At the end of the Somoza era, most Nicaraguans had no or limited access to modern health care. Malnutrition, inadequate water and sewage systems, and sporadic application of basic public health measures led to many diarrheal diseases in addition to pneumonia, tetanus and measles.
Nicaraguans depend on a health system that reflects the fundamental inequalities in their society. The upper class uses private health care and often goes abroad for specialized treatment. A minority of salaried workers in government and industry are served by the Nicaraguan Social Security Institute. And the remainder of the population, approaching 90 percent, is poorly served at public facilities that are generally inadequately staffed and underequipped. The health care services are concentrated in the larger cities, the rural areas being largely unserved.
The Sandinista government restructured the entire health care system in the early 1980s. The authorities combined the medical functions of the Ministry of Health, the Nicaraguan Social Security Institute, and other health care agencies from the Somoza-era, into a unified health care system. Over the next several years, spending on health care was significantly increased. Access to services was broadened and equalized, and more focus was placed on primary and preventive medicine. Various new hospitals were built (largely with foreign aid), and a national network of primary care health clinics was created. Oral Rehydration Centers were established with the help of UNICEF to treat severe childhood diarrhea, the leading cause of infant deaths. In these years there was a substantial drop in infant mortality and reductions in the incidence of transmittable diseases such as polio, pertussis, and measles.
Unfortunately, some of the ground that was gained in the first decade of the 1980s was lost during the second half of the decade. Health care activities, including vaccination campaigns, were restricted in regions with armed conflict. Due to the increase in poverty among the population, many children grew more vulnerable to disease. The economic decline and tight budgetary restraints of this period resulted in shortages basic medical supplies. While in the early 1980s, many students chose to enter the medical field, the deteriorating salaries drove many doctors out of public employment toward the end of the decade.
Despite these problems, the Sandinista decade left behind an overall improved health care system. The Chamorro government inherited a system that emphasized preventive and primary care, while targeting the principal causes of infant, child, and maternal mortality. More people now had access to the health system. The oral rehydration centers, the wide coverage of vaccination campaigns, and the key role of the health brigadistas, have all been maintained by the new government.