Week 8: Health Care in Nicaragua

This week, I’m thinking about health care in Nicaragua. This is, obviously, a very broad topic, so I’d like to focus on a few subtopics for this post: infrastructure and availability.

In terms of infrastructure, the Nicaraguan constitution states that all citizens have equal rights to health, and that it is up to the state to provide the basic conditions to promote and protect this health. The Ministry of Health is responsible for applying and evaluating laws related to health and healthcare, and coordination and supervision of all health-related activities lies in its dominion. There is, therefore, a framework in place for public health and health care. However, as the country currently stands, infrastructure and funding do not meet the needs of the citizens. Lack of investment in health care facilities and personnel has led Nicaragua into a downwards spiral in terms of free medicine and public health care since the early 1990s. Recent data listed Nicaragua’s per capita spending on health care at 144 USD, the lowest per capita health investment of any country in Latin America and the Caribbean. The result is that infrastructure is sorely lacking and access to care is extremely low, with less than 2 in 3 Nicaraguans having access to health care services and only 6.3% of the population having health insurance to help pay for those services.

Speaking specifically about access, there is a huge disparity between urban and rural regions of Nicaragua. As explored by our Forbes and Gutierrez reading, the autonomous regions experience the worst health disparities, with women affected more than men. Rates of contraction of, and death from, preventable infectious diseases like respiratory infection and diarrhea are extremely high, while number of physicians to treat these conditions is very low. Unlike in many countries, the Ministry of Health does not financially incentivize physicians to practice in rural or under-resourced communities. As a result, there is less than 1 doctor per 1,000 Nicaraguan inhabitants of a region, with that statistic skewed heavily towards urban areas.

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These are some pretty sobering statistics, especially for a group of people preparing to head into a rural area of Nicaragua and immerse themselves in the healthcare system there. The area that we are visiting, part of the RAAN, falls into the category described by statistics like “has a chronic childhood malnutrition rate of 22.6%” and “one psychiatrist per entire population of the RAAN and the RAAS”. The extent to which health care services, and the ability to pay for these services, is lacking is truly staggering. Thinking ahead to the sorts of cases we will be seeing, I’ve been thinking back to something that was said by the woman who came in to the CCESP retreat to teach us how to paint fluoride onto teeth – she told us that we shouldn’t expect our work in Nicaragua to look like our practice here, because “we’ve never seen mouths like that”. That’s something that I imagine will apply to the full spectrum of illness that we see. As a result of lack of access to simple preventative care like fluoride and toothpaste and common treatments like antibiotics and steroids, the disease that we’ll see in Nicaragua is likely to have progressed beyond anything we’d likely see in the U.S.

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