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**Prior to this section on Post-revolutionary healthcare systems, the article discusses the history of the healthcare system prior to the Sandinista Revolution.**
Post-revolution
After the 1979 Revolution, the new government established a new Unified National Health System that instated the Nicaraguan Ministry of Health (MINSA) at the head of health services throughout the nation. This system also integrated the Nicaraguan Social Security Institute (INSS) under MINSA's direction in order to make it financially feasible to provide a single national health service available to all Nicaraguan citizens, regardless of socioeconomic background.[1]With the combination of these institutions, the INSS hospitals and clinics, previously only accessible to insured employees, then opened their doors to the larger population.[2]
In 1984, in order to improve existing institutional infrastructure, 10% of the national budget was allocated to the health sector. From 1979 to 1984, the government also successfully pushed for the construction of 309 new primary healthcare facilities and the training of over 3,000 health professionals.[3] Following the wake of the Revolution, MINSA promoted several prevention-based health efforts, one of the earliest being its Brigadista program. This Brigadista program involved the training of community health advocates, the majority of whom were chosen from the Sandinista Youth Organization, who were selected to be trained and transported to serve in underserved rural regions.[4]
Since the 1990s the Nicaraguan government has been changing towards more market-oriented economic policies that have affected the health sector. This healthcare shift has involved increased private sector activity as well as the decentralization of public services.[5] Access to privately-operated healthcare services in Nicaragua may pose challenges for rural communities, influenced by factors including high costs, chronic under staffing, limited diagnostic and pharmaceutical resources, and the remote locations often requiring extended travel to reach such facilities.[6]
Non-governmental organizations (NGO) have become more active in impoverished communities like Nicaragua.[7] A particularly prevalent example of NGO work is medical volunteerism which encompasses free healthcare services, typically provided by international groups. NGO involvement became common around the year 2000, which is the year that the World Health Organization’s Alma Ata Declaration had identified for achieving the goal of health for all. [7] With support from humanitarian agencies and development organizations, NGOs work to meet health care needs that are not met by the country's public health institutions. There is ongoing discussion about the benefits and drawbacks of such medical volunteerism.
***The article then moves onto the next sections titled Levels which discusses the different tiers of the current decentralized model and well as details about the decentralization***
- ^ Donahue, John (2009-02-02). "The Politics of Health Care in Nicaragua before and after the Revolution of 1979". Human Organization. 42 (3): 264–272. doi:10.17730/humo.42.3.x737h47hqw3r2785. PMID 10263281.
- ^ Garfield, R. M.; Taboada, E. (1984-10-01). "Health services reforms in revolutionary Nicaragua". American Journal of Public Health. 74 (10): 1138–1144. doi:10.2105/AJPH.74.10.1138. ISSN 0090-0036. PMC 1651882. PMID 6476169.
- ^ Braveman, P. et al. (1985). Primary health care takes root in Nicaragua. World Health Forum. 6, 369–372.
- ^ Amador, C. (1980). Informe de la Situacion de Salud de Nicaragua. MINSA.
- ^ Birn, A. E.; Zimmerman, S.; Garfield, R. (2000-01-01). "To decentralize or not to decentralize, is that the question? Nicaraguan health policy under structural adjustment in the 1990s". International Journal of Health Services: Planning, Administration, Evaluation. 30 (1): 111–128. doi:10.2190/c6tb-b16y-60hv-m3qw. ISSN 0020-7314. PMID 10707302. S2CID 1189417.
- ^ Nouvet, Elysée; Chan, Elizabeth; Schwartz, Lisa J. (2018-04-03). "Looking good but doing harm? Perceptions of short-term medical missions in Nicaragua". Global Public Health. 13 (4): 456–472. doi:10.1080/17441692.2016.1220610. ISSN 1744-1692.
- ^ a b McKay, Ramah (2020). "Global health's durable dreams: ethnography, 'community health workers' and health without health infrastructure". Africa. 90 (1): 95–111. doi:10.1017/S0001972019000950. ISSN 0001-9720.