Health care reform in Sandinista Nicaragua, 1979-1990



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This dissertation explores the health care system built by the Sandinista government in Nicaragua between the years 1979-1990. Prior to the 1979 victory of the Sandinista revolution, Nicaragua had a limited, balkanized health care system that afforded access to care to only a small percentage of the Nicaraguan population. The Sandinistas sought to build a nationwide health care system that provided free and equal access to health care. This project is a study of how the Sandinistas did that, and an analysis of what success they had. This project relies upon new sources as well as established archival ones. Former Minister of Health Dora María Tellez (1985-1990) recently donated her personal collection of Actas Ministeriales (Ministerial Executive Orders) to the Universidad de Centroamérica's Instituto de Historia de Nicaragua y Centroamérica (IHNCA), a cache that substantially increases the documentary record of the latter half of the 1980s, and thus expands our understanding of the issues at hand and the solutions the Ministry implemented. Also, this dissertation relies heavily upon oral history. Seventy-five interviews with Ministry leaders, health workers, and Nicaraguan citizens create a more personal history of health in Sandinista Nicaragua, and explain how this nationwide effort actually functioned in communities, both urban and rural. The five chapters of this dissertation explore these central questions through multiple lenses. The first chapter provides both a history of foreign intervention and of history of health care in Nicaragua. The second and third chapters explore the historical trajectory of the Ministry of Health during the eleven years of Sandinista rule, first at a national level, and then with a focus on the northern zones of Nicaragua. In the final two chapters the dissertation explores the international angle of this history. The fourth chapter looks at the important role Cuban foreign aid played in helping the Sandinista government build, supply, and maintain their health care system. The fifth and final chapter interrogates the presence of long-term volunteer health care workers from the United States in light of the fact that the U.S. was leading efforts to overthrow the Sandinista government throughout the 1980s.