Nicaragua's Health System

main health determinant for Nicaraguans is poverty. 20% of children aged less than 5 years of age are chronically malnourished. Data from the Ministry of Health (MINSA) show that 9% of children are born with low birth weight. Child mortality for all of Nicaragua is 11 per 100 children. This is not equally distributed through the country with Managua having a rate of 8.7 and Jinotega 14 per 100 children.
Child mortality decreased from 79.8 per 1,000 in 1980-1985 to 35.5 per 1,000 in 2000-2005, as has maternal mortality from 125 per 100,000 to 96.6 per 100,000. The young and adolescents represent 25% of the total population. This population is characterised by early sexual activity and a high rate of pregnancy.
The epidemiological transition in Nicaragua is not homogeneous throughout the country due to different socio-economic factors in different regions of the country. In 2000 MINSA reported that the first cause of death was myocardial infarction (16.7%), followed by cerebrovascular disease (15.4%), perinatal mortality (11.5%) and diabetes (11.3%). In 2002 deaths due to chronic diseases represented 37% of the total. Deaths due to communicable diseases fell from 14.5% in 1985 to less than 5% in 2002. For example in 2002 the prevalence of malaria, dengue and tuberculosis were respectively 14.4, 1.9 and 1.8 per 100,000 population.
The Nicaraguan study on disability in 2003 found that chronic conditions were responsible for 67% of disability followed by 12.2% for accidents.
In looking at causes of disability 67% of blindness in Nicaragua is related to chronic conditions and old age. Other large health problems are mental health with 27.9% of the total population with a specific mental disability, 10.3% of the population over 6 years of age has some form of physical disability and 9% of deaths in women are due to cancer.
The role of MINSA is to “regulate, coordinate, organise, supervise and ensure the promotion, prevention, recovery and rehabilitation of health, delivered in a manner that is equitable, efficient, efficacious and of quality in the institutions that are part of the health system involving civil society for the benefit of the population of Nicaragua.”
The health system is organised through a system called “Modelo de Atencion Integral en Salud” (MAIS, Integrated Model for Health Provision), which integrates 3 components: the provision, management and financing of health. It integrates inter and extrasectorial issues around health and the implementation of programmes in an equitable and efficient way for a specific geographic location and population. MAIS also determines the basic package of care in line with the policy of targeting specific priority populations. The basic package of services will be dependent on the financial resources available and the organisation of services. These services will be determined by each “Sistemas Locales de Atencion Integral en Salud” (SILAIS, Local Systems for Comprehensive Healthcare). These organisations represent MINSA with regards to administration and technical aspects at the level of the Departments.
MINSA is also moving forward with a programme of decentralisation and giving more autonomy to hospitals in order to give them more flexibility to takes decisions with regards to resource utilisation and how to best serve the populations they care for.
MINSA is planning to implement a new model for the provision of services in line with the epidemiology of the country and the needs of the population. In parallel there is the need to increase the number of people covered by the Social Security System including people employed in the informal sector of the economy. This will be done through novel ways of insurance and will act in accordance to the economic development of the country.
The total 2006 budget for MINSA was Cordobas 3,282,690,516 (US$ 182,371,695) or Cordobas 638 per person (US$ 35).
Nicaragua’s provision of care is comprised of a public, social security and private sector.
The Nicaraguan Social Security Institute (INSS) delivers medical services to beneficiaries via Medical Service Companies. It is funded through premiums determined by the INSS. These are made up of a 6.25% of monthly salary worker contribution and 15% employer contribution. 8.5% of total income goes to health the remainder covers insurance, pension, etc. Only 6.3% of the population contributes to Social Security. (Approximately 400,000 people, 22% of active population. If the person insured is male, his wife and children under the age of 12 are covered. If the person insured is female, only children under 12 are covered). INSS covers 872 conditions, 331 medicines, 197 surgeries and 105 exams.
INSS contracts medical providers to provide a basic basket of care, which includes medicines, laboratory tests and consultations. For this INSS pays each provider Cordobas 243 (US$ 13.50) per capita per month. 42 medical care providers are contracted throughout Nicaragua. Of the 42, 23 are in Managua.
There are a total of 33 public hospitals in Nicaragua, with a total of 5,256 beds (102 beds per 100,000 population), 2,001 of these beds are located in Managua. 22 of these are general hospitals with the other being specialised in dermatology, psychiatry, gynaecology, oncology, paediatrics, etc.
The Primary level of care is comprised of 843 Health Posts and 177 Health Centres. Nicaragua’s Health Law states that at Health Centres, care for people with chronic diseases should be available.
Nicaragua as many developing countries faces a shortage of human resources and there is an unequal distribution of these resources. The graph below shows the distribution of nurses and doctors throughout the country.
Article 5 of the General Law on Health states that healthcare for vulnerable sectors of the population will be free. This includes diabetes care.
Nicaragua faces many problems with lack of resources, both financial leading to lack of tools for diagnosis and treatment as well and human resources.
In addition to formal health care workers, Nicaragua has developed “Brigadistas”, or community health workers, who are volunteers with a role of being the extension of the health system within the community. They are involved in primary prevention, reporting of deaths and cases of disease within the community and vaccination campaigns.
Child mortality decreased from 79.8 per 1,000 in 1980-1985 to 35.5 per 1,000 in 2000-2005, as has maternal mortality from 125 per 100,000 to 96.6 per 100,000. The young and adolescents represent 25% of the total population. This population is characterised by early sexual activity and a high rate of pregnancy.
The epidemiological transition in Nicaragua is not homogeneous throughout the country due to different socio-economic factors in different regions of the country. In 2000 MINSA reported that the first cause of death was myocardial infarction (16.7%), followed by cerebrovascular disease (15.4%), perinatal mortality (11.5%) and diabetes (11.3%). In 2002 deaths due to chronic diseases represented 37% of the total. Deaths due to communicable diseases fell from 14.5% in 1985 to less than 5% in 2002. For example in 2002 the prevalence of malaria, dengue and tuberculosis were respectively 14.4, 1.9 and 1.8 per 100,000 population.
The Nicaraguan study on disability in 2003 found that chronic conditions were responsible for 67% of disability followed by 12.2% for accidents.
In looking at causes of disability 67% of blindness in Nicaragua is related to chronic conditions and old age. Other large health problems are mental health with 27.9% of the total population with a specific mental disability, 10.3% of the population over 6 years of age has some form of physical disability and 9% of deaths in women are due to cancer.
The role of MINSA is to “regulate, coordinate, organise, supervise and ensure the promotion, prevention, recovery and rehabilitation of health, delivered in a manner that is equitable, efficient, efficacious and of quality in the institutions that are part of the health system involving civil society for the benefit of the population of Nicaragua.”
The health system is organised through a system called “Modelo de Atencion Integral en Salud” (MAIS, Integrated Model for Health Provision), which integrates 3 components: the provision, management and financing of health. It integrates inter and extrasectorial issues around health and the implementation of programmes in an equitable and efficient way for a specific geographic location and population. MAIS also determines the basic package of care in line with the policy of targeting specific priority populations. The basic package of services will be dependent on the financial resources available and the organisation of services. These services will be determined by each “Sistemas Locales de Atencion Integral en Salud” (SILAIS, Local Systems for Comprehensive Healthcare). These organisations represent MINSA with regards to administration and technical aspects at the level of the Departments.
MINSA is also moving forward with a programme of decentralisation and giving more autonomy to hospitals in order to give them more flexibility to takes decisions with regards to resource utilisation and how to best serve the populations they care for.
MINSA is planning to implement a new model for the provision of services in line with the epidemiology of the country and the needs of the population. In parallel there is the need to increase the number of people covered by the Social Security System including people employed in the informal sector of the economy. This will be done through novel ways of insurance and will act in accordance to the economic development of the country.
The total 2006 budget for MINSA was Cordobas 3,282,690,516 (US$ 182,371,695) or Cordobas 638 per person (US$ 35).
Nicaragua’s provision of care is comprised of a public, social security and private sector.
The Nicaraguan Social Security Institute (INSS) delivers medical services to beneficiaries via Medical Service Companies. It is funded through premiums determined by the INSS. These are made up of a 6.25% of monthly salary worker contribution and 15% employer contribution. 8.5% of total income goes to health the remainder covers insurance, pension, etc. Only 6.3% of the population contributes to Social Security. (Approximately 400,000 people, 22% of active population. If the person insured is male, his wife and children under the age of 12 are covered. If the person insured is female, only children under 12 are covered). INSS covers 872 conditions, 331 medicines, 197 surgeries and 105 exams.
INSS contracts medical providers to provide a basic basket of care, which includes medicines, laboratory tests and consultations. For this INSS pays each provider Cordobas 243 (US$ 13.50) per capita per month. 42 medical care providers are contracted throughout Nicaragua. Of the 42, 23 are in Managua.
There are a total of 33 public hospitals in Nicaragua, with a total of 5,256 beds (102 beds per 100,000 population), 2,001 of these beds are located in Managua. 22 of these are general hospitals with the other being specialised in dermatology, psychiatry, gynaecology, oncology, paediatrics, etc.
The Primary level of care is comprised of 843 Health Posts and 177 Health Centres. Nicaragua’s Health Law states that at Health Centres, care for people with chronic diseases should be available.
Nicaragua as many developing countries faces a shortage of human resources and there is an unequal distribution of these resources. The graph below shows the distribution of nurses and doctors throughout the country.
Article 5 of the General Law on Health states that healthcare for vulnerable sectors of the population will be free. This includes diabetes care.
Nicaragua faces many problems with lack of resources, both financial leading to lack of tools for diagnosis and treatment as well and human resources.
In addition to formal health care workers, Nicaragua has developed “Brigadistas”, or community health workers, who are volunteers with a role of being the extension of the health system within the community. They are involved in primary prevention, reporting of deaths and cases of disease within the community and vaccination campaigns.