{"id":169172,"date":"2025-06-17T01:25:00","date_gmt":"2025-06-17T07:25:00","guid":{"rendered":"https:\/\/confidencial.digital\/sin-categoria\/where-are-the-doctors-nicaragua-among-countries-with-the-fewest-medical-personnel\/"},"modified":"2025-06-24T04:42:31","modified_gmt":"2025-06-24T10:42:31","slug":"where-are-the-doctors-nicaragua-among-countries-with-the-fewest-medical-personnel","status":"publish","type":"post","link":"https:\/\/confidencial.digital\/en\/english\/where-are-the-doctors-nicaragua-among-countries-with-the-fewest-medical-personnel\/","title":{"rendered":"Where Are the Doctors? Nicaragua Among Countries With the Fewest Medical Personnel"},"content":{"rendered":"\n

Nicaragua ranks among the three countries in the Americas with the lowest number of medical personnel\u2014including doctors, nurses, and midwives\u2014available to meet the healthcare needs of its population. According to the World Health Organization\u2019s (WHO) standard benchmark, at least 44.5 health workers are needed per 10,000 people. Nicaragua barely reaches half that target. <\/strong> What factors contribute to this low average, which results in fewer consultations or poor-quality care\u2014despite the government\u2019s promise of free healthcare?<\/p>\n\n

Rub\u00e9n<\/em>, a doctor in southern Nicaragua, says that firings, summons and threats, surveillance, the shutdown of medical organizations, and lack of hiring are part of the daily reality for doctors in the country.<\/p>\n\n

\u201cIt is a reality that anyone who goes to a health center or hospital in Nicaragua can see \u2014 there are not enough of us to attend to patients, <\/strong>and that is evident,\u201d he stresses.<\/p>\n\n

This has been the case \u201cfor years,\u201d says the doctor, who has worked for the Ministry of Health (MINSA) for over a decade. But he believes that since 2018, \u201chostility and pressure have intensified.\u201d <\/p>\n\n

\u201cThere have been many dismissals of staff who protested or helped demonstrators seen as opposition supporters, and many others have resigned out of exhaustion. The reality is that we\u2019re always understaffed<\/strong>, even if we manage to get things done,\u201d he says.<\/em><\/p>\n

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Nicaragua Stagnant in Health Worker Hiring<\/h2>\n\n

At the end of April 2025, the Pan American Health Organization (PAHO) published a report titled \u201cThe Health Workforce in the Americas: Data and Regional Indicators.\u201d<\/em><\/a> The study examines data from 39 countries and territories that make up PAHO, focusing on eight key health occupations: medicine, nursing, midwifery, dentistry, pharmacy, physiotherapy, psychology, and community health work. <\/p>\n\n

Researchers analyzed the most recent data available for each country between 2017 and 2021 and warned that \u201cwithout immediate intervention,\u201d the Americas could face a shortage of between 600,000 and 2 million healthcare workers by 2030.<\/p>\n\n

\u201cHealth workers are the backbone of our health systems. Without them, it\u2019s simply not possible to talk about access or universal coverage,\u201d said PAHO Director Jarbas Barbosa when presenting the study.<\/a><\/p>\n\n

\u201cThis report gives us concrete data to guide investment in training, retention, and decent working conditions\u2014ensuring that healthcare reaches everyone,\u201d Barbosa added.<\/p>\n\n

But Nicaragua\u2019s situation has not changed since the period covered in the study\u2014at least not in the public sector. Between January 2015 and March 2025, the average number of health workers in the country rose by only 2,021 people, according to official figures from the Central Bank of Nicaragua (BCN)<\/a>, analyzed by CONFIDENCIAL<\/strong>. <\/p>\n\n

In 2015, the average annual number of public-sector health workers was 18,446. By the first quarter of 2025, that figure had only grown to 20,467.<\/p>\n\n

The analysis of official statistics also shows that although the number of health workers has increased since 2015, there were years\u2014such as 2020 and 2023\u2014when the annual average actually dropped compared to the previous year. The downward trend returned in the first quarter of 2025. <\/p>\n

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\"Nicaragua<\/figure>\n<\/div>\n

Health sector with much room for improvement<\/h2>\n\n

Only two countries rank below Nicaragua in the average number of healthcare workers: Honduras and Haiti.<\/p>\n\n

The study reports that the regional average in the Americas is 66.57 health workers per 10,000 people, but researchers point out significant disparities across the region.<\/p>\n\n

On one end of the spectrum, countries like Cuba, the United States, and Canada nearly quadruple the WHO benchmark. On the other, Bolivia, St. Kitts and Nevis, Jamaica, Belize, Guatemala, Venezuela, Saint Lucia, Colombia, the Dominican Republic, Peru, and Suriname round out the list of countries with the lowest number of medical personnel. <\/p>\n

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\"PAHO
Chart taken from PAHO<\/figcaption><\/figure>\n<\/div>\n

The PAHO report warns that without strategic investments in training, regulation, working conditions, and equitable distribution of healthcare workers, it will be impossible to build health systems that are \u201ctruly universal, equitable, and resilient.\u201d<\/p>\n\n

\u201cThe challenge isn\u2019t just having more healthcare professionals,\u201d PAHO Director Jarbas Barbosa stressed, \u201cbut making sure they are where they\u2019re needed most and have the right skills to meet the population\u2019s needs.\u201d<\/p>\n\n

The report notes that the COVID-19 pandemic exposed major global weaknesses in the healthcare sector, including staffing shortages, difficulty retaining personnel, unequal distribution, and insufficient investment in training\u2014issues that hinder the development of resilient health systems capable of responding to emergencies.<\/p>\n\n

The pandemic also revealed a widespread \u201clack of data for proper health workforce planning\u201d in many countries in the region.<\/p>\n\n

For instance, the report points out that in Nicaragua, Dominica, the Bahamas, the Dominican Republic, Grenada, Bolivia, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, and Guatemala, there is no data available on midwifery personnel.<\/p>\n\n

Healthcare Workers in Nicaragua: \u201cWe’re Under Surveillance\u201d.<\/h2>\n\n

Byron<\/em> has worked at the Ministry of Health (MINSA) for over two decades and says he\u2019s considered quitting several times. \u201cI don\u2019t do it because I don\u2019t have any other job options\u2014and I\u2019d leave with practically nothing now that they\u2019ve cut back severance pay for public employees,<\/a>\u201d he says. <\/p>\n\n

In November 2023, the Nicaraguan government passed a law drastically reducing severance packages for public sector workers who resign. Under the new law, only employees with at least three consecutive years of service are eligible\u2014unlike the previous law, which granted compensation starting from the first year. Now, those with 3 to 10 years of service receive only one month\u2019s salary; 10 to 15 years: two months; 15 to 20 years: three months; and only those with more than 20 years get five months\u2019 salary. <\/p>\n\n

Byron<\/em> also explains that since 2018 and especially after the COVID-19 pandemic, healthcare workers in Nicaragua have had to keep quiet about public administration and working conditions. \u201cWe keep our mouths shut so we don\u2019t say a single word of criticism against the government,\u201d he explains. <\/p>\n\n

\u201cI\u2019ve seen many colleagues get fired\u2014just for making a minor complaint, for pointing out a lack of medicine, or even because they were suspected of talking to independent journalists,\u201d he adds.<\/p>\n\n

He says medical personnel are constantly being cycled through: \u201cThey fire people, hire new ones, and then fire again\u2014but the overall numbers stay more or less the same.\u201d<\/p>\n\n

For Byron<\/em>, switching to the private sector isn\u2019t a viable option either. \u201cIt\u2019s not growing much, and those who quit usually end up doing something completely different,\u201d he says.<\/p>\n\n

\u201cLow wages and enforced political loyalty.\u201d<\/h2>\n\n

Ana Quir\u00f3s, a public health specialist who was exiled from Nicaragua in 2018 for participating in the April Rebellion protests, has continued her work in Costa Rica, focusing on the Nicaraguan migrant and exile community. She says that in Nicaragua, hiring practices and the current medical workforce are shaped by \u201clow wages and enforced political loyalty.\u201d <\/p>\n\n

\u201cHealth professionals are subjected to arbitrary decisions\u2014from being forced to participate in rallies they have no interest in, to being ordered to stop treating patients based on their political leanings,\u201d explains Quir\u00f3s. <\/p>\n\n

Public employees have denounced that they consider themselves \u201chostages\u201d of<\/a> the regime of Daniel Ortega and Rosario Murillo, which has radicalized political surveillance and party control against state workers.<\/p>\n\n

<\/div><\/div>

Ana Quiros<\/p>

Public Health Expert<\/p><\/div><\/div>

<\/path><\/svg><\/div>

\u201cThere\u2019s a brain drain of health professionals to other countries, because many would rather leave Nicaragua\u2014even if it means working in unrelated jobs\u2014than stay under the limitations imposed on the public health sector.\u201d<\/p><\/div><\/div><\/div><\/div><\/div>\n\n

Some of the pressures health workers face include being forced to participate in marches, mandatory financial contributions to the ruling party, coerced and monitored voting in elections, self-censorship, political indoctrination, and even restrictions on leaving the country. <\/p>\n\n

Quir\u00f3s believes that Nicaragua\u2019s public health system suffers from \u201ca serious problem of political-party dependence,\u201d which has led to many professionals being \u201cfired, sidelined, or punished for speaking their minds\u2014or forced into silence on a regular basis.\u201d <\/p>\n

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The Exodus of Health Workers <\/h2>\n\n

According to Ana Quir\u00f3s, Nicaragua has never reached the number of healthcare workers recommended by the WHO, for several reasons: on one hand, the country\u2019s training programs aren\u2019t sufficient to meet demand; on the other, there\u2019s no effective hiring policy. <\/p>\n\n

The public health specialist warns that this has led to a \u201cbrain drain\u201d in the health sector\u2014especially in nursing, which she describes as \u201ca key pillar of the healthcare system.\u201d <\/p>\n\n

\u201cNurses have a lot of opportunities to find work abroad,\u201d she explains. \u201cEven if it\u2019s not directly in healthcare, they can often find jobs caring for children, the elderly, or people with disabilities\u2014roles that are in high demand in many countries.\u201d <\/p>\n\n

Rub\u00e9n<\/em>, who has worked as a doctor in several cities across Nicaragua, admits that the availability of medical staff depends heavily on location.<\/p>\n\n

\u201cThere are places where doctors and medicines are scarce, and the care available is extremely basic,\u201d he says. <\/p>\n\n

\u201cThere\u2019s a big gap between the concentration of health personnel in Managua and major cities versus rural areas. Many people have to travel long distances to get specialized care,\u201d Rub\u00e9n<\/em> adds.<\/p>\n\n

The core problem, Quir\u00f3s says, is that the country isn\u2019t training enough new professionals\u2014and the situation has worsened due to \u201cthe dismissal of a large number of medical school instructors,\u201d which means no major improvements can be expected in the coming years. <\/p>\n\n

Rub\u00e9n<\/em> also points out that the shutdown of medical organizations that used to \u201csupport the ongoing training and professional development of specialists\u201d is a serious issue that, in his view, \u201chasn\u2019t been treated as the problem it is.\u201d<\/p>\n\n

A data analysis by CONFIDENCIAL<\/strong>, based on the cancellation of legal status for NGOs, estimates that around 218 health-related organizations have been shut down between 2018 and early 2025. <\/p>\n\n

Fired for Thinking Differently<\/h2>\n\n

In Nicaragua, it\u2019s estimated that at least 686 doctors were dismissed by the Ministry of Health<\/a> (Minsa), primarily for protesting in 2018 and for speaking out scientifically or protesting the government\u2019s poor handling of the COVID-19 health crisis.<\/p>\n\n

The Nicaraguan Medical Unit, made up of dismissed doctors, warned that many were fired for providing medical care to those injured during the 2018 civil protests, which were violently repressed by police and paramilitary forces sent by the dictatorship.<\/p>\n\n

The Ministry of Health has also been singled out by national and international human rights bodies as an actor in \u201cserious human rights violations\u201d by limiting medical care to victims of state repression during the 2018 protests. This failure resulted in the deaths of many demonstrators due to lack of medical attention. One of the most well-known cases was the death of teenager \u00c1lvaro Conrado in April 2018. <\/p>\n\n

As a result of this wave of repression, hundreds of doctors went into exile, while others unsuccessfully sought to be reinstated.<\/p>\n\n

The Inter-American Commission on Human Rights (IACHR) documented that between April and September 2018, at least 300 doctors were fired from public hospitals in Managua, Le\u00f3n, Masaya, and Estel\u00ed.<\/p>\n\n

Two years later, in 2020, when the pandemic hit, Minsa fired staff from several hospitals\u2014including Manolo Morales, Bertha Calder\u00f3n, and Antonio Lenin Fonseca\u2014without justification.<\/p>\n\n

Among those dismissed were medical specialists who had decades of experience in the public sector and who, during the pandemic, gave interviews or signed public statements demanding personal protective equipment.<\/a><\/p>\n\n

Many dismissed public workers have reported that, years later, they still have not received their severance payments<\/a> following resignation or unexplained dismissal.<\/p>\n\n

Death of Medical Personnel Due to Negligence <\/h2>\n\n

Just four days before the Ministry of Health (Minsa) reported the first case of COVID-19 in March 2020, the dictatorship forced public workers to participate in the \u201cLove in Times of COVID-19\u201d<\/a> march, putting their health at risk while the rest of the world was starting quarantines to prevent the virus\u2019s spread. The regime also prohibited preventive measures such as wearing masks or face shields, arguing that these could cause panic among the population. <\/p>\n\n

Due to the regime\u2019s negligent attitude, Nicaragua became one of the countries in the Americas with the highest number of medical personnel deaths from COVID-19, with over 200 fatalities, revealed in a report by CONFIDENCIAL<\/strong><\/a>. <\/p>\n

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Nicaragua was one of the countries that did not follow the WHO\u2019s recommendation to vaccinate frontline health workers within the first 100 days of 2021. Vaccination for this sector started later and was not initially widespread. <\/p>\n\n

Private practitioners working in clinics or private offices who treated patients with COVID-19 symptoms were also not prioritized.<\/p>\n\n

Throughout the pandemic, healthcare workers reported not receiving adequate protective equipment and being overworked. Many were dismissed or threatened for raising concerns. Today, no one dares to complain about the difficult conditions under which they continue to work. <\/p>\n","protected":false},"excerpt":{"rendered":"

Nicaragua ranks among the three countries in the Americas with the lowest number of medical personnel\u2014including doctors, nurses, and midwives\u2014available to meet the healthcare needs of its population. According to the World Health Organization\u2019s (WHO) standard benchmark, at least 44.5 health workers are needed per 10,000 people. Nicaragua barely reaches half that target. What factors […]<\/p>\n","protected":false},"author":10,"featured_media":167873,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_eb_attr":"","_eb_data_table":"","footnotes":""},"categories":[15445],"tags":[],"class_list":["post-169172","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-english"],"acf":[],"yoast_head":"\nWhere are the doctors? 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