Rural Nicaragua comprises of 44% of the Nicaraguan people. Improvement of healthcare is difficult in these areas because they are difficult to access primarily due to road conditions. Based off of reports from the Nicaraguan Ministry of Health (MINSA), 50% of Nicaraguans these individuals in rural areas have little access to medications or basic health services.
A major health issue in these rural areas is lack of access to clean water, which in turn leads to poor sanitation. This leaves many individuals susceptible to many preventable diseases.
There is also a significant physician shortage, and the issue does not seem to be improving at this time.
Overall, however, there is more to the healthcare issue than access and quality of care. It is not in their culture to actively seek medical care, as regular checkups are not common for many individuals. Many individuals prefer to self medicate or visits to the health center so there is a culture gap which must be fixed in order for the state of health in Nicaragua to improve.
Source: AMOS Health and Hope (http://www.amoshealthandhope.org/Health_for_all/About_Nicaragua.html)
Healthcare in Totogalpa - A first hand experience
In the municipality of Totogalpa, there exists one main health clinic that is open 24/7 and 4 satellite clinics that are open only select days and hours of the week.
***Main health center***
General: In the Totogalpa health center, there are always doctors on site. Daily, about 250 people come through the health center.
Departments: Emergency room (shown above), basic outpatient clinic for outpatients, lab, dentist
Services offered: Vaccinations, family planning, tuberculosis, maternal health, prenatal health, tooth extraction
Funding: In Nicaragua, healthcare in public facilities are free of cost to everyone. 100% of the medicine in Totogalpa is funded by the government, while other services of the facility are supported by the government, other countries, the World Bank, and NGOs. 25%-35% of the government expenses is on healthcare. This facility specifically has a budget of 7.12 million Cordobas from the government, which has gone up tremendously from the past.
Support: Peace Corps and NGOs in the area focus on health promotion and disease prevention. Physicians from Germany also come and volunteer 2-3 years at a time. There are also many medical brigaders that come and volunteer for short periods of time.
***Healthcare in other rural sectors***
Satellite Clinics: The other 4 clinics in the other sectors of Totogalpa only have limited hours and physician visits once a week. Many residents in the sectors, therefore, generally travel to Totogalpa if they need to seek medical attention.
Community Checks: The health center sends their staff into the rural communities regularly to check the quality of water and food. If they find any contamination, they try and treat the issue. They also send staff to each of the families for regular checkups. If they find an individual who is at risk for any health issues, regular visits are made to that household or the individual is called upon to make regular visits to the health center.
Community Leader System: In the rural communities around Totogalpa, there are designated community leader volunteers that are responsible for overlooking the health of the other community members. They are the only ones that are allowed to call for an ambulance if immediate health care is needed. They also participate in community meetings to work with the youth in spreading health information and family planning.
Maternal Health: After 2005, Totogalpa has changed their maternal health program in the region. In each of the sectors, there are maternity houses where expecting mothers are requested to stay at for 6 weeks before they give birth. When they are ready to deliver, they are brought to the Totogalpa clinic. Since 2008, there have been no maternal deaths and a decrease in the infant mortality rate. Unfortunately, there are still some mothers who have not accepted this method of childbirth, as many prefer to give birth in their own homes.
Healthcare in Rural America
Individuals living in rural areas of America face many issues with access and affordability of healthcare, and in turn a lower quality of life than urban areas in America.
Rural areas are more poverty stricken than urban areas, so many individuals are unable to pay for healthcare and are uninsured or underinsured. A major barrier to obtaining insurance in rural areas is that the economy is dependent on small business, which usually don't offer insurance benefits.
Access is also a pressing issue to rural healthcare. According to UnitedHealth, there are only 65 primary care physicians/100,000 rural Americans, whereas there are 105 physicians/100,000 urban and surburban Americans. With less physicians, there also are less healthcare facilities. This means that many people living in rural areas have to travel far distances to see a physician.
Sources: HealthReform.Gov ( http://www.healthreform.gov/reports/hardtimes/), Reuters (http://www.reuters.com/article/2011/07/27/us-rural-idUSTRE76Q0MJ20110727)
