Health Issues in Nicaragua - Case Study Example

Global Health Paper Health issues in Nicaragua I. Introductions Nicaragua is a country located in Central America and is the largest republic there.The country borders with Costa Roca on the South and Honduras on the North (U.S. Department of State, 2009). The Pacific Ocean forms the western border of Nicaragua and the Caribbean Sea the east one. The size of the country is 129 494 square meters and is a bit larger than New York State. The population of the country is 5, 891 200 estimated in July 2009 (U.S. Department of State, 2009). The capital city of Nicaragua is Managua where 1 million people live. Other major cities can be named – Leon, Granada, Jinotega. Nicaragua is a land with many lakes and mountains, rivers and volcanoes. It is divided into three geographical regions – the Atlantic Lowlands on the east, the Pacific Lowlands on the west and the mountainous Central Region. The terrain of Nicaragua represents extensive Atlantic coastal plains which rise to central interior mountains. The narrow Pacific coastal plain is broken up by volcanoes (U.S. Department of State, 2009). The climate in Nicaragua is tropical in the lowlands and cooler in the highlands. The predominant climate consists of two seasons – rainy and dry or winter and summer. The humidity from both the Pacific and the Atlantic oceans provide Nicaragua with fairly stable changing seasons. In the Central Region the rainy season starts in May and lasts until October. The dry season occurs in November and ends in April. The hottest months in Nicaragua are March, April and May. Nicaragua is one of the countries with the youngest population. 60% are under 17 years old. The density is 42 per square kilometer (U.S. Department of State, 2009). The predominant religion is Roman Catholicism, however the percentage of Evangelical Protestants is rapidly growing. There are several ethnic groups – Mestizo – of mixed Spanish and Indian blood who form the majority 69%, white – 17% and Amerindians – 5%. The official language in Nicaragua is Spanish, however English is widely spoken as well as other indigenous languages on the Caribbean coast (U.S. Department of State, 2009). The average life expectancy is 72.9 years. Nicaragua is named after the main indigenous tribe Nicarao, who lived near Lake Nicaragua. This was the period in the late 1400s and early 1500s. The first permanent Spanish settlement was founded by Hernandez de Cordoba. Nicaragua received its independence from Spain in 1821. After that it became for a short period of time part of the Mexican Empire. In 1838 Nicaragua was acknowledged as independent republic. B. Political Structure. Nicaragua is a constitutional democracy with judicial, legislative, executive and electoral branches. In 2000 changes in the constitution have been introduced allowing the president to be elected with 35% of the population vote, as long as the difference with the other candidates is at least 5%. There is a fairly stable government, represented by the National Assembly which is elected every 5 years. The National Assembly includes 92 deputies (U.S. Department of State, 2009). The economy is based primarily on agriculture, and exports such as cotton, sugar and coffee, tobacco, beef, sesame seeds and rice. Currently, the agriculture forms 60% of the total export which classifies Nicaragua as a poor country since the majority of the exports come from agriculture. Manufacturing accounts for only 10% of the Gross domestic product. Conflicting interests and weak enforcement of property rights had created severe disputes and litigations where many cases of corruption and political influence were reported (U.S. Department of State, 2009). What is more, foreign investors who showed interest in Pacific Coast motivated unscrupulous people to chance ownership rights and settle down unfair land deals. C. Religious/Traditions of Populations that may affect health care The greatest issue in the health care system in Nicaragua is poverty. In the country malnutrition is widespread and sewage systems are poor and inefficient. There is only sporadic application of the most basic public health policies and produce little effect to the impoverished population. Nicaraguans depend on a three-layer health system which mirrors the fundamental inequalities in society there (Health, 2006). The middle and upper class take advantage of the private health care, often going abroad for treatments which are not available in the country. The Nicaraguan Social Security Institute provides specialized health care for privileged minority of government and industry individuals. The irony is that the Social Security Institute serves only 8% of the privileged, but devours between 40% to 50% of the national health budget. The rest of the population which is 90% is served poorly by public facilities which are mismanaged in addition. The public health institutions are underequipped and inadequately staffed (Health, 2006). Another typical aspect of social organization in Nicaragua is that the care services are focused in bigger cities, whereas in rural areas the care facilities are old and unsatisfactory. II. Health Care Model The health care system in Nicaragua is organized through a system named “Modelo de Atencion Integral en Salud” MAIS for short, in translation it means Integrated Model for Health Provision (Nicaragua’s Health System, 2005). The three components are provision, management and funding the health system. MAIS also decides upon the basic package of care which targets specific priority groups. The role of Ministry of Health is to regulate, supervise, coordinate and ensure the delivery, recovery, and provision of health care. The Ministry of Health is also responsible for the decentralization and the autonomy of hospitals in order to provide them with more flexible schemes and resource utilization. In general in health care system, many advantages were gained in the early 1980s, however, they were lost in the late 1980s. Obligatory health care activities such as vaccination campaigns, had to be applied in regions of Nicaragua where the population was experiencing armed conflicts. Therefore, the health care system was full with war victims. With rapidly growing impoverished population more and more children become vulnerable to various diseases. The economic decline in Nicaragua pushed many medical specialists to leave their public employment in favour of the private practice (Health, 2006). In Nicaragua, there are 33 public hospitals and the largest concentration of beds per person is in the capital Managua. 22 of the public hospitals are general and the rest being specialized in dermatology, oncology, paediatrics, psychiatry and so on (Nicaragua’s Health System, 2005). One of the issues connected with health care in poor and developing countries is that shortage of human recourses and the uneven distribution of these resources and insufficient training. Nicaragua faces other financial problems in the health care primarily the lack or scare tools for diagnosis and treatments. Besides formal health care, the country had started a program named “Brigadistas” which is a community health work, delivered by volunteers. This program is seen as an extension of the health care system within the given community or area. “Brigadistas” community workers are primary involved in reporting deaths and cases of diseases within the area they program operates and to organized vaccination campaigns (Nicaragua’s Health System, 2005). A. Education of Nurses Cruickshank (2000) notes that Nicaragua has received a loan from the World Bank’s International Development Association to pilot a project in hospital administration to train nurses as part of the health sector reform. Cruickshank (2000) found out another initiative which contributes to the development of nursing education through the introduction of helping nursing faculty in dealing with computer skills for nurses in preparing different medical tests and applications. Attempts were made to integrate the use of technology into educational nurse programs throughout Nicaragua. B. Role of the Nurse in the Medical Hierarchy Nurses are medical professionals who work together with the doctor to ensure care and assistance to the ill people. The same role play nurses in Nicaragua, even though midwives are believed to have higher rank because of their duties and responsibilities (Cruickshank, 2000). Cruickshank (2000) points out that the nursing role is to integrate patient and family to the medical atmosphere and to convey the knowledge of the situation. In Nicaragua the interpersonal relation between nurse, patient and other medical personnel is of primary importance and has greater impact during the patient’s stay in the institution. C. Major Health Care Issues affecting Population Solo (2003) states that 58% of Nicaraguans are not able to obtain sufficient healthcare and treatment, because of their poverty and social exclusion from the health system. The people who are not affected by this are those living in the rural areas, women and children mostly. They have least access to medical attention and are predisposed to become victims of discrimination and abuses. The study which Solo (2003) refers to, also comments that 20% of children under five often suffer from chronic malnutrition again due to the poor economic and social conditions. Another serious factor that Solo (2003) reports is public health system inability to reply to the population’s healthcare needs. This factor seriously aggravates the efforts to build sustainable health care procedures. 80% of working class do not have any health insurance and 90% of the retired population do not receive social security benefits, including proper health care assistance (Solo, 2003). The study determines that the most common ailments are gastric complaints and respiratory problems. Also depending on the city area people are more likely to suffer from high blood pressure and diabetes in big cities caused by the lifestyle there. Whereas, the proportions are lower in rural regions. Reference List: Cruickshank. C. (2000). Report from Nicaragua: midwifery and structural adjustment Journal of Midwifery & Women’s Health, Volume 45, Issue 5, Pages 411-415 Health, (2006) US Library of Congress Retrieved from http://countrystudies.us/nicaragua/27.htm On 19 February 2010. Nicaragua’s Health System, (2005) Retrieved from http://www.access2insulin.org/html/nicaragua_s_health_system.html On 18 February 2010. Solo, Tony, (2003), Neo-Liberal Nicaragua, Global policy forum, retrieved from http://www.globalpolicy.org/component/content/article/168/28088.html on 17 February 2010. U.S. Department of State, (2009) Background Note: Nicaragua. retrieved from http://www.state.gov/r/pa/ei/bgn/1850.htm On 19 February 2010. Read More