203:
144:
19:
269:
157:
Health (No. 423) the overall aim of MOSAFC is to establish integrated networks of public and private service providers that work together to harbor the responsibility of addressing the health needs of specific populations. The overarching goals of this framework were to offer more efficient delivery of health services, improve patient satisfaction with services, and advance the financial protection of citizen's health.
100:
professionals. Following the wake of the
Revolution, MINSA promoted several prevention-based health efforts, one of the earliest being its Brigadista program. This Brigadista program involved the training of community health advocates, the majority of whom were chosen from the Sandinista Youth Organization, who were selected to be trained and transported to serve in underserved rural regions.
96:
direction in order to make it financially feasible to provide a single national health service available to all
Nicaraguan citizens, regardless of socioeconomic background. With the combination of these institutions, the INSS hospitals and clinics, previously only accessible to insured employees, then opened their doors to the larger population.
86:
There also existed an unequal distribution of health resources. Only 25% of the total health budget was controlled by the
Ministry of Health, and 90% of the services went to 10% of the population. Even though only a quarter of the population lived in the capital city of Managua, health professionals
189:
is US$ 1,025. Additionally, although 52% of
Nicaraguan doctors are specialized in training, this specialization level fails to meet widespread community needs for primary care. In order to improve the healthcare access of those living in more isolated areas, the public medical schools in Nicaragua
47:
guarantees universal free health care for its citizens. However, limitations of current delivery models and unequal distribution of resources and medical personnel contribute to the persistent lack of quality care in more remote areas of
Nicaragua, especially among rural communities in the Central
74:
health system consisted of four distinct agencies and independent health ministry offices in each province. There was little coordination amongst these institutions, and this system was fraught with provincial differences in salaries, administrative procedures, and more. During this 1970s period,
156:
With the intention of maintaining decentralization while expanding citizens' access to quality healthcare, the
Nicaraguan government implemented a structural framework model entitled the Conceptual Model of Family and Community Health (MOSAFC) in 2007. As determined by Nicaragua's General Law of
256:
by the age of 35 years. A study showed that even when screenings services are adequate, patient follow-up and treatment after abnormal results is of poor quality. A low-cost early detection alternative to PAP smears used in
Nicaragua involves visual inspection of cancerous cervical lesions with
122:
had identified for achieving the goal of health for all. With support from humanitarian agencies and development organizations, NGOs work to meet health care needs that are not met by the country's public health institutions. There is ongoing discussion about the benefits and drawbacks of such
103:
Since the 1990s the
Nicaraguan government has been changing towards more market-oriented economic policies that have affected the health sector. This healthcare shift has involved increased private sector activity as well as the decentralization of public services. Access to privately-operated
95:
After the 1979 Revolution, the new government established a new
Unified National Health System that instated the Nicaraguan Ministry of Health (MINSA) at the head of health services throughout the nation. This system also integrated the Nicaraguan Social Security Institute (INSS) under MINSA's
135:
The current
Nicaraguan public health system follows a decentralized model. This model consists of three distinct administrative levels, each associated with different health services. Levels include (1) the central level, (2) the SILAIS (Local Systems of Comprehensive Care) level, and (3) the
99:
In 1984, in order to improve existing institutional infrastructure, 10% of the national budget was allocated to the health sector. From 1979 to 1984, the government also successfully pushed for the construction of 309 new primary healthcare facilities and the training of over 3,000 health
139:
This decentralized model involves annual contracts between MINSA and local hospitals and health centers that are negotiated to set upcoming specific actions, goals, and funding allocation. The contract system is incentive based, and the amount of federal funding decided upon involves the
140:
consideration of institutional performance. As part of the public sector, the revenue generated from hospitals, healthcare centers, and SILAIS are consolidated and calculated by the Ministry of Finance before redistribution of certain percentages to the original institutions.
104:
healthcare services in Nicaragua may pose challenges for rural communities, influenced by factors including high costs, chronic under staffing, limited diagnostic and pharmaceutical resources, and the remote locations often requiring extended travel to reach such facilities.
238:
have limited contraceptive use. Educational promotion of contraception is generally only conducted by nongovernmental agencies or women's groups, and it is popular belief among many that various forms of contraceptive methods are detrimental to one's health.
190:
require their graduates to perform two years of social service in high-need settings, after which they can opt to work in private institutions. This requirement aligns with MINSA's objective to encourage these graduates to work for the public health sector.
165:
There is an unequal distribution of healthcare workers throughout Nicaragua's different provinces. Most healthcare workers are located on the Pacific coast region, while there is a huge need for primary health professionals in the cities of
193:
Amongst Nicaraguan doctors, there persists a lack of gender diversity. Nicaraguan women are underrepresented in the field of medicine, and within the healthcare field have an unemployment rate that is 3.5 times higher than that of men.
593:
251:
incidence rates in the world and the second highest morbidity rate in Latin America, second only to Haiti. Although screenings are provided through their national public health system, only 35% of women have had a
174:, as well as along the Caribbean coast. In the year 2000, while Managua contained 20% of the population, the city continued to harbor around half of the country's entire health care professionals.
48:
and Atlantic region. To respond to the dynamic needs of localities, the government has adopted a decentralized model that emphasizes community-based preventative and primary medical care.
345:
Birn, A. E.; Zimmerman, S.; Garfield, R. (2000-01-01). "To decentralize or not to decentralize, is that the question? Nicaraguan health policy under structural adjustment in the 1990s".
230:
Lack of use of contraceptives contributes to this high pregnancy rate. Out of all sexually active female adolescents, only 7% utilize condoms and only 47% use any modern method of
318:
Angel-Urdinola D., Cortez R., Tanabe K. (2008). Equity, Access to Health Care Services and Expenditures on Health in Nicaragua. Health, Nutrition and Population of the World Bank.
114:
which encompasses free healthcare services, typically provided by international groups. NGO involvement became common around the year 2000, which is the year that the
177:
This trend can be explained by overall low financial incentives for health care personnel, especially for work in remote areas. The average monthly salary for a
808:
Zelaya, E.; Peña, R.; GarcĂa, J.; Berglund, S.; Persson, L. A.; Liljestrand, J. (1996-12-01). "Contraceptive patterns among women and men in LeĂłn, Nicaragua".
492:
Holland B., Davis J., Syncrisis, G. (1972). The Dynamics of Health, #9: Nicaragua. U.S. Department of Health Education and Welfare. DHEW Pub. No. 74-50007.
136:
municipal level. The Nicaragua Ministry of Health (MINSA) directs the central level and is committed to ensuring universal access to free health services.
891:
Drain, Paul K.; Holmes, King K.; Hughes, James P.; Koutsky, Laura A. (2002-07-10). "Determinants of cervical cancer rates in developing countries".
991:
Vastbinder, M.; Castillo, C.; Bekkers, R. (2010). "Barriers to follow-up of abnormal Papanicolaou smears among women in Leon, Nicaragua".
87:
were disproportionately concentrated there. In 1972, half of all Nicaraguan doctors and more than two-thirds of nurses worked in Managua.
223:. Around half of women in Nicaragua give birth before the age of 20. Approximately one-quarter of all the births in the country involve
332:
Sequeira M., Espinoza H., Amador J. J., Domingo G., Quintanilla M., and de los Santos T. (2011). The Nicaraguan Health System. PATH.
798:
Blandon L., et al. Early childbearing in Nicaragua a continuing challenge, In Brief, New York: Guttmacher Institute, 2006, No. 3.
83:
in the regional area. Both of these measures have improved markedly up to 2016, average life expectancy now reaching 74.5 years.
110:(NGO) have become more active in impoverished communities like Nicaragua. A particularly prevalent example of NGO work is
36:'s health outcomes have improved over the past few decades with the efficient utilization of resources relative to other
202:
732:
Drake, J.; et al. (2011). "Stakeholder perceptions of a total market approach to family planning in Nicaragua".
944:"Determinants of cervical cancer screening in a poor area: results of a population-based survey in Rivas, Nicaragua"
594:"Global health's durable dreams: ethnography, 'community health workers' and health without health infrastructure"
1101:
502:
Donahue, John (2009-02-02). "The Politics of Health Care in Nicaragua before and after the Revolution of 1979".
143:
292:
18:
772:
Nigenda, G. and Machado, M. (2000). From State to market: the Nicaraguan labour market for health personnel,
107:
1096:
1036:"Performance of the acetic acid test when used in field conditions as a screening test for cervical cancer"
632:
483:
Braveman, P. et al. (1985). Primary health care takes root in Nicaragua. World Health Forum. 6, 369–372.
705:
Muiser, Jorine; Sáenz, MarĂa del RocĂo; BermĂşdez, Juan Luis (2011). "The health system of Nicaragua".
551:
115:
670:
Jack, W. (2003). "Contracting for health services: an evaluation of recent reforms in Nicaragua".
119:
44:
40:
nations, it still confronts challenges responding to its population's diverse healthcare needs.
1034:
Claeys, P.; De Vuyst, H.; Gonzalez, C.; Garcia, A.; Bello, R. E.; Temmerman, M. (2003-08-01).
282:
67:
942:
Claeys, P.; Gonzalez, C.; Gonzalez, M.; Page, H.; Bello, R. E.; Temmerman, M. (2002-11-01).
758:
MINSA. (2007). Marco Conceptual del Modelo de Salud Familiar y Comunitario (MOSAFC). MINSA.
287:
178:
124:
111:
8:
515:
234:. A highly tradition-based culture, a conservative government, and the influence of the
1073:
1016:
924:
435:
402:
378:
877:
850:
The World Bank. Effective family planning programs. Washington D.C.: World Bank, 1993.
821:
648:
552:"Looking good but doing harm? Perceptions of short-term medical missions in Nicaragua"
1065:
1057:
1052:
1035:
1008:
973:
965:
960:
943:
916:
908:
833:
825:
741:
714:
687:
652:
613:
571:
519:
440:
422:
370:
362:
297:
224:
1077:
928:
1047:
1020:
1000:
955:
900:
873:
860:
Berglund, S.; Liljestrand, J.; Marin, F. M.; Salgado, N.; Zelaya, E. (1997-01-01).
817:
679:
644:
633:"Cost sharing in health service provision: an empirical assessment of cost savings"
605:
563:
511:
430:
414:
382:
354:
274:
80:
567:
248:
235:
76:
37:
358:
862:"The background of adolescent pregnancies in Nicaragua: a qualitative approach"
216:
609:
467:
347:
International Journal of Health Services: Planning, Administration, Evaluation
1090:
1061:
969:
912:
829:
656:
617:
575:
426:
366:
231:
220:
683:
418:
1069:
1012:
1004:
977:
920:
745:
718:
691:
523:
374:
837:
444:
32:
involves the collaboration of private and public institutions. Although
904:
861:
171:
71:
33:
206:
Women waiting outside a gynecological exam room in Masaya, Nicaragua
253:
182:
167:
23:
536:
Amador, C. (1980). Informe de la Situacion de Salud de Nicaragua.
550:
Nouvet, Elysée; Chan, Elizabeth; Schwartz, Lisa J. (2018-04-03).
151:
859:
186:
1033:
457:
Golladay, F. (1980). Health sector policy paper. World Bank.
941:
990:
890:
807:
61:
344:
403:"Health services reforms in revolutionary Nicaragua"
264:
704:
147:
Pacayita health post in Catarina, Masaya, Nicaragua
549:
181:in Nicaragua under MINSA is US$ 544 while that of
785:Juan Roque. (2006). "Los salarios en Nicaragua".
631:Chalkley, Martin; Malcomson, James (2002-01-01).
630:
1088:
400:
197:
884:
152:Model of Family and Community Health (MOSAFC)
1040:Tropical Medicine & International Health
948:Tropical Medicine & International Health
401:Garfield, R. M.; Taboada, E. (1984-10-01).
22:Nicaraguan nurse preparing to administer a
79:at birth and one of the highest levels of
1051:
959:
434:
201:
142:
17:
501:
1089:
587:
585:
210:
768:
766:
764:
731:
591:
160:
62:Before the 1979 Sandinista Revolution
669:
479:
477:
396:
394:
392:
340:
338:
328:
326:
324:
314:
312:
51:
582:
543:
516:10.17730/humo.42.3.x737h47hqw3r2785
13:
844:
792:
761:
242:
90:
14:
1113:
474:
407:American Journal of Public Health
389:
335:
321:
309:
247:Nicaragua has one of the highest
1053:10.1046/j.1365-3156.2003.01082.x
961:10.1046/j.1365-3156.2002.00953.x
267:
1027:
984:
935:
893:International Journal of Cancer
853:
801:
779:
752:
725:
698:
663:
624:
530:
75:Nicaragua had one of the worst
495:
486:
460:
451:
293:List of hospitals in Nicaragua
108:Non-governmental organizations
1:
878:10.1016/s0277-9536(96)00084-6
822:10.1016/s0010-7824(96)00203-x
649:10.1016/s0047-2727(01)00126-8
568:10.1080/17441692.2016.1220610
303:
254:Papanicolaou (PAP) smear test
7:
866:Social Science and Medicine
637:Journal of Public Economics
359:10.2190/c6tb-b16y-60hv-m3qw
260:
198:Women and children's health
10:
1118:
672:Health Policy and Planning
56:
610:10.1017/S0001972019000950
219:is one of the highest in
185:is US$ 1,332 and that of
130:
116:World Health Organization
787:El Observador econĂłmico
734:Rev Panam Salud Publica
707:Salud PĂşblica de MĂ©xico
468:"Nicaragua | Data"
419:10.2105/AJPH.74.10.1138
215:Nicaragua's adolescent
30:Healthcare in Nicaragua
1102:Health care by country
1005:10.1258/td.2009.090076
207:
148:
26:
684:10.1093/heapol/czg024
592:McKay, Ramah (2020).
283:Abortion in Nicaragua
205:
146:
68:Sandinista Revolution
45:Nicaraguan government
21:
556:Global Public Health
288:History of Nicaragua
179:general practitioner
125:medical volunteerism
120:Alma Ata Declaration
112:medical volunteerism
1097:Health in Nicaragua
211:Reproductive health
504:Human Organization
225:adolescent mothers
208:
161:Healthcare workers
149:
27:
905:10.1002/ijc.10453
413:(10): 1138–1144.
298:Project Nicaragua
77:life expectancies
52:Healthcare system
24:Papanicolaou test
1109:
1082:
1081:
1055:
1031:
1025:
1024:
988:
982:
981:
963:
939:
933:
932:
888:
882:
881:
857:
851:
848:
842:
841:
805:
799:
796:
790:
783:
777:
770:
759:
756:
750:
749:
729:
723:
722:
702:
696:
695:
667:
661:
660:
628:
622:
621:
589:
580:
579:
547:
541:
534:
528:
527:
499:
493:
490:
484:
481:
472:
471:
464:
458:
455:
449:
448:
438:
398:
387:
386:
342:
333:
330:
319:
316:
277:
275:Nicaragua portal
272:
271:
270:
81:infant mortality
66:Before the 1979
38:Central American
1117:
1116:
1112:
1111:
1110:
1108:
1107:
1106:
1087:
1086:
1085:
1032:
1028:
993:Tropical Doctor
989:
985:
954:(11): 935–941.
940:
936:
889:
885:
858:
854:
849:
845:
806:
802:
797:
793:
784:
780:
771:
762:
757:
753:
730:
726:
703:
699:
668:
664:
629:
625:
590:
583:
548:
544:
535:
531:
500:
496:
491:
487:
482:
475:
466:
465:
461:
456:
452:
399:
390:
343:
336:
331:
322:
317:
310:
306:
273:
268:
266:
263:
249:cervical cancer
245:
243:Cervical cancer
236:Catholic Church
213:
200:
163:
154:
133:
93:
91:Post-revolution
64:
59:
54:
12:
11:
5:
1115:
1105:
1104:
1099:
1084:
1083:
1046:(8): 704–709.
1026:
983:
934:
899:(2): 199–205.
883:
852:
843:
816:(6): 359–365.
800:
791:
778:
760:
751:
740:(5): 329–336.
724:
697:
678:(2): 195–204.
662:
643:(2): 219–249.
623:
581:
562:(4): 456–472.
542:
529:
510:(3): 264–272.
494:
485:
473:
459:
450:
388:
353:(1): 111–128.
334:
320:
307:
305:
302:
301:
300:
295:
290:
285:
279:
278:
262:
259:
244:
241:
217:fertility rate
212:
209:
199:
196:
162:
159:
153:
150:
132:
129:
92:
89:
63:
60:
58:
55:
53:
50:
9:
6:
4:
3:
2:
1114:
1103:
1100:
1098:
1095:
1094:
1092:
1079:
1075:
1071:
1067:
1063:
1059:
1054:
1049:
1045:
1041:
1037:
1030:
1022:
1018:
1014:
1010:
1006:
1002:
998:
994:
987:
979:
975:
971:
967:
962:
957:
953:
949:
945:
938:
930:
926:
922:
918:
914:
910:
906:
902:
898:
894:
887:
879:
875:
871:
867:
863:
856:
847:
839:
835:
831:
827:
823:
819:
815:
811:
810:Contraception
804:
795:
788:
782:
776:(3): 312–318.
775:
769:
767:
765:
755:
747:
743:
739:
735:
728:
720:
716:
712:
708:
701:
693:
689:
685:
681:
677:
673:
666:
658:
654:
650:
646:
642:
638:
634:
627:
619:
615:
611:
607:
604:(1): 95–111.
603:
599:
595:
588:
586:
577:
573:
569:
565:
561:
557:
553:
546:
539:
533:
525:
521:
517:
513:
509:
505:
498:
489:
480:
478:
469:
463:
454:
446:
442:
437:
432:
428:
424:
420:
416:
412:
408:
404:
397:
395:
393:
384:
380:
376:
372:
368:
364:
360:
356:
352:
348:
341:
339:
329:
327:
325:
315:
313:
308:
299:
296:
294:
291:
289:
286:
284:
281:
280:
276:
265:
258:
257:acetic acid.
255:
250:
240:
237:
233:
232:contraception
228:
226:
222:
221:Latin America
218:
204:
195:
191:
188:
184:
180:
175:
173:
169:
158:
145:
141:
137:
128:
126:
121:
117:
113:
109:
105:
101:
97:
88:
84:
82:
78:
73:
69:
49:
46:
41:
39:
35:
31:
25:
20:
16:
1043:
1039:
1029:
999:(1): 22–26.
996:
992:
986:
951:
947:
937:
896:
892:
886:
869:
865:
855:
846:
813:
809:
803:
794:
786:
781:
773:
754:
737:
733:
727:
710:
706:
700:
675:
671:
665:
640:
636:
626:
601:
597:
559:
555:
545:
537:
532:
507:
503:
497:
488:
462:
453:
410:
406:
350:
346:
246:
229:
214:
192:
176:
164:
155:
138:
134:
106:
102:
98:
94:
85:
65:
42:
29:
28:
15:
872:(1): 1–12.
713:: 233–242.
1091:Categories
304:References
72:Nicaraguan
1062:1365-3156
970:1365-3156
913:1097-0215
830:0010-7824
657:0047-2727
618:0001-9720
576:1744-1692
427:0090-0036
367:0020-7314
172:Matagalpa
34:Nicaragua
1078:36686753
1070:12869091
1013:20008060
978:12390599
929:25852758
921:12115570
746:21709937
719:21877088
692:12740324
524:10263281
375:10707302
261:See also
183:Honduras
168:Jinotega
1021:5078884
838:8968664
445:6476169
436:1651882
383:1189417
57:History
1076:
1068:
1060:
1019:
1011:
976:
968:
927:
919:
911:
836:
828:
744:
717:
690:
655:
616:
598:Africa
574:
522:
443:
433:
425:
381:
373:
365:
187:Panama
131:Levels
70:, the
1074:S2CID
1017:S2CID
925:S2CID
538:MINSA
379:S2CID
1066:PMID
1058:ISSN
1009:PMID
974:PMID
966:ISSN
917:PMID
909:ISSN
834:PMID
826:ISSN
742:PMID
715:PMID
688:PMID
653:ISSN
614:ISSN
572:ISSN
520:PMID
441:PMID
423:ISSN
371:PMID
363:ISSN
170:and
43:The
1048:doi
1001:doi
956:doi
901:doi
897:100
874:doi
818:doi
680:doi
645:doi
606:doi
564:doi
512:doi
431:PMC
415:doi
355:doi
118:’s
1093::
1072:.
1064:.
1056:.
1042:.
1038:.
1015:.
1007:.
997:40
995:.
972:.
964:.
950:.
946:.
923:.
915:.
907:.
895:.
870:44
868:.
864:.
832:.
824:.
814:54
812:.
774:15
763:^
738:29
736:.
711:53
709:.
686:.
676:18
674:.
651:.
641:84
639:.
635:.
612:.
602:90
600:.
596:.
584:^
570:.
560:13
558:.
554:.
518:.
508:42
506:.
476:^
439:.
429:.
421:.
411:74
409:.
405:.
391:^
377:.
369:.
361:.
351:30
349:.
337:^
323:^
311:^
227:.
127:.
1080:.
1050::
1044:8
1023:.
1003::
980:.
958::
952:7
931:.
903::
880:.
876::
840:.
820::
789:.
748:.
721:.
694:.
682::
659:.
647::
620:.
608::
578:.
566::
540:.
526:.
514::
470:.
447:.
417::
385:.
357::
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
