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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
Males Females