Nicaragua Health Profile 2012

Nicaragua faces severe social problems. Large segments of the impoverished population, especially in rural areas, are beyond the reach of the country’s social safety net. There is also a significant difference in the quality of education and health services, not only between urban and rural areas but even more so between private and public services. Systematic efforts to reduce poverty have been planned and implemented since 2001 within the framework of Poverty Reduction Strategy Papers (PRSPs). In addition to health and education services, special social protection programs range from food assistance, social infrastructure and programs for special target groups to rural development. The Ortega administration has begun to expand these programs further, but financial and organizational constraints have hampered initiatives such as “Zero Hunger” as well as attempts to offer free health services and education. According to official estimates, a sum of about $750 million, half of the government’s budget (or about 11% of GDP), was allocated to social or poverty-reduction services in 2008. Although public spending on these services has increased considerably in absolute terms, it did not increase as a share of the state budget or GDP during the evaluation period. It also has to be noted that most additional funds slated for these sectors were used to finance higher wages. In some areas such as reproductive health and education, some deterioration has even been observed in recent years. Moreover, the small number of workers employed in the formal sector limits participation in official social security schemes with determined entitlements for old age, disability and health. Only 16% of the economically active population is insured by the official system. In April 2000, a law was passed to change the pension scheme from a pay-as-you-go system to an individually funded system. However, due to uncertainties regarding transition costs, implementation was postponed, and parliament repealed the law in November 2005.

HEALTH & DEVELOPMENT
The Ministry of Health (MOH), other ministries (Defense and Government), and the Nicaraguan Social Security Institute (INSS) are public providers that cover 67% of consultations, although only 60% represent free servicesb; 31% of consultations are with private providers, who receive direct payment from users.

There are inequities in access to health services due to geography, socioeconomic status, gender, and ethnicity. Only 6.3% of the population is insured (INSS)c. Out-of-pocket expenditures constitute a serious barrier for the poor and ethnic minoritiesd, over and above the lack of access in rural areas. Perinatal mortality remains high in the poorest departments and is associated with respiratory diseases, neonatal sepsis, congenital malformations, and diarrhoea. The main causes of death among children under-5 years in poor and indigenous communities are respiratory diseases, diarrhoea, malnutrition, and meningitis. Maternal mortality remains high in disadvantaged groups (rural areas, indigenous populations, the poor, adolescents, and women with low levels of schooling), even though the total fertility rate has fallen. Some 55% of women in rural areas give birth at home; 65% are illiterate. Maternal mortality remains high in these populations, and adolescents account for approximately one-third of maternal deaths. Some 22% of children in the most disadvantaged quartile of the urban area suffer from malnutrition versus 0.4% in the richest quartile; 9% of births produce infants with low birthweight. Communicable diseases continue to increase. Malaria (Plasmodium falciparum) is concentrated in municipalities with indigenous populations. Tuberculosis is prevalent in the poorest, most inaccessible areas. The incidence of HIV/AIDS is rising, especially among the female population; the ratio of males to females with HIV/AIDS has gone from 5:1 in 1999 to 3:1 in 2005e. Vaccine-preventable diseases are under control, with coverage rates between 84.7% and 97.6%.

Noncommunicable diseases result in high morbidity and mortality; the leading causes of mortality are cardiovascular disease, diabetes, external causes, and cancer. Traffic accidents, suicide, drowning, injuries from external causes, and leukemia are the leading causes of death in young people (10-19 years). Mental illness, neurosis,alcoholism, general violence and domestic violence have increased, primarily in urban areas. Growing environmental degradation, vulnerability, and risk of disasters; rapid, irresponsible economic development, the indiscriminate felling of trees, and the deterioration in production conditions, habitat, and soils have heightened the risk of man-made disasters and increased the vulnerability to natural disasters (earthquakes, volcanic eruptions, hurricanes, landslides, droughts).

OPPORTUNITIES
• National Development Plan 2004-2015 seeks to reduce social fragmentation and inequities
• Strengthened Strategy for Economic Growth and Poverty Reduction includes an index of poverty and economic vitality for the allocation of resources
• The General Health Law, Comprehensive Health Care Model (MAIS), and National Health Plan 2004-2015
• The opening of opportunities for social and community participation
• Culmination point in the Heavily Indebted Poor Countries Initiative (HIPC II) in 2005,in its debt relief process.

CHALLENGES
• Achieving greater equity among regions and social groups in the country in terms of social protection in health and overcoming the fragmentation and segmentation of the health system
• Increasing investment in health and its determinants, as a means of overcoming poverty
• Helping to lower health service access barriers and improve the quality of care
• Improving information systems to monitor progress and the attainment of the Millennium Development
Goals
• Overcoming the critical shortage of human resources and their limited development.