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Global Health Thought Leadership

Innovative Health Care Delivery in Nicaragua

By Charles Redding, MedShare CEO & President

As Covid-19 continues its “roller-coaster” assault on the U.S. and countries around the world, communities lack the infrastructure needed to identify infected individuals and perform contact-tracing to contain the spread.  Faced with limited resources and the prevalence of chronic conditions and infectious diseases that permeate their poorest communities, many of the developing countries that we support have developed novel approaches to addressing these health care challenges.  

Is it possible that some of the methodologies and systems deployed in these communities could be used in the U.S. to solve some of our own health care challenges?  In conversations with other colleagues in the global health community, we refer to this as “GLOCAL” meaning global solutions that can be applied locally.

During a visit to Nicaragua with board members in 2016,  I was struck by how the country augmented the limited resources in the health system with trained volunteers. Nicaragua is one of the poorest countries in the Western Hemisphere, lagging behind other Central American countries on many socioeconomic indicators. Adult literacy is 77%; per capita gross national income (GNI) is US$2,720, and 48% of the population live below the poverty line. Between 35% and 40% of the population lack access to health services, and 78% of the economically-active population (more than 1,748,000 people) have no health insurance.

One of the strengths of the Nicaragua health system is its nationwide community-based health network that includes almost 4,400 home-based community clinics and 33 maternal homes or casa maternas. This health network utilizes an impressive pool of trained independent volunteers, including 12,700 “brigadistas,” 6,200 midwives, and 7,100 “voluntary collaborators,” all linked to the Ministry of Health (MINSA); 2,800 health promoters who work with projects linked to nongovernmental organizations; and 340 health representatives on community boards linked to the municipal governments. 

These individuals undertake health promotion activities at the community level. The program to train independent health volunteers, known as “brigadistas,” was started by MINSA during the Sandinista government of the 1980s, primarily to serve rural areas. Brigadistas receive several months of training and are responsible for primary prevention and tracking activities in the communities they serve including:

  • Providing community-based education and health outreach. 
  • Identifying and referring patients to health units for treatment, with emphasis on children and women.
  • Reporting deaths and referring and reporting cases of potentially infectious diseases.
  • Conducting a community census.
  • Providing support for national health campaigns (immunization, anti-epidemic days) within their communities. 
  • Weighing children monthly as part of a community-based activity called PROCOSAN. 
  • Administering contraceptives to local women previously registered for this program in the health units. 
  • Monitoring patient progress in accordance with referrals made by health units.

As the world continues to battle this unprecedented pandemic, perhaps we should look for solutions in countries that deal with these types of issues every day. Global health challenges require global solutions, not just solutions from the developed world but the sharing of best practices and utilization of proven methods from developing countries as well. There are countless rural, impoverished communities in the U.S. that could benefit from a different approach to improving health care delivery and outcomes.


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