Pan American Health Organization (PAHO) Data 2008

Health Systems Profile - Nicaragua

Monitoring and Analyzing Health Systems Change

Pan American Health Organization/World Health

Organization PAHO/WHO

May 2008

MINSA is the Department of Health in Nicaragua. MINSA targets primary and secondary levels of care in Nicaragua. This makes sense. When the resources are limited, the best approach is to focus on the basics. However, this implies that tertiary level care is not available to the public, unless this is provided by a private physician, clinic, or hospital. This means for instance, that dialysis would not be available for a child with kidney failure.

The table below outlines who pays for the health care in Nicaragua. MINSA pays for the majority. The total does not add up to 100%, which implies that no one pays for the missing 20%. This actually might imply that one fifth of the population does not receive any care! I suspect that these are the individuals who are not registered with MINSA. Unless you have a number you do not exist. This is a real concern because without a MINSA registration, an individual cannot access care, and individuals are actually turned down in this situation. Ridiculous bureaucratic obstacles exist in every jurisdiction. 

	Percent
MINSA	60
Nicaraguan Social Security Institute INSS	8
Government and Military	8
Private	4
Total	80

MINSA has a list of essential drugs and reviews what should be included every two years. MINSA likely only chooses generic medications. Cutting edge (read expensive) therapies are not likely considered. Every month the local MINSA physician reports data on the patients and medications dispensed and the supply for the next month is based on this data. I learned that the supplies always run out well before the end of the month. I imagine the more organized patients turn up in the first week to obtain their chronic medications. 

The inventory of equipment at the first level of care fails to meet user demand for these services. My experience certainly confirms this. 

At the second level of care serious obstacles hinder efforts to maintain existing equipment, including a lack of qualified equipment maintenance personnel. I am sure this is the case. There are no parts or personnel to fix any out-of-the-ordinary mechanical or electrical device, much less sophisticated medical equipment. For example, if I were to purchase a car in Nicaragua, there are only a few makes and models that would routinely have parts and service available. Why would anyone purchase something different?   

Physicians per 10,000 population increased from 4.0 in 2000 to 4.7 in 2007. By comparison, the number of physicians in Canada per 10,000 population is 22. 


In 2007 there were 1376 male physicians and 1231 female physicians in the public health sector. Many of these are brand new graduates. I learned that physicians who graduate from medical school in Nicaragua are obliged to serve for two years in a MINSA clinic. The physicians are posted to a clinic immediately after they graduate and the public service is therefore their postgraduate training program. I graduated from a first class medical school that included a lot of clinical experience prior to graduation but I spent 6 more years of postgraduate training before the Canadian Medical Profession let me practice my specialty without supervision. For general paediatrics at that time the minimum duration was 4 years and for family medicine the duration was 2 years. Posting brand new graduates to meet community needs sounds ridiculous, but any knowledge and help, however inexperienced, is better than no knowledge or help.

Great Egret on a windy day.
The wind is only apparent with the feathers behind the neck.
The branch was really swaying and the egret needed to
brace the legs and lean into the wind to keep steady.