De Keyser y Ulatte J. Educación, participación en salud e ideología: Nicaragua pasado y presente. [Education, participation in health, and ideology: Nicaragua past and present.] Revista Centroamericana de Ciencias de la Salud [Central American Journal of Health Sciences] 1980; 17: 143-157.

Objective: Analyze the actions of the health sector in Nicaragua during the period that community medicine was in force (decade of the 1960s), through the first year of the Sandinista government.

Methodology: Descriptive and interpretive.

Results: The author provides an historical survey of medical services in Central America , noting the delayed appearance during the 1950s of state medicine and social security. The principal purpose of these healthcare services was the preservation of the industrial labor force.

In the 1960s the development model favored by the United States aimed at structural reforms in the underdeveloped countries. In the field of health, these reforms marked the appearance of community medicine whose basic strategy was to impel the participation of the community in the provision of healthcare.

Community medicine asserts that it is possible, by means of education, to effect changes in the health behavior of individuals. These programs yielded weak results in all countries of the region. In Nicaragua , the developmentalist model that was proposed could not be implemented with the same degree of success achieved in other countries due to political and social conditions, marked by the existence of a strong and repressive dominant class. The National Health System and the Ministry of Health were incapable of broadening healthcare coverage. In the end, this benefited private medicine, since the impoverished sectors of society had to resort to it, given the lack of coverage available via the public sector.

Community medicine developed in Nicaragua through vertical projects, financed by the state or by international agencies but without coordination among them. The emphasis was put on education, organization, and community participation. Nevertheless, the community activities undertaken by the marginalized sectors could not implant a true sense of participation or reverse their state of impoverishment.

Through the triumph of the Sandinista revolution, the Unified National Healthcare System was created, offering broad coverage, with emphasis on prevention and the incorporation of the populace in healthcare matters. To this was added a literacy campaign and the institutionalization of popular education about health.

Conclusion: Participation in and education about health are conditioned by the socio-economic structure, as is the provision of health care. The repressive governments preceding the Nicaraguan revolution brought about the failure of the reformist development project and made improvements in the health of the population impossible. Under the new popular government, conditions were favorable for education and community participation in health from an integrated, preventive perspective.

Copyright 2007 University of New Mexico