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Investing in health care: the example of Nicaragua

News from Nicaragua | Tuesday, 3 February 2015 | Origional source: https://walesnicaragua.wordpress.com/2015/02/03/health-improvements-in-nicaragua/

In sharp contrast to austerity-ridden UK, since returning to power in 2007, the Sandinista government has tripled spending on health care.

The Wales NSC delegation to Nicaragua interviewed Minister of Health Sonia Castro to find out what difference this investment has made in health care provision particularly for those who are most impoverished.

Can you tell us about what steps the government has taken in health since 2007?

After 2007, during the second phase of the revolution under Comandante Daniel, we proposed a new health model. Our principal strategy aimed at prevention is based on outreach with the family and community. For sixteen years the previous governments’ model was curative, not going out into the streets and working with communities.

The other big difference is that our model is holisitic. A person is part of a family, a community. We have an integrated focus, an all-encompassing model. It’s not yet fully established, but something we are working on, and strengthening. Within this integrated model we have priorities. They are:

  • women
  • children
  • the elderly
  • people with disabilities

But in order to back up these priorities the MINSA is one of three ministries that has more money assigned to it. We have had C$10 billion (cordobas) more each year in the budget. For 16 years there was no investment in the infrastructure. Now we are working to improve that. Since 2008 we have built 10 primary care hospitals in poor, rural areas. We have also strengthened the system by improving existing hospitals, and improving technology, for example, equipment for scans. This has helped reduce the technology gap between Nicaragua and other countries. We have also invested in the basics – beds, bedsheets, medicines. In addition the government is constructing three modern hospitals, to “First World” standards, in Chinandega, Managua and Leon, each at a cost of $100 million.

The third area we have invested in is human resources. In 2007 there were 22,000 workers. Today there are 32,000. But beyond this we have been building capacity. Lots of doctors and nurses have received training in their specialisms – neo-natal care, trauma etc. We’ve also invested in training staff in social work.

I will give you one example. Before 2007 fifty to sixty doctors a year would pursue a further degree, which they financed themselves. Since 2007 we have paid for 250 doctors to pursue these courses, at a cost of $40,000 each over four years. They have to commit to giving back to the people of Nicaragua. We have also provided grants for staff to study their specialisms in other countries.

In the context of all this investment in the health service, what has this achieved?

In services to individuals we now attend to 20 million people a year, compared with 7 million in 2007. This is all free, including medicines.

In health indicators, if we look at child mortality, in 2007 it was 27 deaths per 1000.This has now been reduced to 17 per 1000. It is a result of our model, working alongside the community. We also have a very good free vaccine programme, and a very good neonatal and maternal monitoring programme. To this we can add our Amor Por Los Ninos programme, based on a strategy of non-violence and love as well as health. Another factor is the amount of paediatricians in rural areas, which have greatly increased. The Millennium Development Goal (MDG) was to reduce infant mortality to 19 per 1000, and we have met and exceeded this.

Can you tell us about another of your priorities, women’s health?

We have organised the model around the different steps in their lives – as girls, when they start considering having children or have children, when they grow older and become more susceptible to different diseases. For example, we have increased the early detection of cervical cancer and HIV.

Regarding the Millennium Development Goals again, another is around maternal mortality. We have strengthened the capacity of mid-wives, particularly in rural areas, and introduced the birth plan. We meet with the community, and work with them so they are organised if a woman has a problem during pregnancy and they need to take her for help.

Another strategy is the Casa Maternas (maternity houses). They started in the 1980s, but by 2007 there were only 50 of them. Most of these were run by NGOs and solidarity groups. We set ourselves the target of a Casa Materna in each locality. Today there are 165, in every municipality apart from thirteen, which are run by the government.

Our final effort was to improve health units, with equipment for gynaecology and obstetrics. We’ve also equipped strategic locations if specialised help is needed.

In 2006 the maternal mortality rate was 94 per 100,000. In 2014 it was 39 per 100,000. When the previous neo-liberal governments discussed the MDG of 40, they said it couldn’t be done, but the Sandinista government have done it by investing in the health service.

We have also succeeded in attacking the transmission of HIV from mother to child. When we detect the disease we treat the mother with retro-virals, and transmission rates have dropped to less than 2%.

Are there other areas where you feel the government has been successful?

In children’s health 98% of children under 6 receive free vaccines. They prevent 13 different diseases. Another of our indicators is the prevention of epidemics. Last year we dealt with four – leptospirosis, dengue, chikungunya and influenza. Our model has been recognised as a good example in dealing with epidemics, by the Pan American Health Organisation for others to follow.

We also have one of the best cardiology hospitals in Central America. Another important factor has been the legal recognition of natural medicine as complementary to modern medicine.

Can you tell us about the relationship with the workers in the health system?

We have involved the trade unions in decisions. Now they negotiate every two years on deciding their terms and conditions. They also have the responsibility, as a trade union, of taking the revolutionary project forward. Many are also members of the Frente Sandinista. This involvement gives them a sense of ownership. It’s not just about getting a salary. They have a social responsibility. The workers are also there to oversee the leaders of the institutions.

How are the health improvements related to Nicaragua’s membership of ALBA (the Bolivarian Alliance for the Peoples of Our America)?

Because of ALBA we have the first high-tech neurological centre in Nicaragua. ALBA has also funded 15 mobile screening units – gynaecology, ultrasound scans and ontology. It has also funded grants for students to study medicine, and now funds studying specialisms for doctors to improve their skills. But the ALBA does not only provide additional funding. We have co-operated with Cuba on Operacion Milagro (Miracle Operation), which has provided 100,000 eye operations since 2007. We have the objective of increasing these operations to 20,000 a year by 2017. Another important programme is Todos con Vos (Everyone with You). It started with a census in 2012 of people with disabilities. Having identified 120,000 people, it has now developed a programme, including support and adaptations.