Health Care in Nicaragua: Primary Care Under Changing Regimes

Despite two decades of natural disasters, political upheaval, and economic decline, Nicaragua has maintained a system of health care that responds to the needs of most of its people. This important work accurately describes the twists and turns in Nicaragua's health policy during the last two decades. The authors, an epidemiologist and a health educator, have taken part in that system for twelve years, and bring a wealth of data and experience to this unique survey. They draw on detailed comparisons with other countries to examine attempts to promote community participation, harness international assistance, manage the private sector, and develop public services under changing political regimes. The health system under the Somoza dictatorship, the Sandinista revolution, and the post-Sandinista chamorro government is scrutinized in light of several key issues. These include the decisions to focus on primary care or hospitals; to limit or expand the roles for volunteers; to provide care to the entire population or only priority groups; to rely mainly on public or private services; and whether to depend on central government or local control. No other book depicts a developing country's health system with as much analytical detail or with as extensive documentation. Yet this work simultaneously remains an account of the patients, community organizers, health workers, and political leaders. It is a thought provoking case study of people, programs, and policies in international health.