Nicaragua: Health system strengthening and response to epidemiological emergencies project - Project information document (PID), concept stage

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1. Key development issues and rationale for Bank involvement

Over the past decade, Nicaragua has achieved notable improvement in public health indicators and has made significant progress in key areas. To date, Nicaragua has reduced maternal and infant mortality, and increased overall life expectancy. Nonetheless, the country continues to struggle with persistent challenges, including critical gaps in access and quality that leave vulnerable groups with little or no access to high quality public health care services. The health care policies of the Government of Nicaragua address essential challenges in terms of equity, quality and efficiency.

Since 2005, the Health Services Extension and Modernization (APL II) project has been instrumental in supporting the Government of Nicaragua make significant progress in the health sector. The ongoing Project has led to notable increases in coverage of basic pre- and post-natal care services. The Project has also contributed to the reduction of child malnutrition and infant mortality. Chronic malnutrition has also decreased slightly from 17.8 percent in 2001 to 16.9 percent in 2006.

In terms of institutional strengthening, the Project has supported improvements in the general decentralization of services and strengthening of health care networks, boosting hospital discharge rates in the targeted regions from 4.1% to 5.3% and increasing local budget power in the targeted SILAIS. Despite progress, Nicaragua remains highly vulnerable.

Rationale for Bank Involvement

In April 2009, following the outbreak of the new A/H1N1 Influenza, the virus quickly spread into the Central America region. As of August 28, 2009, the World Health Organization had declared a worldwide pandemic with a total of 116,046 confirmed cases in 35 countries in the Americas Region. A total of 2,234 deaths have been detected among the confirmed cases in 22 countries.

Currently the WHO reports that Nicaragua has more than 659 confirmed cases of the A/H1N1 Influenza, and two official deaths have been reported. While the current impact on health services has been low, there is a high risk of the virus becoming more destructive and burdensome. The Nicaragua health system, however, is not fully prepared to deliver services or mitigate the effects of the virus if the number of cases were to increase substantially.

Nicaragua's health care system faces persistent challenges, making it difficult to respond to the current epidemic. There are critical gaps in access and supply of basic health care services that leave many rural and indigenous groups (especially in the Center and the Atlantic regions) highly vulnerable. These areas also continue to experience the poorest maternal and infant health indicators in the country. These challenges are further compounded by other supply-side constraints including a lack of medicines, inconsistency in service, affordability constraints, and limited basic health care resources. As a result, these populations are likely to be vulnerable to external health shocks like the A/H1N1 Influenza pandemic.