NICARAGUA

[Guest]

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[Natasha]

NICARAGUA


Nicaragua (IPA: /ˌnɪkəˈrɑgwə/) officially the Republic of Nicaragua (Spanish: República de Nicaragua (help·info), IPA: [reˈpuβlika ðe nikaˈɾaɣwa]), is a representative democratic republic and the largest nation in Central America. It is also the least densely populated with a demographic similar in size to its smaller neighbors. The country is bordered by Honduras to the north and by Costa Rica to the south. The Pacific Ocean lies to the west of the country, while the Caribbean Sea lies to the east. Falling within the tropics, Nicaragua sits 11 degrees north of the Equator, in the Northern Hemisphere.

The country's name is derived from Nicarao, the name of the Nahuatl-speaking tribe which inhabited the shores of Lago de Nicaragua before the Spanish conquest of the Americas, and the Spanish word Agua, meaning water, due to the presence of the large lakes Lago de Nicaragua (Cocibolca) and Lago de Managua (Xolotlán), as well as lagoons and rivers in the region.


Nicaragua's economy ranks as 61st freest economy, although it is 1.7% lower than in 2006, it ranks 14 (out of 29) in the Americas. Nicaragua's economy is 62.7% free with high levels of fiscal, government, labor, investment, financial, and trade freedom.[61] Nicaragua is primarily an agricultural country, but light industry (maquila), tourism, banking, mining, fisheries, and general commerce are expanding. Nicaragua's agrarian economy has historically been based on the export of cash crops such as bananas, coffee, sugar, beef and tobacco. At present agriculture constitutes 60% of its total exports which annually yield approximately US $300 million. In addition, Nicaragua's Flor de Caña rum is renowned as among the best in Latin America, and its tobacco and beef are also well regarded. Nicaragua also depends heavily on remittances from Nicaraguans living abroad, which totaled $655.5 million in 2006.

As in many other developing countries, a large segment of the economically poor in Nicaragua are women. In addition, a relatively high proportion of Nicaragua's average homes have a woman as head of household: 39% of urban homes and 28% of rural homes.


Tourism in Nicaragua is booming, it is currently the second largest industry in the nation, over the last 7 years tourism has grown about 70% nationwide with rates of 10%-16% annually. Nicaragua has seen positive growth in the tourism sector over the last decade and is expected to become the first largest industry in 2007. The increase and growth led to the income from tourism to rise more than 300% over a period of 10 years. The growth in tourism has also positively affected the agricultural, commercial, and finance industries, as well as the construction industry. Despite the positive growth throughout the last decade, Nicaragua remains the least visited nation in the region.

Every year about 60,000 U.S. citizens visit Nicaragua, primarily business people, tourists, and those visiting relatives.Some 5,300 people from the U.S. reside in the country now. The majority of tourists that visit Nicaragua are from the U.S., Central or South America, and Europe. According to the Ministry of Tourism of Nicaragua (INTUR), the colonial city of Granada is the preferred spot for tourists. Also, the cities of León, Masaya, Rivas and the likes of San Juan del Sur, San Juan River, Ometepe, Mombacho Volcano, the Corn Islands, and others are main tourist attractions. In addition, ecotourism and surfing attract many tourists to Nicaragua.

According to TV Noticias (news program) on Canal 2, a Nicaragua television station, the main attractions in Nicaragua for tourists are the beaches, scenic routes, the architecture of cities such as León and Granada and most recently ecotourism and agritourism, particularly in Northern Nicaragua.

http://en.wikipedia.org/wiki/Nicaragua

[Claus-Peter]

[Claus-Peter]

Geography

Largest but most sparsely populated of the Central American nations, Nicaragua borders on Honduras to the north and Costa Rica to the south. It is slightly larger than New York State. Nicaragua is mountainous in the west, with fertile valleys. Two big lakes, Nicaragua and Managua, are connected by the Tipitapa River. The Pacific coast is volcanic and very fertile. The swampy Caribbean coast is aptly called the “Mosquito Coast.”

Government
Republic.

History

Nicaragua, which derives its name from the chief of the area's leading Indian tribe at the time of the Spanish Conquest, was first settled by the Spanish in 1522. The country won independence in 1838. For the next century, Nicaragua's politics were dominated by the competition for power between the Liberals, who were centered in the city of León, and the Conservatives, centered in Granada.

To back up its support of the new Conservative government in 1909, the U.S. sent a small detachment of marines to Nicaragua from 1912 to 1925. The Bryan-Chamorro Treaty of 1916 (terminated in 1970) gave the U.S. an option on a canal route through Nicaragua and naval bases. U.S. Marines were sent again to quell disorder after the 1924 elections. A guerrilla leader, Gen. César Augusto Sandino, fought the U.S. troops from 1927 until their withdrawal in 1933.

After ordering Sandino's assassination, Gen. Anastasio Somoza García was dictator from 1936 until his own assassination in 1956. He was succeeded by his son Luis, who alternated with trusted family friends in the presidency until his death in 1967. He was succeeded by his brother, Maj. Gen. Anastasio Somoza Debayle. The Somozas ruled Nicaragua with an iron fist, reducing its dependence on banana exports, exiling political foes, and amassing a family fortune.

Sandinista guerrillas, leftists who took their name from Sandino, launched an offensive in 1979. After seven weeks of fighting, Somoza fled the country on July 17, 1979. The Sandinistas assumed power two days later. On Jan. 23, 1981, the Reagan administration suspended U.S. aid, charging that Nicaragua, with the aid of Cuba and the Soviet Union, was supplying arms to rebels in El Salvador. The Sandinistas denied the charges. Later that year, Nicaraguan guerrillas known as “Contras” began a war to overthrow the Sandinistas. Elections were finally held on Nov. 4, 1984, with Daniel Ortega, the Sandinista junta coordinator, winning the presidency. The war intensified in 1986–1987. Negotiations sponsored by the Contadora (neutral Latin American) nations foundered, but Costa Rican president Oscar Arias promoted a treaty signed by Central American leaders in Aug. 1987.

Violetta Barrios de Chamorro, owner of the opposition paper La Prensa, led a broad anti-Sandinista coalition to victory in the 1990 elections, ending 11 years of Sandinista rule. Enthusiasm for Chamorro gradually faded. Business groups were dissatisfied with the pace of reforms; Sandinistas, upset with what they regarded as the dismantling of their earlier achievements, threatened to take up arms again; and many people were disillusioned over governmental corruption.

Former Managua mayor and Conservative candidate Arnoldo Alemán won the 1996 election. Former Sandinista leader Daniel Ortega was his closest rival.

In 1998, Hurricane Mitch killed more than 9,000 people, left 2 million people homeless, and caused $10 billion in damages. Many people fled to the U.S., which offered Nicaraguans an immigration amnesty program until July 1999. Nicaragua remains one of the poorest countries in the Western Hemisphere.

In the Nov. 2001 presidential elections, Enrique Bolaños, the ruling Liberal Party leader, defeated Ortega, who was attempting a comeback.

In Aug. 2002, former president Arnoldo Alemán was charged with fraud and embezzlement, and in 2003 he was sent to prison for 20 years. Current president Bolaños triumphantly called it the “frying of the Big Fish.” The anticorruption watchdog, Transparency International, ranks Alemán among the most corrupt leaders of the past two decades.

The country received an enormous show of support from the international community in 2004 when the IMF and World Bank forgave $4.5 billion of Nicaragua's debt. In April 2006, a free-trade agreement with the U.S. (CAFTA) went into effect.

Former Sandinista president Daniel Ortega won the November 2006 presidential election with 38% of the vote and took office in Jan. 2007.

On March 7, 2008, during a summit meeting in the Dominican Republic, the leaders of Colombia, Ecuador, Venezuela, and Nicaragua ended their diplomatic dispute over Colombia's raid into Ecaudor that occurred on March 1, 2008.

[Claus-Peter]

Republic of Nicaragua


National name: República de Nicaragua

President: Daniel Ortega (2007)

Land area: 46,430 sq mi (120,254 sq km); total area: 49,998 sq mi (129,494 sq km)

Population (2007 est.): 5,675,356 (growth rate: 1.9%); birth rate: 24.1/1000; infant mortality rate: 27.1/1000; life expectancy: 70.9; density per sq mi: 122

Capital and largest city (2003 est.): Managua, 1,390,500 (metro. area), 1,146,000 (city proper)

Monetary unit: Gold cordoba

Languages: Spanish 98% (official); English and indigenous languages on Atlantic coast (1995)

Ethnicity/race: mestizo 69%, white 17%, black 9%, Amerindian 5%

Religions: Roman Catholic 73%, Evangelical 15%, Moravian 2%, none 9% (1995)

Literacy rate: 68% (2003 est.)

Economic summary: GDP/PPP (2005 est.): $13.24 billion; per capita $2,400. Real growth rate: 4%. Inflation: 9.6%. Unemployment: 6.9% plus considerable underemployment of 46.5%. Arable land: 15%. Agriculture: coffee, bananas, sugarcane, cotton, rice, corn, tobacco, sesame, soya, beans; beef, veal, pork, poultry, dairy products; shrimp, lobsters. Labor force: 2.01 million; agriculture 30.5%, industry 17.3%, services 52.2% (2003 est.). Industries: food processing, chemicals, machinery and metal products, textiles, clothing, petroleum refining and distribution, beverages, footwear, wood. Natural resources: gold, silver, copper, tungsten, lead, zinc, timber, fish. Exports: $1.55 billion f.o.b.; note—includes free-trade zones (2005 est.): coffee, beef, shrimp and lobster, tobacco, sugar, gold, peanuts. Imports: $2.865 billion f.o.b. (2005 est.): consumer goods, machinery and equipment, raw materials, petroleum products. Major trading partners: U.S., El Salvador, Mexico, Costa Rica, Venezuela, Guatemala, South Korea (2004).

Communications: Telephones: main lines in use: 140,000 (1996); mobile cellular: 7,911 (1997). Radio broadcast stations: AM 63, FM 32, shortwave 1 (1998). Radios: 1.24 million (1997). Television broadcast stations: 3 (plus seven low-power repeaters) (1997). Televisions: 320,000 (1997). Internet Service Providers (ISPs): 3 (2000). Internet users: 20,000 (2000).

Transportation: Railways: 6 km (2002). Highways: total: 19,032 km; paved: 2,094 km; unpaved: 16,938 km (2000). Waterways: 2,220 km (including 2 large lakes). Ports and harbors: Bluefields, Corinto, El Bluff, Puerto Cabezas, Puerto Sandino, Rama, San Juan del Sur. Airports: 176 (2002).

International disputes: territorial disputes with Colombia over the Archipelago de San Andres y Providencia and Quita Sueno Bank region; with respect to the maritime boundary question in the Golfo de Fonseca, the ICJ referred to the line determined by the 1900 Honduras-Nicaragua Mixed Boundary Commission and advised that some tripartite resolution among El Salvador, Honduras, and Nicaragua likely would be required; legal dispute over navigational rights of San Juan River on border with Costa Rica.

[Claus-Peter]

HEALTH SITUATION ANALYSIS AND TRENDS SUMMARY


GENERAL SITUATION AND TRENDS

Nicaragua has a surface area of 130,244 km2. The country is divided into 15 departments and two autonomous regions. The Pacific region, which covers 15.2% of its land area, has 58.2% of the population.

Demography: The population was estimated at 5,710,670 inhabitants as of the year 2000 and 56.4% lived in urban areas. The indigenous population comprise approximately 5% of Nicaragua 's total population. Most indigenous groups live on the Caribbean coast. For the period 1995-2000, life expectancy at birth was 68.4 years, the birth rate was 35.3 per 1,000 population , and the fertility rate was 4.4 children per woman, being greater in rural areas. However, the annual rate of population growth slowed 2.7% over the period 1995 to 2000. Emigration and internal migration have a strong impact on the country's economy. According to the National Quality of Life Survey conducted in 1998 by the National Statistics and Census Bureau (INEC), as of 1998, 47.9% of the population was living in poverty and 17.3% was living in conditions of extreme poverty.

Literacy: The survey also showed that the illiteracy rate was 23.4% in 1998. The three cornerstones of the Government's social development strategy are the furtherance of economic growth, particularly in rural areas; the promotion of spending on social programs for the poor that are designed to reduce their vulnerability to economic, social, and environmental risks; and the building of a stronger social safety net for vulnerable groups in order to break the vicious cycle of intergenerational poverty.

Economy: The size of the economically active population (EAP) as of 1998 was estimated at 1,728,900 individuals, 11% of whom were unemployed. Unemployment more heavily affects women (in 1999, 14% of the EAP in urban areas and 30% of the EAP in rural areas). In July 1999 the Ministry of Labor reported that 56% of the urban gainfully employed EAP earned less than US$ 9.20 per month, while the cost of the basic basket of goods was US$ 13.30. Only 17% earned more than US$ 19.40 a month. A mere 12% of female workers had monthly incomes of over US$ 19.40. Efforts to downsize the national government are a pivotal part of the structural adjustment process. The assistance furnished by the international community was crucial to reinforce coverage levels for top-priority social services in the wake of Hurricane Mitch. Per capita GDP stood at US$ 455.80 for the period from 1991 to 1998. It grew at an average rate of 3.2%.

Mortality: The general mortality rate was 26.5 per 100,000 population in 2000. Infectious diseases fell from fourth to fifth place among the leading causes of death in the last two years, with the number of deaths attributable to this cause down by nearly 50% from 1996. The number of deaths attributable to external causes rose in 1998 in the wake of Hurricane Mitch.



SPECIFIC HEALTH PROBLEMS

Analysis by population group
Children (0-4 years): The infant mortality rate for the period from 1997 to 2000 was 45.2 per 1,000 live births. The leading causes of death among children under one year of age during this period were respiratory and cardiac problems originating in the perinatal period, pneumonia, diarrhea and gastroenteritis, bacterial sepsis of the newborn, and congenital malformations. The leading causes of death among children 1- 4 years of age were pneumonia, diarrhea and gastroenteritis, and transport accidents.

Schoolchildren (5-9 years): The leading causes of reported deaths in 1999 and 2000 were transport accidents, pneumonia, accidental drowning and submersion, and accidental exposure to other unknown factors.

Adolescents (10-14 years and 15-19 years): The fertility rate for adolescents in 1999 was 152 births per 1,000 teenage girls of childbearing age (15-19 years of age). Thus, 3 out of every 10 births involved teenage mothers in this age group. The leading reported causes of deaths among adolescents in 1998 were: death associated with natural disasters, pesticide poisoning, and accidents. Youths between 15 -19 years of age comprised 30% of cases of acute pesticide poisoning.

Adults (20-59 years): The family planning service coverage level nationwide was 21% in 1999. According to ENDESA-98, the rate of contraceptive use in Nicaragua was comparatively high: 68% of all women of childbearing age reported having used some form of birth control at some point in their lives. In terms of maternal mortality, the nationwide Maternal Mortality Surveillance System showed fluctuations, with rates of 102 per 100,000 in 1998, and 133 per 100,000 in 1999. Maternal deaths stemmed from obstetrical problems, with the leading causes being hemorrhages caused by placenta retention, pregnancy-induced hypertension, sepsis, rupture of the uterus, and abortions.

The elderly (60 years and older): The number of elderly was estimated at 4.7% of the population for the year 2000, with males accounting for 45.4%. The age group 75 and over made up 1% of the total population.

Workers' health: An estimated 24,000 children 10-14 years of age were working at jobs in the informal sector, with another 6,000 employed in the formal sector. Between 90% and 100% of farmers and farmhands are exposed to some type of pesticide every year. Official statistics for 1999 put the work-related pesticide poisoning rate at 5 cases per 10,000 population . However, studies conducted in various parts of the country estimate annual incidence rates for pesticide poisoning at from 3% to 9% of exposed farm workers.

The disabled: The National Rehabilitation Program operated by the Ministry of Health estimated the percentage of the population with some type of disability at 12.1% in 2000. The most common types of reported disabilities were visual impairments (63.9%) and hearing impairments (9.2%). The leading causes of disabilities were problems at birth (10%), disease (29%), war (3%), and accidents (12%).

[Claus-Peter]

Analysis by type of health problem


Natural disasters: The worst disaster during this period was Hurricane Mitch, which struck the country in October of 1998. It caused 2,823 fatalities, with another 885 persons reported missing, and damaged 49 municipalities. The most recent disaster was the earthquake that struck the city of Masaya in July of 2000, with a death toll of nine.

Vector-borne diseases: The largest number of malaria cases (76,269) was reported in 1996, with an annual parasite index of 18.4 per 1,000 population . There was a downward trend in malaria cases over the 1997-2000 period . The number of cases of P. falciparum malaria nationwide fell 67.2% over the period. The risk of contracting dengue quadrupled in 1998, with an incidence rate of 28.1 per 100,000 population . Circulation of cases of dengue fever serotypes 3 and 2 were confirmed and 432 confirmed cases of dengue hemorrhagic fever were observed. A nationwide entomological survey was conducted from 1998-1999 to establish the prevalence of triatomine infestations in 14 departments (125 municipalities, 31,466 dwelling units), finding prevalence rates of 1%-10%. A seroprevalence study of 11,375 blood samples collected from schoolchildren between 7 and 14 years of age found 387 cases of Chagas ' disease (3.4%).

Diseases preventable by immunization: Nicaragua has successfully controlled the spread of diseases preventable through immunization by achieving and maintaining high vaccination coverage levels over the past few years and introducing new vaccines (the MMR vaccine in 1998 and the pentavalent vaccine in 1999). Vaccination coverage for different biologicals ranged from 90% to 100% in 1999 and 2000. There were a total of 132 clinically diagnosed cases of pertussis over the 1997-2000 period . The last registered case of neonatal tetanus dates back to 1997. Vaccination coverage for women of childbearing age is over 95% in most municipalities around the country. There were 37 cases of non-neonatal tetanus reported over the period from 1997 to 2000, the majority of which involved persons over 15 years of age whose occupations put them at a higher risk of exposure. Haemophilus influenzae type b vaccination coverage among children under 1 year of age was already greater than 90%. H. influenzae type b comprised 56% of all cases of bacterial meningitis, which meant that nearly 200 cases a year could have been prevented through immunization.

Intestinal infectious diseases: After Hurricane Mitch, there were outbreaks of cholera, with 1,451 reported cases (28.2 per 100,000 population) and 36 deaths (0.7 per 100,000 population), for a fatality rate of 2.4%. Only 12 cases and 1 death were reported in 2000. Acute diarrheal diseases are one of the main types of notifiable diseases. Children under 5 years of age are hit hardest by these diseases, accounting for 73% of the total reported. The morbidity rate was 484 cases per 100,000 population in 1997 and 415 in 1998, with mortality rates around 7 per 100,000 in the same years.

Chronic communicable diseases: Tuberculosis is endemic in the country, the incidence rates fluctuated between 13 and 111 per 100,000 population . In 2000, there were 2,396 cases, 1,467 positive by microscopic examination. The population 15-24 years were hardest-hit, accounting for 26% of all cases of tuberculosis.

Acute respiratory infections : Acute respiratory infections were the most common notifiable disease with an incidence rate for the 1997-2000 period of 2,658 per 10,000 population. Children under 5 years of age were the hardest-hit, accounting for 57% of all treated cases of the disease. The mortality rate was 6.47 per 100,000 population , with the hardest-hit group that of children under 1 year of age, which accounted for 55% of all fatalities.

Zoonoses: Two cases of human rabies were reported in the 1997-1999 period, both caused by wounds inflicted by wild animals. Vaccination coverage for canine rabies improved to over 85% countrywide. A leptospirosis epidemic was reported in 1998 in the wake of the flooding caused by Hurricane Mitch, with 705 suspected cases reported.

HIV/AIDS: The total cumulative number of cases of infection by HIV/AIDS over the period from 1987 to the year 2000 was 643 with 294 AIDS patients, of whom 164 have died. The hardest-hit was the 20-44 age group, 81% of all cases, while 74% of all cases were males. The leading mode of transmission was by sexual contact, (88% of all cases, 64% by heterosexual contact), with 9 % attributable to intravenous drug use, 2% to mother-to-child transmission, and 1% to blood transfusions.

Nutritional and metabolic diseases : ENDESA-98 found one out of every three children malnourished and 9% of all children severely malnourished. The percentage of children in rural areas suffering from some degree of malnutrition was 32%, compared with 19% in urban areas. The mortality rate for all forms of malnutrition was 11 per 100,000 in 1998. Though iodine deficiency is not a public health problem in Nicaragua , thanks to the fortification of salt with iodine, there are high-risk groups in the South Pacific region where the prevalence of goiter in certain communities is over 20%. The nationwide prevalence rate for anemia in children between the ages of 12 and 59 months was 28.4% with an average hemoglobin level of 10.6 mg/ dL .

Diseases of the circulatory system: Cerebrovascular disease accounted for 31.7% of deaths due to diseases of the circulatory system in 1992-1993. Hypertension was responsible for 12.6% of deaths attributable to this group in 1998.

Accidents and violence: The leading causes of death in the year 2000 were transport accidents (9.5 per 100,000 population), suicides (7.3), and homicides (6.6). According to ENDESA-98, 29% of the married or in-union women surveyed had suffered sexual or physical abuse at some time. There were 2,473 reported cases of attempted suicide by pesticide poisoning over the period between 1997 and 2000, with a case fatality rate of 25.5%. Women accounted for 44% of these cases.

Oral health: In 1997, of the 233 communities covered by a study on fluoride content of drinking water, only 12% had water supplies with optimal fluoride levels (0.5-1.0 mg/kg). The total prevalence rate for dental caries in children between 6 and 15 years of age was 85% with diagnosis of mild fluorosis in 2.6%, while only 0.8% of the children studied had moderate to severe fluorosis .

[Claus-Peter]

RESPONSE OF THE HEALTH SYSTEM


National health policies and plans: The National Health Policy 1997-2002 is an extension of the commitment of social policy to alleviate poverty and to improve service coverage, particularly for the poorest and most vulnerable segments of society. There are five separate health policies, aimed at modernizing the health sector, strengthening the Ministry of Health, improving hospital care, formulating new public health strategies, and modernizing the social security system. A number of initiatives designed to strengthen the steering functions of the Health Ministry were initiated based on technical instruments such as the health system profile, health analysis, and the Ministry of Health's investment plan for 2000-2002.

The health system: Institutional organization: The health sector encompasses both the public and private sectors. The public health sector consists of the Ministry of Health; the Nicaraguan Social Security Institute; and the health services operated by the Ministry of Government and by the Ministry of Defense. The divisions of the Comprehensive Local Health System (SILAIS) represent the Ministry of Health in technical and administrative matters at the departmental level. The private sector includes hospitals, clinics run by health insurance management companies, and nongovernmental organizations.

Developments in health legislation: The National Health Policy 1997-2002 calls for revising and updating of the existing legal framework through the passage of a number of laws and regulations, including the General Health Act, the Unified Health System Act, the Social Security Act, the Drug and Pharmacy Act, food monitoring regulations, regulations for the control of pesticides and toxic and hazardous substances, regulations governing ionizing radiation, regulations for professional health practice, and regulations under the Health Administrators Law.

Organization of regulatory actions: At the primary care level, in 1997-2000, coverage was provided by the different health delivery networks: public networks, 60%; INSS networks, 10%; private networks, 20%; and other networks, 10%. The private sector provides curative care to the insured population (15% of the EAP). The Ministry of Health is the leading health service provider at both the primary and the secondary care levels. At the primary care level, it operates health centers (some with beds and some not) and health posts. Secondary care level offers general and specialized medical care and outpatient and inpatient care in basic areas. The private health sector consists of eight hospitals, private medical and dental practices and clinics providing outpatient care, clinical laboratories, and diagnostic imaging centers. Insurance management companies provide insurance plan members with prescribed curative services outsourced by the INSS. Insurance management companies have begun offering prepaid plans to expand their service offerings. The Regulations Office also investigates and responds to complaints with respect to the handling or treatment of patients in public health care facilities and conducts audits to control the quality of health care. The Office of Environmental Health monitors water quality through sampling procedures conducted at specific points of the water supply network. The Ministry of Environment and Natural Resources is also involved in regulatory activities, exercising its powers under Law 290. However, the regulatory framework for environmental protection is lacking, and the country has no systems in place for the assessment of environmental risks. The Ministry of Environment and Natural Resources and the Ministry of Agriculture and Forestry is putting into place programs designed to protect natural ecosystems, with the emphasis on soil and water conservation. The quality of food products is controlled through health inspection and monitoring procedures and surveillance for foodborne disease. The Ministry of Labor is in charge of formulating and coordinating occupational safety and health regulations with relevant agencies and overseeing their enforcement in the workplace.

Evaluation of health technology: The equipment is insufficient and its use is limited by lack of resources for operation and maintenance. In 2000, of all available equipment, 73% was used for diagnostic and treatment purposes and in direct support of medical care; 82 % was in hospitals but only 73% was in proper working order. The health centers and health posts had 18% of equipment.

Organization of public health care services: Health analysis, epidemiological surveillance, and public health laboratory systems : The national register is maintained by the National Vital Statistics System (SINEVI), which records official morbidity (mainly hospital-data) and mortality statistics with a one-year delay. The national and local epidemiological surveillance systems covers 25 specific health problems subject to immediate notification requirements, such as outbreaks of disease and disasters. Both SINEVI and the epidemiological surveillance system data are used for strategic planning and health service management purposes at the local and national levels.

Potable water and sewerage services: Potable water supply was 89.4% in 1998, the urban coverage was 89.5% and the rural coverage 33.7%. Of the samples collected in 1999, 4% contained over 50 fecal coliform bacteria per 100 mL . The percentage of the population without access to adequate excreta disposal service dropped to 21.1% in 1998. Only 4.7% of the urban population was still without service, compared with 31.7% of the rural population. Only 34% of collected wastewater received any type of treatment. The urban population generated an estimated 1,396 metric tons of solid waste in 1999, 65% of which were not subject to proper disposal methods. A great deal of progress has been made in the area of environmental protection legislation, with the passage of the General Environment and Natural Resources Act, environmental impact assessment regulations, the Law Governing Pesticides and Toxic and Other Hazardous Substances, regulations governing effluents, and the act creating the Environmental Protection Agency.

Organization of individual health care services: The primary health care network offers virtually all types of health promotion and risk and disease prevention services as well as general curative care and preventive and restorative dental care. The physical infrastructure administered by the Ministry of Health consists of 996 health care facilities, 48.3% of which are concentrated in the Pacific coast area. Managua has 11 hospitals, more than a third of all hospital facilities. The INSS has no health delivery infrastructure of its own, outsourcing health care services to public and private service providers.

Health supplies: Efforts to develop a pharmaceutical industry are based on the country's National Medicinal Drug Policy, whose strategies for the 1997-2001 period focus on institution-building, promoting access to essential drugs, quality assurance, and rational drug use. The essential drugs list for 2001 consists of 345 active ingredients, with their generic names, and 509 drugs in their various pharmaceutical forms. The list is used as a yardstick for the procurement, distribution, and use of drugs in the public sector and the for-profit and not-for-profit private sector. According to the Drug Regulations Office attached to the Ministry of Health, as of the year 2000, there were 12,000 registered products, 255 drug importers/distributors, 12 domestically owned pharmaceutical laboratories whose output covered an estimated 20% of nationwide needs.

Human resources: In 1999, there were 23,285 health care workers, 32% of the government workforce, of whom 47.4% were assigned to the primary care level and 52.6% to the secondary care level. The wages of health care personnel consumed 60% of the Health Ministry budget. In 2000 there were 5,656 registered general practitioners, 950 specialists, 323 professional nurses, 974 dentists, 1,042 pharmacists, 56 mid-level laboratory technicians, and 21 radiologists. The number of nursing personnel in 1999 totaled 1,538, of whom 62% were assigned to the secondary care level, and 23% concentrated in Managua . Of the auxiliary personnel, 52% worked at the primary care level. In order to practice, health professionals must register their university degrees with the Regulations and Accreditation Office attached to the Ministry of Health. An estimated 90% of the nation's physicians are registered.

Health sector expenditure and financing: Health resources are drawn from the public sector (41.5%), the private sector (44.8%), and external cooperation (13.7%). Per capita health spending in 1998 reached US$ 45.1. The government allocation to the Ministry of Health for 1998 as a percentage of GDP was 3.2% in real terms, or the equivalent of 9.5% of the general budget. International assistance to the Ministry of Health over the period from 1991 to 1998 as a percentage of GDP was approximately 1.3%, or the equivalent of 25.6% of its total budget. Household spending on health as a percentage of GDP ranged from 2.5% to 2.8%.

[Claus-Peter]

Nicaragua: Overview


A land of poetry and revolution, lakes and volcanoes, war and peace.

To the new generation of travelers, Nicaragua represents booming beach breaks, volcano hiking, island paradises and laid-back colonial towns. It seems that the message - 'the civil war finished decades ago people!' - has finally gotten across to a world who had the country pegged as a troublespot.

Yet the iconic images of idealistic young people giving their lives for a dream of liberty endure, and Nicaragua remains a land where people, whatever their beliefs, tend to go beyond cheap chatter. A place of artists and poets, the country's people are an even greater asset than its natural splendor.


Travel Warning: Criminality in the North

Incidents of banditry occur in the remote North Atlantic Autonomous Region (RAAN), particularly around Bonanza, Siuna and along the Honduran border. Travelers should exercise high levels of caution when visiting these remote areas.

severity: Mid-level alert


Nicaragua: When to Go


Nicaragua has distinct dry and rainy seasons, the timing of which varies from coast to coast. With the possible exception of the last month of the dry season (usually mid-April to mid-May) when the land is parched and the air full of dust, there really is no bad time to visit. However, the most pleasant time to visit the Pacific or central regions is early in the dry season (December and January), when temperatures are cooler and the foliage is lush.

Most Nicaraguans spend the holy week of Semana Santa (around Easter) at the beach; all available rooms will be sold out weeks or even months in advance.

Weather

Nicaragua has a range of microclimates, and it's worth checking the weather to see where you want to go first. On the Pacific side, invierno (winter), or rainy season, runs May to November, at its rainiest in September and October when sea turtles nest 3000-strong to a beach. Verano (summer), or dry season, is November to April, the best time for hiking, camping and partying, as it coincides with high tourist season (December to March), most pronounced along the Costa Rican border. As verano desiccates to a close, the Pacific forests lose their leaves and lake levels drop revealing sandy lake beaches that you'll put to good use as temperatures soar.

Then there are the mountains, from the islands of cool cloud forests atop each volcano to the monolithic granite peaks of the central highlands, where seasons become blurred in the chilly misty mornings, with temperatures between 12°C (54°F) and 24°C (75°F). On the Atlantic side rainy and dry seasons are almost entirely academic; along the Río San Juan, one of the wettest places on earth, always pack a raincoat.

[Claus-Peter]

Corn Islands are one of the best places to go in Nicaragua.


Once a haven for British buccaneers; now an unspoilt, low-key island paradise.

Big and Little Corn Islands (Islas del Maíz) are veritable tropical paradises in an isolated corner of the Caribbean. Both islands boast clear turquoise water, white sandy beaches fringed with coconut palms, excellent fishing, phenomenal coral reefs to explore and an unhurried, peaceful pace.


Corn Islands: History


Pre-20th-Century History

The original inhabitants of Big and Little Corn Islands were the Kukras Indians, who came across from the mainland. They were an agricultural people, who took advantage of the islands' great fishing conditions - whilst also reportedly supplementing their diet with the occasional meal of human flesh. First European contact came when Christopher Columbus breezed through in 1502, but it wasn't until 1660, when a French pirate by the name of Jean David Nau arrived, that continuous contact was made with the Indians.

British pirates and African slaves arrived in the 1700s, and both groups mingled with the Kukras. Although the British left the islands in 1786 as part of a treaty with the Spanish, they returned in 1841 after independence from Spain. Gathering all the islands' inhabitants together, Superintendent of British Honduras, Colonel Alexander McDonald, announced the liberation of the slaves, on behalf of Queen Victoria and King Robert Charles Frederic of the Mosquito Coast. This event is still celebrated on the islands in late August every year with crab soup, beauty pageants and dancing. The Corn Islands remained a British protectorate until 1894, when the Nicaraguan government claimed them.

Modern History

In 1914, the Nicaraguan government handed the Corn Islands over to the United States for a 99-year lease under the Bryan-Chamorro Treaty. Though this meant the islands were subject to American law, they remained Nicaraguan territory and their administration continued to be handled locally. The lease was terminated in 1971, under the Convention of Managua.

Fishing and the production of palm oil were the islands' major industries throughout much of the 20th century. However, after Hurricane Joan destroyed most of the palm trees on the islands in 1988, lobster fishing took over as the main source of income - although over-fishing is now threatening this industry as well.

Recent History

In recent years, tourism has become a very important part of the Corn Islands' economy. Big Corn Island has more infrastructure in place than Little Corn Island, but both are peaceful, relaxing travel destinations as yet unspoiled by Cancún-style resorts. The diving in the area is excellent pretty much year-round, and the beaches are a sunworshipper's dream.

Unfortunately, the islands' isolation and relatively minimal coastguard surveillance has made them a popular refuelling pit stop for Colombian drug boats. In the instances when these boats are pursued by police, the traffickers simply dump their booty overboard. Local fishermen soon discovered that fishing for this so-called 'white lobster' (as opposed to the real, increasingly scarce crustacean) was a lucrative source of income. As a result, the islands experienced a surge in petty theft, muggings and assaults - problems which were quickly addressed by a stronger police presence, and are now vastly improved.

[Claus-Peter]

a bungalow at Derick's, Little Corn Island





Miss Elsa's, Little Corn Island: all your tropical island fantasies come to life