the nicaraguan health system

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The Nicaragua Health Care System October 28, 2016 Paul Treadwell

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Page 1: The Nicaraguan health system

The Nicaragua Health Care SystemOctober 28, 2016Paul Treadwell

Page 2: The Nicaraguan health system

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

Page 3: The Nicaraguan health system

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 .

Page 4: The Nicaraguan 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)

Page 5: The Nicaraguan health system

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

Page 6: The Nicaraguan health system

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

Page 7: The Nicaraguan health system

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

Page 8: The Nicaraguan health system

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

Page 9: The Nicaraguan health system

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.

Page 10: The Nicaraguan health system

Health care and the Atlantic CoastIndigenous and western medicine in the RAAN

Page 11: The Nicaraguan health system

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

Page 12: The Nicaraguan 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.

Page 13: The Nicaraguan health system

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.”

Page 14: The Nicaraguan health system

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]

Page 15: The Nicaraguan health system

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).

Page 16: The Nicaraguan health system

Contact

Paul Treadwell Adjunct Instructor Tompkins Cortland Community College [email protected]