Last Updated on Friday, 13 July 2012 20:01

USAID health programs improve access to maternal and child healthcare (MCH), family planning, and to HIV/AIDS prevention awareness, counseling and testing.

As a major donor in the health sector, USAID activities directly contribute to the improvement in health indicators, reported by the Nicaraguan Ministry of Health (MOH), including:  the reduction of maternal mortality (62.5 maternal deaths for every 100,000 live births in 2008 to 60.5/100,000 in 2009); the increase of institutional deliveries (77.6 percent in 2008 to 78.7 percent in 2009); and an increase in the number of pregnant women receiving prenatal care (80.6 in 2006 to 88.8 percent in 2009).  National data also shows a nine percent reduction in the number of neonatal deaths (1,335 deaths in 2008 to 1,219 in 2009). 

In carrying out its health programs, USAID coordinates closely with Nicaraguan government institutions, medical schools, and community health organizations.  USAID health programs transfer methodologies, skills, and capacities to counterparts at the Ministry of Health (MOH) and to medical and nursing schools.  USAID activities also updated MCH, HIV/AIDS and Family Planning norms, standards and protocols in the medical and nursing curricula. Community health programs reach more than 280,000 people in the 78 poorest municipalities in the country.

HIV/AIDS Programs

According to statistics from the MOH, three new cases of HIV are diagnosed in Nicaragua each day.  The most recent Center for Disease Control (CDC) survey (2010) shows the epidemic, still concentrated, is most prevalent among men who have sex with men (7.5 percent) and female sex workers (2.4 percent).  The most affected populations are transsexuals (18.8 percent), homosexuals (10.6 percent), and bisexuals (5.1 percent).  As such, the MOH is leading the national response to control and mitigate the epidemic with the support of USAID partners and other health donors in health system strengthening activities.  Additionally, approximately $60 million is being provided through the Global Fund.

USAID has continued to focus its HIV/AIDS portfolio on prevention, increasing healthy behavior among most at risk populations; voluntary counseling and testing; and condom use and reduction of sexual partners through regional and bilateral programs.

In 2011, USAID prevention activities reached over 141,000 individuals through community outreach and Behavior Change activities, targeting most at-risk populations (88 percent), 73 percent of whom are men.  More than 81 new condom service outlets were opened.  Under USG-assisted activities, 9,255 individuals received counseling and testing for HIV and received their test results, 79 percent of whom were women.  

USAID implements the following HIV/AIDS programs in Nicaragua:

The Health Care Improvement Project (HCI/URC) and the AIDS Prevention (PrevenSida/URC) Program target health system strengthening with in-service and pre-service training to reduce stigma and discrimination in 11 health centers in areas with the highest prevalence rates and promotes comprehensive high-quality services and institutional strengthening to 20 local non-governmental organizations (NGOs) working in HIV/AIDS that provide services to people living with AIDS and most at risk populations. 

The programs actively participate in the HIV/AIDS national response while working to reduce stigma and discrimination associated with the disease among health service providers.  USAID technical assistance to expand and improve health services provided by the Ministry of Health and NGOs include: 1) health personnel trained in voluntary testing and counseling, prevention of mother-to-child transmission, stigma and discrimination; and 2) new primary health units that provide voluntary counseling and testing, increasing the total number of outlets to 163.  USAID also targets seven Health Districts with the highest rates of Tuberculosis (TB) to improve TB-HIV co-infection healthcare services. 

The AIDS Prevention Program is addressing gender issues in dealing with HIV/AIDS and improves access to preventive services for sexual minorities, including the transgender population, homosexuals, bisexuals and sex workers. 

The HCI and AIDS Prevention programs and the Program for Strengthening the Central American Response to HIV (PASCA) and the  Pan American Social Marketing Organization (PASMO) regional programs contribute to updating laws and national policies and plans and to generate new strategic information to measure the impact of those policies and plans in the HIV/AIDS epidemic. 

PASCA is also helping the HIV/AIDS national commission to evaluate and monitor its National HIV/AIDS Strategic Plan, and to bring together private and public-sector leaders around key issues. Both Programs have undertaken quantitative studies on the impact of prevention and qualitative studies on female sex workers. Other studies include the HIV/AIDS program index (API 2009), costs of the epidemic, and an evaluation of the national HIV/AIDS strategic plan for policy improvement.  An important study on seroprevalence was conducted by the CDC and the MOH, in coordination with USAID and 20 other organizations. These results and other research findings from USAID projects, UNAIDS, and the Global Fund, provide valuable information for making programmatic decisions that will be used to improve the national response to contain and mitigate the epidemic.

Maternal and Child Health Programs

USAID’s technical assistance in Maternal Child Health (MCH) focuses on improving the quality of maternal and child health services, working at different levels of the health system.  MCH activities include strengthening public health systems, increasing coverage of community health activities, and supporting the implementation of the national Family and Community Healthcare Model.  USAID programs help improve the implementation of treatment protocols, monitoring and evaluation of quality standards, and service provision at the institutional and community levels in nine national Health Districts.

USAID programs provide support for the Ministry of Health’s logistics system and the in-service training program based on updated norms, standards, and protocols. 

USAID currently implements the following Maternal and Child Health Programs:

The Deliver/ and Health Care Improvement projects provide support for the Ministry of Health logistics system and in-service training program based on updated norms, standards, and protocols.  In health centers and hospitals supported by these USAID programs, 78,000 pregnant women benefitted from the increased quality of prenatal care visits by trained providers and 48,585 births were delivered by a skilled birth attendant.  Health personnel were trained in maternal and newborn health, evidence-based clinical guidelines and treatment for infections.  These activities contributed to an 18 percent decrease in discharges with obstetric complications in hospitals and a modest reduction of neonatal problems. 

The programs also helped update the educational curriculum of medical and nursing schools to strengthen the delivery of care, using proven practices that reduce maternal and perinatal death. 

USAID’s Famisalud Project, implemented by 10 NGOS from the NICASALUD network, contributes to service provision at the institutional and community levels in nine national Health Districts.  Famisalud works closely with 288 health units’ staff in eight departments to implement their community strategy and the new health model.  This program reaches over 800 poor communities, supporting child nutrition and family planning services in hard to reach areas and expanding the availability of clean drinking water.  In 2011, over 2,500 people were trained in child health and nutrition. 

Family Planning and Reproductive Health

Over the last 20 years Nicaragua received family planning assistance and now is scheduled to graduate from direct USAID assistance by September 2012.  As part of the graduation strategy, in 2009 USAID discontinued the provision of contraceptives in Nicaragua while securing increased investments in contraceptives from the Ministry of Health.  In 2010, the Ministry of Health provided 50 percent of the total costs to purchase contraceptives, a significant increase from the 12 percent of total costs covered by the Ministry of Health the previous year.  The United Nations’ Population Fund (UNFPA) covered the remaining 50 percent. USAID also assisted the health ministry in monitoring the supply of 24 tracer medical commodities.  Stock-outs of family planning methods were reduced to less than five percent in health centers from 10 targeted Health Districts and on-the-job logistics system training was provided in 545 health facilities. All USAID health programs are strengthening Nicaragua’s capability to provide quality contraceptives and family planning services after graduation.  Programs address five critical areas: contraceptive security; market segmentation; health system strengthening (HSS); healthcare services and quality assurance; and data for decision making.

USAID currently implements the following family planning programs:

USAID's Deliver Project benefits 17 departments in the country and focuses on ensuring contraceptive availability through sustainable logistics and supply management systems within the Ministry of Health, the Nicaraguan Institute of Social Security (INSS), non-governmental organizations (NGOs) and private sector clinics.  The Ministry of Health is leading the implementation of the Contraceptive Security (DAIA) Committee, receiving USAID assistance since 2005 through the Deliver project. This Committee was created by a multi-donor, multi-agency group, including the private sector and NGOs.  It is currently implementing its second multiannual plan. The 2010-2012 DAIA plan analyzes future demand of contraceptives based on demographic projections, potential donor funding, the role of the private sector, and market segmentation.  Logistics management was also included in the Pharmacy School pre-service training curricula, and a logistics manual was developed for social security clinics, with Deliver project support.

The Health Care Improvement Program also improved family planning healthcare services by ensuring compliance with quality standards and key Ministry of Health indicators.  Family planning counseling was expanded or improved in 18 hospitals, 86 health centers, and six INSS clinics.  Over 90 percent of post-obstetric patients received family planning counseling and accepted a family planning method. 

All USAID health programs contributed to gender equality, increasing the coverage of family planning services.  In Nicaragua, the responsibility for family planning and birth spacing falls almost entirely on women.  In response, USAID programs seek to guarantee the provision of contraceptive methods for men through public sector clinics, in addition to increasing the involvement of men in reproductive health issues through male facilitators, religious leaders and teachers.

The overall goal of the Water and Sanitation Project in Carazo is to promote health and hygiene for rural families in 15 communities in four municipalities - Diriamba, Jinotepe, Santa Teresa and La Conquista – in the Department of Carazo.  The activity focuses on social outreach and expanding household water infrastructure.  The social outreach component promotes hygiene through educational workshops and training.  The infrastructure component includes the construction of latrines, sanitary micro fillings for filtration, wells, water collection tanks, and the purchase of equipment such as filters and storage tanks.