HEALTHCARE

IN NICARAGUA
GMB 2015
CURRENT
HEALTHCARE SYSTEM
The National Unified Health System (1980s)
o Run by the MINSA
o Works to provide free and universal
access to primary care for all
Nicaraguan citizens
3 administrative levels
o 32 public hospitals
o 855 health posts
o 4.5 doctors and 3.5 nurses per
10,000 persons
Community-based components
Brigadistas (ie. GMB!)
HEALTH HISTORY
Pre-1979: Somoza family dictatorship extremely poor health indicators
1979: Sandanistas Revolution creation of the National Unified Health System
1990s: Structural Adjustment Programs health sector deterioration
SAP IMPACTS
Nicaragua is the 2nd poorest nation in Central America
GNP per capita: 1,851 USD
HDI: 0.614
42.5% of Nicaraguans live under the national poverty line
Large dependency on a few agricultural crops
High debt burden due to SAPs
Public debt: 58.6% of GDP
Total external debt: 79.7 billion USD
Debt to IMF: 12.6% of total public debt
Loans from World Bank: 533,413,000 USD
RESULTS
SAPs cut government ability to provide universal care
o Decentralization and privatization
o Reduction in government spending
Lack of resources
o Primary vs. specialty care
Low provider:patient ratios
Switched focus from preventative to curative care
Uneven distribution of hospitals and healthcare posts
o Rural areas isolated from care
o https://www.google.com/maps/d/edit?mid=z5DB62HE4toI
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BURDEN OF DISEASE
Top DALYs:
Ischemic heart disease
Lower respiratory infections
Congenital abnormalities
Top causes of premature death:
Lower respiratory infections
Ischemic heart disease
Congenital abnormalities
Pre-term birth complications
Chronic kidney disease
Top causes of disability
Depression and anxiety disorders
Back and neck pain
Anemia
 increase in mortality rate between 1990 and 2010. 0

The greatest reductions in all-cause mortality rate were

experienced by females aged 1-4 years (69%). Males aged 80+
years saw the largest increase in mortality rate (8%). Age group

Males Females

CAUSES OF PREMATURE DEATH

Years of life lost (YLLs) quantify premature mortality by weighting younger deaths more than older deaths.
Ranks for top 25 causes of YLLs 1990-2010, Nicaragua
# YLLs in thousands # YLLs in thousands
(% of total) Rank and disorder 1990 Rank and disorder 2010 (% of total) % change
276 (22.3%) 1 Diarrheal diseases 1 Lower respiratory infections 64 (7.6%) -58 This chart shows the
159 (12.9%) 2 Lower respiratory infections 2 Ischemic heart disease 61 (7.2%) 82 change in the top 25
103 (8.4%) 3 Preterm birth complications 3 Congenital anomalies 57 (6.8%) -13
72 (5.8%) 4 Congenital anomalies 4 Preterm birth complications 51 (6.1%) -51
causes of YLLs due to
58 (4.7%) 5 Neonatal encephalopathy 5 Chronic kidney disease 41 (4.8%) 155 premature mortality
49 (3.9%) 6 Neonatal sepsis 6 Stroke 38 (4.5%) 19 from 1990 to 2010.
34 (2.7%) 7 Ischemic heart disease 7 Diarrheal diseases 37 (4.3%) -87 Solid lines indicate a
33 (2.6%) 8 Protein-energy malnutrition 8 Road injury 30 (3.6%) 4
30 (2.4%) 9 Stroke 9 Interpersonal violence 30 (3.5%) 59 cause has moved up in
29 (2.4%) 10 Road injury 10 Neonatal encephalopathy 30 (3.5%) -48 rank or stayed the
24 (1.9%) 11 Meningitis 11 Neonatal sepsis 29 (3.4%) -40 same. Broken lines
19 (1.5%) 12 Interpersonal violence 12 Cirrhosis 27 (3.1%) 152
indicate a cause has
16 (1.3%) 13 Chronic kidney disease 13 Diabetes 26 (3.1%) 140
16 (1.3%) 14 Mechanical forces 14 Self-harm 22 (2.6%) 113 moved down in rank.
16 (1.3%) 15 Syphilis 15 Drowning 13 (1.5%) 4 The causes are color
14 (1.1%) 16 Tuberculosis 16 Protein-energy malnutrition 12 (1.5%) -59 coded by blue for
13 (1.1%) 17 Drowning 17 COPD 11 (1.3%) 53
11 (0.9%) 18 Cirrhosis 18 Meningitis 11 (1.3%) -54
non-communicable
11 (0.9%) 19 Diabetes 19 Alcohol use disorders 11 (1.3%) 169 diseases, green for
11 (0.9%) 20 Self-harm 20 Cervical cancer 11 (1.3%) 28 injuries, and red for
9 (0.7%) 21 Leukemia 21 Leukemia 11 (1.3%) 19
communicable,
8 (0.7%) 22 Cervical cancer 22 Hypertensive heart disease 10 (1.2%) 65
8 (0.7%) 23 Asthma 23 Stomach cancer 9 (1.1%) 30 maternal, neonatal, and
7 (0.6%) 24 COPD 24 Tuberculosis 9 (1.1%) -34 nutritional causes of
7 (0.6%) 25 Maternal disorders 25 Liver cancer 8 (0.9%) 131 death.
26 Stomach cancer 31 Mechanical forces
27 Hypertensive heart disease 33 Maternal disorders
34 Alcohol use disorders 34 Syphilis
37 Liver cancer 43 Asthma

http://www.healthmetricsandevaluation.org Nicaragua | GBD | page 1

ESTEL
Total population: 220,706 persons
Rural population: 86,093 persons
Area: 222,969 sq. km
Number of hospitals: 4
Attending physicians: 170
Main health burdens:
Polio
Tuberculosis
Diphtheria
Pertussis
Tetanus
Hepatitis B
Influenza
GMBS ROLE
Health facilities are clustered around the capital in Estel,
so many of the rural population do not have regular
access to healthcare
GMB provides basic healthcare access to rural
populations in Estel
GMB provides doctors
and much needed
medicines
Sustainability with
public health and
charla components