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Geographical Locations - Nicaragua
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- (Statistical) Number of Inhabitants per Doctor: 1,882
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- A case study of reproductive health supplies in Nicaragua
"Whereas the wealthiest fifth of the Nicaraguan population had an average fertility rate of only 1.8 children per woman in 2006/2007 — having dropped below replacement level — the figure for the poorest fifth was 4.5. Thus, it is to be expected that the eight percent overall unmet need for family planning among women married or in union chiefly affects lower income women. Together with the higher prevalence of poverty in the countryside, this would explain that fertility in rural areas is 3.5 children per woman, which is 59 percent higher than the urban level (2.2)." [Population Action International, June 2009]
- Assessment of biosand filter performance in rural communities in southern coastal Nicaragua: an evaluation of 199 households
Introduction: Lack of access to safe drinking water is a major health issue for more than one billion people globally. In areas where community-wide water treatment is not possible, point-of-use (POU) solutions are necessary. The biosand filter (BSF) is one of several such POU technologies available to treat water in the home to reduce the risk of infection. This study was conducted to evaluate the use and performance of BSFs in the rural communities surrounding San Juan del Sur, Nicaragua. Approximately 600 filters had been installed in this area over the preceding 2 years by local workers supported by US and Canadian NGOs. Methods: This field study was conducted In July and August 2009. Unannounced household visits were carried out by US volunteers supported by a local interpreter and driver. Visits were made to a convenience sample of 199 households where BSFs had been in place for an average of 12 months. Water for analysis was collected from wells, filter spouts and storage buckets and an 11 item questionnaire was administered. Laboratory analyses were performed on water samples using the membrane filtration method to determine Escherichia coli colony forming units (CFUs). Results: Forty-five of 199 households visited had discontinued use of their BSF. In the 154 households tested, median CFU of E. coli per 100 mL of water from the source, filter spout and storage vessel were 313, 72, and 144, respectively. Median bacterial removal efficiency for the filters was 80%. Although biosand filtration reduced CFUs in 74% of households in which it was used, in only 26 cases (17%) did it reduce CFUs to <10 CFUs/100 mL. Recontamination was an important problem and reduced the overall efficacy (from well to storage bucket) to 48%. Participants were generally satisfied with their filter's performance, citing improved health and better tasting water. Conclusion: Water quality testing of BSFs deployed in the field showed results somewhat inferior to previous reports. Possible explanations include lack of use of best practices and the inclusion of some filers in the analysis that may not have been in active use. Despite these results and high rates of recontamination in the storage bucket, most households members were pleased with their filters and claimed that their use had enhanced their health. This inconsistency could be due to inaccurate responses to the questionnaire for purposes of secondary gain. [author abstract] [Rural and Remote Health 10: 1483. (Online), 2010]
- Assessment of Youth Reproductive Health Programs in Nicaragua
"In 2001, Nicaragua undertook the latest in a series of demographic and health surveys (Encuesta de Demografía y Salud 2001 – ENDESA 2001) that have been done over the years and had cause for cautious optimism about the state of Nicaraguan health. Most key indicators, including infant mortality, overall fertility among women in reproductive age, and malnutrition, showed important improvements since the prior survey in 1998. Adolescent fertility and contraceptive behavior also showed signs of improvement, although the 2001 data remain alarmingly high. On the other hand, the median age of sexual debut decreased somewhat (a negative trend) and the percentage of 19-year-old women who are, or have ever been, pregnant showed no change between the two survey years." [YouthNet, September 2003]
- Candies in hell: women's experiences of violence in Nicaragua
The aim of this study was to describe the characteristics of domestic violence against women in León, Nicaragua. A survey was carried out among a representative sample of 488 women between the ages of 15-49. The physical aggression sub-scale of the Conflict Tactics Scale was used to identify women suffering abuse. In-depth interviews with formerly battered women were performed and narratives from these interviews were analysed and compared with the survey data. Among ever-married women 52% reported having experienced physical partner abuse at some point in their lives. Median duration of abuse was 5 years. A considerable overlap was found between physical, emotional and sexual violence, with 21% of ever-married women reporting all three kinds of abuse. Thirty-one percent of abused women suffered physical violence during pregnancy. The latency period between the initiation of marriage or cohabitation and violence was short, with over 50% of the battered women reporting that the first act of violence act took place within the first 2 years of marriage. Significant, positive associations were found between partner abuse and problems among children, including physical abuse. Both the survey data and the narrative analysis pointed to extreme jealousy and control as constant features of the abusive relationship. Further, the data indicate that battered women frequently experience feelings of shame, isolation and entrapment which, together with a lack of family and community support, often contribute to women's difficulty in recognizing and disengaging from a violent relationship. These findings are consistent with theoretical conceptualisations of domestic violence developed in other countries, suggesting that, to a large degree, women's experiences of violence transcend specific cultural contexts. [author abstract] [Social Science & Medicine 51 (2000) 1595-1610]
- Case study: Women’s Network Against Violence, Nicaragua
"In Nicaragua, systematic, organized efforts have been undertaken over the past almost ten years to fight against violence directed at women. Civil society — particularly the women's movement — has carried out a range of actions from within different spheres to confront the problem of domestic violence." [Presented at Symposium 2001: “Gender violence, health and rights in the Americas”, Cancun, Mexico, 4-7 June 2001]
- Civil Society Perspectives on HIV/AIDS Policy in Nicaragua, Senegal, Ukraine, the United States, and Vietnam: overview
"National governments and international agencies attempting to address HIV/AIDS continue to exclude or ignore marginalized groups that are disproportionately affected by the epidemic. In countries ranging from the United States, with some of the world’s best medicine and health care technology, to Senegal, where more than 50 percent of the population lives below the poverty line, marginalized groups — injecting drug users, sex workers, men who have sex with men, prisoners, and ethnic minorities — are frequently excluded from the design, implementation, and evaluation of national HIV/AIDS policies and programs. The Open Society Institute’s Public Health Watch HIV/AIDS Monitoring Project has documented the varying degrees and different forms that stigma and discrimination against marginalized groups can take in five developed and developing countries: Nicaragua, Senegal, Ukraine, the United States, and Vietnam. The results of this research, which are highlighted in this overview and available in five separate country reports, have made it clear that national governments and international agencies must collaborate more effectively with these groups in order to hear their concerns and address their needs." [Public Health Watch, Open Society Institute, 2007]
- Concentrations of Organochlorine Pesticides in Milk of Nicaraguan Mothers
Breast-milk samples from 101 mothers from the basin of Rio Atoya, Nicaragua, were collected on two occasions within the first trimester of lactation. Milk samples were analyzed for 13 organochlorine pesticides: (1) p,p'-dichlorophenyldichloroethylene; (2) p,p’-dichlorophenyltrichloroethane; (3) p,p’-dichlorophenyldichlorodiene; (4) α-hexachlorocyclohexane; (5) β-hexachlorocyclohexane; (6) γ-hexachlorocyclohexane; (7) δ-hexachlorocyclohexane; (8) toxaphene; (9) dieldrin; (10) endrin; (11) aldrin; (12) heptachlor; and (13) heptachlor-epoxide. Organochlorines of the dichlorodiphenylethane class (i.e., p,p'-dichlorodiphenylethane and p,p'-dichlorodiphenylethane) were found in all samples and at the highest mean concentrations observed in the study. Chemicals in the hexachlorocyclohexane family (i.e., α- and δ-hexachlorocyclohexane) were not found at all (0%), and the other hexachlorocyclohexane compounds (i.e., β > γ) were found in less than 6% of the samples. Twenty percent or less of the sample contained chlorinated cyclodienes (i.e., dieldrin > endrin > heptachlor-epoxide > heptachlor). No measurable concentrations of α-hexachlorocyclohexane, aldrin, p,p'-dichlorophenyldichlorodiene, and toxaphene were found in the breast milk samples. Analysis of variance demonstrated that only the concentration of p,p'-dichlorophenyldichloroethylene p,p'-dichlorophenyltrichloroethane, and endrin were affected significantly by maternal age. Overall, with the exception of p,p'-chlorophenyldichloroethylene, and p,p'-dichlorophenyltrichloroethane, the mean concentrations of the analyzed pesticides were low. Total p,p'-dichlorophenyltrichloroethane concentrations that exceeded the allowed daily intake set by the World Health Organisation were found in 5.9% of the samples. [author abstract] [Archives of Environmental Health, Vol. 55, No. 4, pp.274-278, July/August 2000]
- Developing Public Health Management Training Capacity in Nicaragua
The Cooperative for Assistance and Relief Everywhere (CARE) and Centers for Disease Control and Prevention (CDC) Health Initiative in Nicaragua is distinctive in its focus on developing a cadre of in-country trainers whose aim is to equip frontline public health managers with widely applicable tools and techniques to assist them in identifying and solving implementation problems. Since 1999, 137 trainees — 37% more than originally planned — have demonstrated competence by completing and presenting applied management projects. Nineteen professors from the preventive medicine faculty at the Autonomous University of Nicaragua also have been trained. The country office now has a cadre of seasoned trainers who can meet the ongoing management training needs of CARE staff and their counterparts in the Ministry of Health and in other nongovernmental organizations. [author abstract]
- Discourses on Violence in Costa Rica, El Salvador, and Nicaragua: Laws and the Construction of Drug- and Gender-Related Violence
In Central America, legislation aiming to reduce violence and crime has become an important topic in the security debate. Focusing on Costa Rica, El Salvador, and Nicaragua, this paper analyzes laws and other legal texts regarding the trade in and consumption of drugs on the one hand, and gender-related violence on the other. It shows how the content and the wording of legal texts contribute to the social construction of stereotyped offenders, such as youth gang members, drug users, or foreign nationals. The legal texts in Costa Rica, El Salvador, and Nicaragua reflect both the hegemonic and the counter-discursive influences on each country's legal discourse. [author abstract] [Click on One-Click Download to open document in a new page] [GIGA Research Programme: Violence, Power and Security, N° 72 March 2008]
- Gender and Corruption in Public Health Services in Nicaragua: Empirical and Theoretical Conclusions for Governance
The paper takes as its starting point the question about the supposedly beneficial role of women in governmental, political and administrative posts in relation to good governance (World Bank, Dollar). Are women less involved in corruption because they are women or because they have fewer opportunities to corruption because of their gender role (Goetz)? The paper is based on fieldwork carried out in November 2006. To start with, it presents the different potential gateways (windows) to corruption found in interviews with authorities, donor and civil society observers and end users. All the different forms of corruption listed by the Utstein Group (U4) and Transparency International were found, of which theft of supplies and working time (absenteeism) are the most widely spread. In the minds of end users, (il)legal payments and bribes get confused. This is in part due to the environment of scarcity created by political decision-making and the limitations to public spending imposed in the name of budgetary discipline; a scarcity at the macro level creating incentives for corruption at the level of individual health service facilities. While having an important poverty impact both on state budget and individual poor households, corruption constitutes a regressive redistribution of resources from the poor to the non-poor. It can be claimed that corruption supports, stabilises and deepens social and economic inequality. The fieldwork also highlighted the importance of social capital in corrupt practices. Especially Coleman’s notion of “open” social capital proved to be useful. In corrupt networks of open social capital, strong solidarity and internal cohesion develop: there is a “pact of silence” between corrupt colleagues who form a “circle of trust” (Hellstén). This aspect has been mostly neglected in anti-corruption strategies. A bribe paid becomes, as it were, the “price” to pay for not belonging to one of the open networks of social capital. In analysing corruption from a gender point of view, it was found that women are more affected by corruption in healthcare because of their biological sex (reproductive cycle); they are the large majority of service users. Corruption is also gendered on the demand side. E.g. referral to private practice of doctors at the public payroll is an almost exclusively male domain; their female colleagues combine professional activity with their role of housewives. Thus, the female gender role can “protect” women from engaging in corrupt exchanges. The fieldwork findings tend to suggest that corruption should also be seen as a field where gender roles are performed and gender role expectations fulfilled. But as the model of accountability in Nicaragua is informal and nepotist, an increase in the number of women in public office alone is not likely to be conducive to a reduction of corruption. The paper ends with a discussion about practical measures to fight corruption in order to ensure gender equality. These range from measures taken at the level of individual service facilities to the creation of “closed” national-level social capital. Finally, important policy incoherence in the global aid architecture will be pointed out. [extract from author abstract] [12th EADI General Conference: Global Governance for Sustainable Development – The Need for Policy Coherence and New Partnerships, 10-11 November 2008]
- Health in the Americas 2007: Nicaragua
As a health agency, the Pan American Health Organization’s core discipline is epidemiology, which enables the measurement, definition, and comparison of health problems and conditions and their distribution from the perspectives of population, geography, and time. This publication on Nicaragua addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in Nicaragua, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups. [Adapted from the preface of Health in the Americas 2007]
- Healthy Housing in Nicaragua: An Intersectoral Approach to Improving Livelihoods
"This paper focuses on the negative impacts Nicaragua’s substandard housing can have on the health — physical, mental, and social — of its population. It examines resources from the World Health Organization, the Pan-American Health Organization, and the Inter-American Healthy Housing Network to establish a framework for understanding the many relationships between housing quality and health status. Further, by using these resources, this paper offers suggestions to urban planners, nongovernmental organizations, and others looking to implement housing programs as a component of public health initiatives." [Wisconsin Coordinating Council on Nicaragua, Working Paper Series No. 2, Fall 2004]
- HIV/AIDS Policy in Nicaragua: A Civil Society Perspective
"During the past five years, the HIV/AIDS epidemic has been spreading more rapidly in Nicaragua and is now on its way to creating a public health emergency. The Nicaraguan government initially downplayed the magnitude of the situation, however, demonstrating a significant lack of political commitment and leadership in implementing measures to prevent the spread of the disease and increase access to treatment... Although the government has taken steps to develop prevention campaigns that target specific vulnerable groups, procure antiretroviral (ARV) drugs, decentralize access to health services, and train health care workers, these efforts have lacked the necessary continuity and depth. In recent years, the government has started to demonstrate more concern over the spread of HIV/AIDS, for example, by collaborating closely with local and international nongovernmental organizations (NGOs) and by creating a multisectoral agency with the mandate to support HIV/AIDS control. The government of the newly elected president, Daniel Ortega, has likewise shown signs of its willingness to place HIV/AIDS in a more prominent position on the national agenda, as evidenced by the recent publication of the much-awaited 2006–2010 national strategic plan on HIV/AIDS and the national policy for prevention and control of sexually transmitted infections (STIs), HIV, and AIDS... The government’s recent shift in attitude is encouraging, but Nicaragua must also take more incisive, comprehensive, and systematic measures. It has not yet recognized the HIV/AIDS epidemic as a national priority. The 2006–2010 national strategic plan does not include a mechanism for monitoring and evaluating the country’s progress toward preventing and controlling HIV/AIDS. It also does not include a centralized strategy or implementation guidelines to coordinate the multiple national and international efforts, including those of civil society organizations. In addition, the government has yet to conduct a comprehensive national HIV-prevalence survey, which would provide reliable data on the extent of the spread of HIV." [Public Health Watch, Open Society Institute, 2007]
- Integrated Anemia Control Strategy has significantly reduced anemia in women and children in Nicaragua
"Anemia was identified as a problem of public health significance in Nicaragua since 1993, when its prevalence amounted to 28.5% in children 1-4 years and 33.6% in non pregnant women of childbearing age. The average intake and absorption of iron by both children and the general population was very low, and intake of other nutrients (vitamin A, thiamine, riboflavin, niacin and folate) was also deficient. Because of the grossly deficient iron intake, most anemias were attributed to iron deficiency; other possible causal factors were intestinal parasites (especially hookworms) and systemic infections. Vitamin A deficiency (VAD) was also significant in children. As part of a National Micronutrient Plan (NMP), an Integrated Anemia Control Strategy (IACS) was developed by the Ministry of Health (MOH) and implemented since 2004. The IACS included iron and iron/folic acid supplementation for pregnant women and children <5 years; periodic delivery of anthelminth medications to children 2-10 years; fortification of wheat flour with iron and B-vitamins; interventions to control vitamin A deficiency (supplementation and fortification of table sugar); behavioral change communications (BCC); comprehensive training of health service personnel, community health volunteers (CHVs) and non governmental organizations (NGOs); strengthening of other public health interventions; and a program monitoring and evaluation (M&E) system. Steps for implementing IACS comprised: clear policies; updated technical guidelines; incorporation of iron and iron/folic acid supplements in the official list of essential medicines; addressing supply issues by establishing effective systems for procurement and logistical management of supply, as well as demand and compliance issues; and conducting operational research to address key constraints to implementation. The effectiveness of involving community health volunteers (“brigadistas”) in supplement delivery, follow up and counseling, was tested with positive results. Better knowledge and skills of health care providers and CHVs on anemia, supplementation and counseling improved supplement demand and compliance with supplementation. The community-based “brigadista” model for iron supplementation was gradually extended throughout most of the country. Mandatory wheat flour fortification with iron, thiamin, riboflavin, niacin and folate was established in 1997; a mass media campaign was carried out to inform the population about the benefits of fortified foods (e.g. fortified wheat flour). Regulatory monitoring by the MOH/FCD was established, which comprises periodic inspections at production plants and collection of samples of wheat flour from plants and retail stores for assessment of iron content; monitoring has consistently shown adequate iron content. Household monitoring was established in 2002; samples of bread have shown to comply with expected minimum levels of iron (55 mg/kg). Ferrous fumarate substituted for reduced iron in wheat flour fortification since 2003." [Micronutrient Initiative, 2007]
- Prices of Reproductive Health Medicines in Nicaragua
"Poor reproductive health constitutes a significant portion of the disease burden in developing countries, yet essential reproductive health medicines often are not available to the majority of the population in these countries. This leaves millions of women and men vulnerable to unwanted pregnancy, sexually transmitted infections (STIs), including HIV/AIDS, and unsafe childbirth. For example, it is estimated that approximately 201 million couples who are at risk of unintended pregnancy, and who would like to space or limit their births, are not using modern contraception to do so. Access to contraceptives, obstetrical and antenatal medicines and technologies, and STI and HIV/AIDS drugs is a fundamental requirement for maintaining good sexual and reproductive health services. Increased demand, inefficient resource use, lack of government commitment and/or resources, and donor support that has not kept pace with demand, have all contributed to this lack of access to reproductive health commodities. Ensuring the availability of and access to essential reproductive health medicines — contraceptives, medicines for prevention and treatment of STIs and HIV/AIDS, and medicines that enable healthy pregnancy and delivery — requires strong government commitment and a range of activities to guarantee financing, procurement logistics management, and effective service delivery… PATH conducted a study of reproductive health commodity prices in Nicaragua… [which] aimed to gain an understanding of how prices and price components of reproductive health commodities affect the end user’s ability to access these reproductive health medicines and how this affects access, affordability, and equity for all population segments. If essential reproductive health medicines are available, affordable, of good quality, and properly used, they can significantly improve reproductive health." [PATH, March 2006]
- Profile of the health services system of Nicaragua
"The [Nicaraguan] health sector is comprised of two subsectors: the public, made up of the Ministry of Health and other State institutions, such as the Ministry of Government, the Ministry of Defense, and the Nicaraguan Social Security Institute; and the private. The Comprehensive Local Health Systems (SILAIS) are the entities that represent the Ministry of Health in technical and administrative aspects at the territorial level (departments). The system has created Medical Services Companies to sell services to the Social Security system. An integrated community subsystem made up of networks of brigade members, midwives, and other volunteers working in and for the health of their communities is also available, basically engaging in promotion and prevention activities. To carry out these activities, the community subsystem owns Community and Maternity Houses. It is assumed that the Ministry of Health covers 60% of the population; Social Security covers 6%. The population without coverage is estimated at 30%-35%." [Pan American Health Organization, 2nd ed.: February 2002]
- Promotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial
Background: In Latin America, motels rent rooms for commercial and non-commercial sex. We investigated the impact of providing health-education material and condoms on condom use in Managua, Nicaragua. Methods: In a randomised controlled trial, in 19 motels, we gave condoms on request, made them available in rooms, or gave condoms directly to couples, with and without the presence of health-education material in the rooms. In a factorial design we assessed condom use directly by searching the rooms after couples had left. Findings: 11 motels were used mainly by sex workers and their clients and eight mainly for non-commercial sex. 6463 couples attended the motels in 24 days. On 3106 (48·0%) occasions, at least one used condom was retrieved. Condom use was more frequent for commercial sex than for non-commercial sex (60·5 vs 20·2%). The presence of health-education material lowered the frequency of condom use for commercial sex (odds ratio 0·89 [95% CI 0·84–0·94]) and had no effect on use for non-commercial sex (1·03 [0·97–1·08]). Condom use increased for commercial (1·31 [1·09–1·75]) and non-commercial sex (1·81 (1·14–2·81) if condoms were available in rooms. Directly handing condoms to couples was similarly effective for commercial sex but less effective for non-commercial sex (1·32 [1·03–1·61] vs 1·52 [1·01–2·38]). Interpretation: In Latin America, motels are key locations for promoting the use of condoms. Making condoms available in rooms is the most effective strategy to increase condom use, whereas use of health-education material was ineffective. These findings have important implications for HIV-prevention policies. [author summary] [Lancet 2000; 355: 2101–2105]
- Rapid Assessment of Drinking-Water Quality in the Republic of Nicaragua: Country report of the pilot project implementation in 2004-2005
"During 2004 and 2005 the Republic of Nicaragua and five other countries participated in a World Health Organization/United Nations Children’s Fund (WHO/UNICEF) pilot project to test a rapid, low-cost, field-based technique for assessing water quality. The project was named the Rapid Assessment of Drinking-Water Quality (RADWQ) and its purpose was to develop a tool that would help the WHO/UNICEF Joint Monitoring Programme (JMP) monitor global access to safe drinking water, as a means of assessing progress towards the water and sanitation target of the Millennium Development Goal 7… The RADWQ survey results provide a statistically representative snapshot of the water and sanitation status of Nicaragua. Extreme values of pH were seen for all types of water delivery technology, with the exception of public piped water supplies. However, over one-third of the public piped water supplies had levels of residual chlorine that were inadequate for disinfection, as did over 97% of water samples from the other technologies assessed. Many water sources had extremely high values for turbidity and electrical conductivity, particularly protected wells in the Atlantic broad area. High levels of iron were detected in some public piped supplies in the Pacific broad area, and in boreholes (tubewells) and protected wells in the Central North broad area. In contrast, most water supplies in Nicaragua were in compliance with the WHO guideline values for arsenic and fluoride. None of the 895 water samples analysed for nitrate exceeded the WHO guideline value. Many of the water supplies had medium or high sanitary risk levels, even public piped-water supplies, and 15.7% of the water supplies had unacceptable levels of sanitary risk (high and very high). To the extent that the same situation continues to prevail, these figures show that the sanitary integrity of the water supplies is in jeopardy." [WHO and UNICEF, 2010]
- Social franchising of sexual and reproductive health services in Honduras and Nicaragua
This document outlines the outcome of three franchising projects implemented by Partners of Marie Stopes International (MSI) in Honduras and Nicaragua. The projects were designed to pilot full and partial social franchising models as part of an initiative to test and develop alternative forms of delivering quality sexual and reproductive health (SRH) services by a non government organisation (NGO). This report: (i) assesses the suitability of the models used for the provision of sustainable SRH services to the target populations in the project areas; (ii) presents the major costs, benefits and risks to the franchisee, the franchisor and the donor agencies; [and] (iii) addresses the ways in which the viable elements of these social franchising models could be replicated successfully. [publication summary] [Marie Stopes International, 2006]
- Social security health insurance for the informal sector in Nicaragua: a randomized evaluation
This article presents the results from an experimental evaluation of a voluntary health insurance program for informal sector workers in Nicaragua. Costs of the premiums as well as enrollment location were randomly allocated. Overall, take-up of the program was low, with only 20% enrollment. Program costs and streamlined bureaucratic procedures were important determinants of enrollment. Participation of local microfinance institutions had a slight negative effect on enrollment. One year later, those who received insurance substituted toward services at covered facilities and total out-of-pocket expenditures fell. However, total expenditures fell by less than the insurance premiums. We find no evidence of an increase in health-care utilization among the newly insured. We also find very low retention rates after the expiration of the subsidy, with less than 10% of enrollees still enrolled after one year. To shed light on the findings from the experimental results, we present qualitative evidence of institutional and contextual factors that limited the success of this program. [author summary] [Health Econ. 19: 181–206 (2010)]
- Studies of Decentralization of the Health System in Nicaragua: Final Report
"There are no ideal models of decentralization. Each country needs to develop its own approach so that objectives of equity, efficiency, quality and financial soundness can be achieved. This Harvard School of Public Health study of decentralization in Nicaragua shows some important positive achievements and some negative problems that are apparent in the current health system. The studies also show some potential for improving the health system through selected procedures like ‘needs based formulae’ and through expanding some local choice (.decision space.) at the SILAIS and municipal levels. The studies first defined the ‘decision space’ or range of choice over key functions, that is currently allowed to the SILAIS officials. Then quantitative data on financing, expenditures, utilization of services and coverage, and infant mortality were examined at the municipal and SILAIS levels. A qualitative study of 8 SILAIS and 10 municipalities involved questionnaires for the Directors and Equipos de Direccion of SILAIS, municipal facilities, hospitals and alcaldes. The study of the current decision space map of the range of choice at the SILAIS level suggests that SILAIS officials have moderate choice over central government funded expenditures, over own source revenues and over fees collected at local facilities. They also have moderate choice over assignment and transfer human resources and over community participation. Other decentralized countries in Latin America have had wider ranges of choice suggesting that the range of choice in Nicaragua could be expanded – especially for financial functions – without much risk of granting too much control." [Harvard School of Public Health, USAID and International Health Systems Group, September 2001]
- Successful vitamin A supplementation in Nicaragua
Clinically evident vitamin A deficiency (VAD) was found to be "a significant problem in Nicaragua since the mid-1960s but specific actions were not taken then. In 1993 the Nicaraguan Ministry of Health (MOH), with USAID assistance, carried out a national study to assess the prevalence of subclinical VAD in children and of anemia in women and children, and to estimate family and individual food consumption. The study revealed that about 60% of the children 12–59 months of age and 70% of the families consumed less than the recommended amounts of vitamin A per day, and 31% of the children had sub-clinical VAD. With these findings, the MOH nutrition group engaged in creating awareness on the health and development implications of micronutrient deficiencies, including the seriousness of VAD and the need to act. Sensitisation efforts targeted all levels of the public and private sector, academic institutions, politicians and the general population. This resulted in strong political commitment to address VAD as a priority problem." [Sight and Life Newsletter, 3/2002, pp.75-79]
- The cost-effectiveness of a competitive voucher scheme to reduce sexually transmitted infections in high-risk groups in Nicaragua
Current evidence suggests that sexually transmitted infection (STI) interventions can be an effective means of human immunodeficiency virus (HIV) prevention in populations at an early stage of the epidemic. However, evidence as to their cost-effectiveness when targeted at high-risk groups is lacking. This paper assesses the cost-effectiveness of a competitive voucher scheme in Managua, Nicaragua aimed at high-risk groups, who could redeem the vouchers in exchange for free STI testing and treatment, health education and condoms, compared with the status quo (no scheme). A provider perspective was adopted, defined as: the voucher agency and health care providers from the public, NGO and private sectors. The cost of the voucher scheme was estimated for a 1-year period (1999) from project accounts using the ingredients approach. Outcomes were monitored as part of ongoing project evaluation. Costs and outcomes in the absence of the scheme were modelled using project baseline data and reports, and relevant literature. The annual cost of providing comprehensive STI services through vouchers was US$62 495, compared with an estimated US$17 112 for regular service provision in the absence of the scheme. 4815 vouchers were distributed by the voucher scheme, 1543 patients were tested for STIs and 528 STIs were effectively cured in this period. In the absence of the scheme, only an estimated 85 cases would have been cured from 1396 consultations. The average cost of the voucher scheme per patient treated was US$41 and US$118 per STI effectively cured, compared with US$12 per patient treated and US$200 per STI cured in its absence. The incremental cost of curing an STI through the voucher scheme, compared with the status quo, was US$103. A voucher scheme offers an effective and efficient means of targeting and effectively curing STIs in high-risk groups, as well as encouraging quality care practices. [author abstract]
- The establishment of injury surveillance systems in Colombia, El Salvador, and Nicaragua (2000–2006)
"An estimated 5.2 million people worldwide died from injuries in 2002 — a mortality rate of 83 per 100 000 population. Injuries accounted for 9% of the world’s deaths in 2002 and 12% of the world’s burden of disease. More than 90% of deaths occurred in low- and middle-income countries. Consequently, injuries are a major public health problem throughout the world and represent a leading cause of mortality and morbidity. Research and surveillance of the frequency, mechanisms, and outcomes of injuries in the developing world remains largely neglected. Injury surveillance is useful for identifying high-risk groups and behaviors and assessing intervention effectiveness. Although some research has been published on injury surveillance systems in developing countries, significant gaps exist concerning the establishment and maintenance of such programs. Some injury surveillance systems in developing countries have relied on mortuary statistics as their data source. These systems fail to capture the disproportionate number of non-fatal injuries that occur. The aim of this article is to describe key lessons learned in establishing an emergency department (ED)–based injury surveillance system in resource-poor settings." [Rev Panam Salud Publica. 2008; 24(6): 379–389]
- The relationship between family structure and exclusive breastfeeding prevalence in Nicaragua
Objective: To examine the relationship between family structure and the prevalence of exclusive breastfeeding (EBF) in Nicaragua. Material and Methods: A subset of the Nicaraguan Demographic and Health Survey conducted in 1998 was obtained by selecting all last-born infants less than 4 months old at the time of the survey. Weighted chi-squared and multivariate logistic regression analyses were used to examine the association. Results: Interviewee women heads of household and interviewee women whose husbands were the heads of the household had a significantly lower prevalence of EBF. Exposure to the health care system was not related to EBF. Conclusions: New approaches are needed to promote that men support women’s decisions to breastfeed. Health institutions should effectively communicate the benefits of breastfeeding on both the mother and the child. [author abstract] [Salud Publica Mex 2002; 44: 499-507]
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