast that recognize traditional medicine.

1. The Nicaragua Health Care
System
October 28, 2016
Paul Treadwell

2. Sandinista priorities and healthcare
July 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

3. 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 .

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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.

10. Health care and the Atlantic Coast
Indigenous and western medicine in the RAAN

11. 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

12. 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.

13. 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.”

14. 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]

15. 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).

16. Contact
 Paul Treadwell
 Adjunct Instructor
 Tompkins Cortland Community College
 pt006@tc3.edu