|
Nicaragua Health
Like education, health care was among the top
priorities of
the Sandinista government. At the end of the Somoza era,
most
Nicaraguans had no access or only limited access to modern
health
care. Widespread malnutrition, inadequate water and
sewerage
systems, and sporadic application of basic public health
measures
produced a national health profile typical of impoverished
populations. Enteritis and other diarrheal diseases were
among
the leading causes of death. Pneumonia, tetanus, and
measles,
largely among children less than five years old, accounted
for
more than 10 percent of all deaths. Malaria and
tuberculosis were
endemic.
By the beginning of 1991, twenty-eight persons had
tested
positive for the human immunodeficiency virus (HIV) that
causes
acquired immune deficiency syndrome (AIDS), and eight of
those
individuals had died. These figures were low in comparison
with
neighboring countries, but health officials regarded them
as
accurate because the government had conducted an
aggressive
search for HIV among prostitutes, blood donors, and
tuberculosis
patients in the late 1980s. The same officials cautioned
against
complacency toward AIDS. A large number of sexually
transmitted
diseases was reported in Managua and Bluefields, and if
HIV were
introduced into groups with multiple sex partners, AIDS
cases
would rise rapidly.
Nicaraguans depend on a three-tier health system that
reflects the fundamental inequalities in Nicaraguan
society. The
upper class uses private health care, often going abroad
for
specialized treatment. A relatively privileged minority of
salaried workers in government and industry are served by
the
Nicaraguan Social Security Institute. These workers and
their
families compose about 8 percent of the population, but
the
institute devoured 40 to 50 percent of the national health
care
budget. The remainder of the population, approaching 90
percent,
is poorly served at public facilities that are typically
mismanaged, inadequately staffed, and underequipped.
Health care
services are concentrated in the larger cities, and rural
areas
are largely unserved. In fact, the Ministry of Health,
which has
sole responsibility for rural health care, preventive
health
care, and small clinics, received only 16 percent of the
health
budget, most of which it spent in Managua.
In the early 1980s, the Sandinista government
restructured
and reoriented the entire health care system. Following a
recommendation made by AID in 1976, authorities combined
the
medical functions of the Ministry of Health, the
Nicaraguan
Social Security Institute, and some twenty other
quasi-autonomous
health care agencies from the Somoza era into a unified
health
care system. Within a few years, spending on health care
was
substantially increased, access to services was broadened
and
equalized, and new emphasis was placed on primary and
preventive
medicine. During this period, the number of students
annually
entering medical school jumped from 100 to 500, five new
hospitals were built (largely with foreign aid), and a
national
network of 363 primary care health clinics was created.
With help
from the United Nations Children's Fund (UNICEF), 250 oral
rehydration centers were established to treat severe
childhood
diarrhea, the leading cause of infant deaths, with a
simple but
effective solution of sugar and salts. The Ministry of
Health
trained thousands of community health volunteers (health
brigadistas) and mobilized broad community
participation
in periodic vaccination and sanitation campaigns.
The expansion of access to health care was reflected in
a
doubling of the number of medical visits per inhabitant
and a
reduction from 64 percent to 38 percent in Managua's share
of
total medical visits between 1977 and 1982. These early
years
also saw a substantial drop in infant mortality and
reductions in
the incidence of transmittable diseases such as polio,
pertussis,
and measles.
In health as in education, some of the ground gained in
the
early 1980s was lost during the second half of the decade.
Health
care activities, including vaccination campaigns, had to
be
curtailed in regions experiencing armed conflict. The
health care
system was flooded with war victims. Among an increasingly
impoverished population, children especially grew more
vulnerable
to disease. But the steep economic decline and tight
budgetary
restraints of the period resulted in severe shortages of
medicines and basic medical supplies. In addition,
deteriorating
salaries drove many doctors out of public employment.
Despite the problems of the late 1980s, however, the
Sandinista decade left behind an improved health care
system.
According to a 1991 AID assessment of Nicaraguan
development
needs, the Chamorro government inherited a health care
system
that emphasized preventive and primary care; targeted the
principal causes of infant, child, and maternal mortality;
provided broad coverage; and elicited high levels of
community
participation. The AID report noted the effectiveness of
the oral
rehydration centers, the wide coverage of vaccination
campaigns,
and the key role of the health brigadistas, three
programs
maintained by the new government. The report concluded
that the
major problem of the health sector was lack of budgetary
resources.
Data as of December 1993
|
