Case Study of Nicaragua - Medical Devices and Biomaterials for the Developing World - page 34

Table 3.1 Division of regions in Nicaragua
Region % of total land area % of total population

Paci fi c 15.2 54

Central 28.4 32

Atlantic 56.4 14

Source : PAHO ( 2007 )

Fig. 3.1 Administrative
regions of Nicaragua

totally eliminated from the population (PAHO 2007). The major challenges cur-
rently facing the nation are acute respiratory infections, noncommunicable and car-
diovascular diseases, and malnutrition. This parallels a trend in developing societies
worldwide.
Since the 1980s, the theme of decentralization, a strong immunization program
including National and Regional Health Days focused on 100% coverage, and
movement from an institutional/professional model to a popular model have char-
acterized the Nicaraguan health system. Notable in this shift has been the training
and usage of Community Health Workers, commonly known as “Brigadistas”
throughout the nation, but especially in the less densely populated Atlantic region.
The Brigadista model relies heavily on inter-training of workers for self-perpetuation,
and it has been a successful solution to the general lack of human resources, especially
in rural areas (Donahue 1991).
The disparities in care and different models employed on the Pacific and Atlantic
coasts are significant, and they are still manifested in the health situation of today.
The areas with highest child malnutrition are RAAN, Jinotega, Madriz, and
Matagalpa, which are all located in the north and in the Atlantic or Central Regions
(PAHO 2008 ) .
The Pacific Coast is characterized by an institutional primary health care plan as
well as vertical integration of services and popular participation. The Atlantic
Coast, on the other hand, generally provides fewer services. As of the early 1990s,