Healthcare in Nicaragua: Overcoming Challenges through Public Health Awareness
As with many developing countries, Nicaragua faces a number of challenges regarding access to quality healthcare. Many health needs can be tied to issues stemming from poverty, geographical positioning, and a disorganized healthcare system. One of the main contributors to the suboptimal health outcomes observed in Nicaragua is the lack of access to and healthy cooking methods. In 2011, approximately 73 percent of households in rural areas did not have access to suitable water supplies, 33 percent of households had no electricity, and 59 percent of households were using firewood for cooking. The same year, studies found that 70 percent of the country’s garbage was neither collected nor processed and that 14 percent of households regularly threw garbage into the street instead of disposing of it properly. In addition, a third of Nicaragua’s population was found to be living without access to an adequate toilet.
The considerable lack of access to sanitary living conditions has had serious consequences for the health of the Nicaraguan people, particularly young children. Drinking unsafe water and poor sanitation standards cause over 100 children to die each year from diarrhea. In addition, large segments of Nicaragua’s population are negatively impacted by high rates of maternal mortality, infant mortality, and child malnutrition. While progress has been made to decrease maternal and infant mortality rates in recent years, health outcomes for women and children remain relatively poor. As of 2011, more than 28 percent of all Nicaraguan children suffered from some degree of undernutrition, while almost 37 percent of children in rural areas were undernourished.
The significant gap in nutrition observed between urban and rural areas of Nicaragua highlights another prominent issue with health and access to healthcare: an inequality of access among different regions of the country. In 2011, a study reported that 35 to 40 percent of the population did not have access to health services. One of the main reasons for the observed disparities in healthcare is the uneven distribution of medical centers across Nicaragua’s territory. Though the country has 32 public hospitals, the majority of them are located on the Pacific side of the country, mostly in Managua, Nicaragua’s capital city. In contrast, there are only three public hospitals in the Caribbean region of the country, despite the fact that this region makes up approximately 55 percent of the total national territory. The same pattern can be observed with health centers, most of which are located in the Pacific and Central regions of the country. Given these disparities, the average number of people served by each hospital and health center varies widely by region, with health facilities in the underserved Caribbean region unable to provide the same quality of care as those in other regions. The consequences of Nicaragua’s unequal healthcare system become clear when regional health outcomes are observed. For example, maternal mortality rates on the Caribbean coast are much higher than those of other regions, a trend that has been tied to instances of postpartum hemorrhage and the difficulty of accessing health services to obtain life-saving postpartum medical care.
The World Health Organization (WHO) outlined Nicaragua's most pressing health concerns:
- Inequities in Access to Health Services: Only 6.3 percent of the population is insured. Out-of-pocket expenditures constitute a serious barrier for the poor and ethnic minorities, over and above the lack of access in rural areas.
- Infant mortality remains high in the poorest regions and is associated with respiratory diseases, neonatal sepsis, congenital malformations, diarrhea, malnutrition, and meningitis.
- Maternal mortality remains high in disadvantaged groups—rural and indigenous populations, the poor, adolescents, and women with low levels of schooling—even though the total fertility rate has fallen. Some 55 percent of women in rural areas give birth at home. Adolescents account for approximately one-third of maternal deaths.
- Child Nutrition: Some 22 percent of children living in the most disadvantaged urban areas suffer from malnutrition versus 0.4 percent in the richest areas.
- Communicable diseases continue to increase. Malaria 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 2005.
- Non-communicable diseases have resulted 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 of age). Mental illness, neurosis, alcoholism, general violence, and domestic violence have increased, primarily in urban areas.
- Growing environmental degradation of habitats and soils and the deterioration in production conditions threaten Nicaragua's health, agricultural, and ecological balance. Similarly, rapid, irresponsible economic development and the indiscriminate felling of trees have left Nicaragua increasingly more vulnerable to natural disasters, such as hurricanes and earthquakes. Hurricane Katrina is a prime example.
Hurricane Mitch devastated Nicaragua's infrastructure in October 1998, further debilitating the healthcare system and drawing international attention to the country's plight. The Health Ministry responded by consulting with the WHO to increase patient access, improve the coordination of international aid, and analyze Nicaraguan disaster response strategies.
Nicaraguan doctors and nurses receive wages barely over that of doctors and nurses in Malawi—an African country whose per capita income is 80% below Nicaragua's. At the same time, Honduras, a neighboring country whose per capita income is comparable, pays doctors three times the wages of those in Nicaragua. Although Nicaragua receives a large amount of international aid, both fiscally and in the form of volunteers from developed nations, combating the country's endemic health problems will necessitate more resources put in the right hands.
How FSD is Working in Nicaragua
FSD interns and volunteers have the opportunity to directly support a move toward a healthier Nicaragua by assisting nurses and doctors, training youth to be peer health educators, and helping to organize vaccination and education campaigns that address a variety of problems. FSD partners with health centers, health posts, hospitals, and public health organizations throughout Nicaragua to address the variety of issues in the healthcare field.
Recently, Elizabeth Asonye, an FSD intern in Masaya, Nicaragua, helped develop a cervical cancer brochure to be used by two health centers and 14 health posts. This brochure was part of a larger project aimed at providing women in Masaya with accurate, accessible, and culturally appropriate health information. Cervical cancer prevention is one of the many women's health issues that have been supported by FSD and our interns. Likewise, many intern projects have supported maternal health, pregnant teens, or family planning. Nancy Yang helped to establish a support group for pregnant women so they could have access to education and support from the health center. Julianna Drew worked in Monimbo (a small community in Masaya) to increase family planning education and women's health with adolescents. Delana Eby worked in Jinotepe to reduce the rate of teen and unplanned pregnancy through education. Matt Hing worked to improve access to family planning services and reproductive health education in rural communities, and Michelle Tran worked with at-risk girls to start a peer health group led by community members to help educate others and improve the overall community health.
Another issue that is prevalent throughout Nicaragua is diabetes. Both Kristina Dickman and Brad Kawano conducted community research with one of our health center partners to identify ways that the health center could advance medical care for diabetic patients. Brad also played an integral part in establishing a diabetes support group that allowed individuals to gather together and learn ways to control their diabetic symptoms.
Through the work of FSD, we are slowly changing the healthcare climate in Nicaragua, but this change will not be a quick fix, but rather a slow and gradual increase in the quality and frequency of services offered. If you are interested in supporting the public health work we do in Nicaragua, contact our international programs team at firstname.lastname@example.org