By Nan McCurdy and Katherine Hoyt

Nicaragua’s advances in nutrition, public health and health care may not be recognized in the mainstream media but they have been recognized by international organizations. Dr. Suzanne Serruya of the Pan American Health Organization (PAHO) stated in August that “It is very important to bear in mind that not all countries have a universal and free healthcare model capable of achieving the results that we observe in Nicaragua. …. These results are only possible when the State recognizes as a principle that health is a human right of the population.” Nicaragua has lowered child malnutrition and achieved 90% food sufficiency through its agricultural and anti-poverty programs. The Food and Agricultural Organization (FAO) representative for Latin America, Alfredo Mayén, noted that “Nicaragua is an example of food and nutritional security in part due to its application of best practices in community seed banks and the implementation of participatory plant breeding strategies.” PAHO has noted that, at 89.4%, Nicaragua is the country in Central American with the highest percentage of people fully vaccinated against COVID-19.

What follows here are some of the recent advances Nicaragua has made in the areas of health and nutrition, concentrating on the current year 2022.

In the last 15 years the Sandinista government has built more than 500 new health units including hospitals, health centers, health posts and specialized centers, said Dr. Martha Reyes, head of the Ministry of Health (MINSA). Reyes recalled that in 2007 there were only 1,091 health units, while today there are 1,596.  Since 2007, 24 hospitals have been built; 17 major health centers and 454 health posts. Nicaragua has also built 81 new maternal wait homes. “We also have 51 houses for people with special needs, to serve people with chronic diseases, 188 natural medicine clinics, the national cytology center, three epidemiology laboratories, a clinical center for people with HIV and 33 different projects that include warehouses, the ambulance center and other important structures.”

In 2006, Nicaragua had 23,000 health workers, including doctors, nurses, technicians and support staff. Today there are more than 37,500 workers, 63% more, Health Minister Reyes reported. “In 2006 there was a budget of US$186 million and today it is US$509 million; 274% more to ensure good health attention to the population,” she added. In 2006 MINSA spent US$24.4 million on medical supplies and now it spends more than US$160 million, or 556% more. MINSA organizes an average of 900 health fairs nationwide in neighborhoods to bring health to the population in remote areas.

The Pan American Health Organization (PAHO) has reported that with 89.4% of the population fully vaccinated against COVID-19, Nicaragua is the country in Central American with the highest percentage of fully vaccinated people followed by Costa Rica (81.6%); Panama (71.6%); El Salvador (66.2%); Honduras (54.9%); Guatemala (36.9%).

During the National Vaccination Campaign, medical brigades, mobile clinics, and the 19 Local Health Systems (SILAIS) attended more than two million people from two-month-old infants to senior citizens. Nearly two million doses of vaccines were administered between April 19 and May 8th, as well as 1.74 million doses of anti-parasite medicine and 783,140 doses of vitamins A to children between one and six years old. The representative of the Pan-American Health Organization (PAHO) Ana Solís Ortega Treasure, stated that “For PAHO, it is always satisfying to see how the staff of the National Immunization Program works tirelessly to ensure that the vaccines reach the very last corner of the country. We are very pleased to see that the vaccination goal has been met and exceeded.”

The Director of the Latin American Center for Perinatology (maternal-fetal medicine) of the Pan American Health Organization (PAHO), Dr. Suzanne Jacob Serruya, was recently in Nicaragua to visit health centers and hospitals. On August 19, Dr. Serruya stated that “the healthcare model in Nicaragua is universal, free and extends throughout the national territory. It is very important to bear in mind that not all countries have a universal and free healthcare model capable of achieving the results that we observe in Nicaragua. These results are only possible when the State recognizes as a principle that health is a human right of the population.” She also noted that “in Nicaragua there are three fundamental components of the healthcare system that deserve recognition not only from PAHO but from other countries as well: The medical brigades that guarantee direct access between the community and the healthcare system even in the most remote places of the country; the Maternal Wait Homes, which have radically reduced maternal and infant mortality rates; and the National Emergency Code that requires that the entire medical hierarchy be notified when there is an emergency involving maternal health. All these strategies converge and create a healthcare system that is comprehensive, family and community oriented, as well as successful, benefitting the entire population.” 

The Government reduced maternal mortality from 92.8 to 31.6 deaths per 100,000 live births between 2006 and 2021, a 66% reduction. Maternal Wait homes with trained midwives have grown from 50 to 181.

The first “smart” maternal-fetal operating room in the Central American region will be built at the Bertha Calderón Women’s Hospital in Managua, with an investment of about US$3 million to continue doing surgeries in the mother’s womb. Dr. Carolina Dávila, presidential advisor for SILAIS Managua, highlighted that the work also includes the installation of four “smart” screens, a balcony for other doctors to watch the surgery, and will also include the ability to communicate with the neonatal area and the labor and delivery areas of the hospital.  Some 15,000 women will benefit from the mega project. The construction of the first “smart” operating room will make it possible to train up to 10 types of specialists with surgeries in real time. “Currently, we perform 15 types of surgeries free of charge, the most frequent being for hydrocephalus, lung alterations, spinal column and abdominal wall defects and, most frequently, placental separation in twin pregnancies, with 22 procedures.” Each surgery is valued at around US$25,000, in addition to US$12,000 in hospital expenses; however, in Nicaragua it is completely free of charge.

Nicaragua has registered 3,700 cases of malaria so far in 2022, a 57% reduction compared to the same period in 2021, when more than 10,000 cases were registered. During the Sixth International Congress on Malaria, Dr. Carlos Saenz explained that the reduction is due to the strategies promoted through the Family and Community Health Model in which a series of actions were developed to reduce malaria. Saenz also mentioned that the authorities of Nicaragua, Honduras and Costa Rica signed a multilateral agreement with the goal of carrying out cross-border coordination actions to eliminate malaria in these territories.

The Ministry of Health has reported that construction of the “Nuevo Amanecer” Regional Hospital in Bilwi, Northern Caribbean Autonomous Region, is 46% completed and will become fully operational in 2023 benefiting 600,000 inhabitants. At a cost of US$82 million the project is financed through the General Budget with support from the Central American Bank for Economic Integration.

The rehabilitated Francisco José Gómez Urcuyo National Dermatology Center in Managua was inaugurated on September 1^st. The US$2.81 million investment includes rehabilitation, expansion and equipping of the emergency room, outpatient clinic, pharmacy, and laboratory, benefiting patients nationally. Photos: https://radiolaprimerisima.com/noticias-generales/destacado/centro-nacional-de-dermatologia-cuenta-con-nuevas-instalaciones/

The Food and Agriculture Organization (FAO) representative for Central America, Alfredo Mayén stated that “Nicaragua is an example of food and nutritional security in part due to its application of best practices in community seed banks and the implementation of participatory plant breeding strategies.” Gloria Sandoval of the Mexican Agency for International Cooperation noted that “we are pleased to support the Nicaragua Government in the implementation of projects and strategies that continue to strengthen food systems and make the production processes of farmers more sustainable.”

The representative of the World Food Program in Nicaragua, Giorgia Testolín, has highlighted the government school meal program saying, “The emblematic School Meal Program is an important investment in the new generations.” Testolín said she was pleased to see that also “in the National Plan to Fight Poverty, the North Caribbean Coast is well highlighted as a region of attention, investment and programs.… She said that the WFP supports the government’s sustainable food systems, the whole thematic of integrated risk management, and adaptation to climate change. Small producers and cooperatives are also supported.

In an interview on television station TN8 on July 26, Agriculture Minister Isidro Rivera addressed the steady progress of food security in terms of productivity, efficiency and policies to support small and medium producers. He stated, “Indeed, food security and sovereignty are very important; having food for all in Nicaragua is very important. Remembering the years 2005-2006, not all food was produced in the country, not even the basic food basket. However, in 2007 President Daniel Ortega took charge of transforming the productive matrix, making Nicaragua a food producing country that can sustain itself, and that also contributes to the food security of other countries.” He added, “Fortunately now, we can easily say that we have 90% food self-sufficiency. We still import 1.5 million hundred weights of rice while our current production is six million hundred weights. Rice consumption at the national level is 7.5 million. In one more agricultural cycle, we will be producing all the rice we consume.”

The yearly Nutritional Census was carried out in March to study nutrition of children from birth to 14 years of age in rural and urban areas. The census surveyed 1.5 million boys and girls and found that, among children between birth and six years of age, acute malnutrition has been reduced 2.3% and chronic malnutrition fell by 8.6%. Among children from 6 to 14, acute malnutrition was reduced by 11% and chronic malnutrition decreased by 16.5%. Based on this data, programs like Zero Hunger, Family Gardens, School Lunches, and Food Production Packages will be strengthened to eradicate malnutrition.

The Sandinista government, through ENACAL, has invested millions of dollars in potable water and sanitary sewerage since 2007 and it plans another 23 projects before 2026, improving the quality of life of thousands of Nicaraguans, the executive president of ENACAL, Ervin Barreda, told INFORME PASTRAN. He noted that, contrary to the intention of the neo-liberal governments between 1990 and 2006 to privatize the drinking water service, the Sandinista government with a well-determined political will has achieved the financing to bring more and better-quality water to homes and create adequate sanitation. Between 2006 and 2021, US$979.2 million was invested in projects. Currently we have in execution another portfolio for US$388.5 million for the period 2022-2026. “We are meeting and exceeding the United Nations Sustainable Development Goals. From 2006 to 2021 we reached 93% of the population with drinking water. And with the political will of this government, whose priority is the poor and the reduction of poverty, we will reach 98% of families with drinking water by 2026 and 80% of the population with sanitary sewerage.”

(Sources: Nicaragua News, Radio La Primerisima, Informe Pastran, TN8)