Global Presence

Decades of social, economic, and political instability have greatly hindered the Nicaraguan government from delivering quality health services to its people. Fortunately, Nicaragua's transition to democracy has prompted numerous reforms aimed at improving the quality of health services and reducing inequalities and inefficiencies. The Prosalud project supports these initiatives as a partnership between the Nicaraguan Ministry of Health, USAID, Management Sciences for Health, and numerous private voluntary organizations (PVOs).

MSH has provided technical assistance and support to the Nicaraguan Ministry of Health since 1994. Under the USAID-funded Decentralized Health Services Project (DHSP), MSH assisted with the decentralization of health management functions from the central level to the provincial offices (SILAIS). The project made significant progress in the management and administration of health centers and health posts, as well as maternal and child health, and strengthening institutional capacity. In addition, infant mortality was reduced, the global fertility rate dropped, and maternal mortality rates shrunk significantly in project areas.

In 1999, MSH was awarded the Prosalud project to extend the decentralization process from the SILAIS to health facilities. Prosalud works with 156 health centers and health posts in Jinotega, Matagalpa, and Boaco with the following objectives:

• Improve integrated child health, including the Integrated Management of Childhood Illness (IMCI) and nutritional practices;
• Improve integrated women's health and reproductive health;
• Strengthen management and support alternative sources of financing;
• Train health care workers in clinical skills and case management;
• Increase community and municipal mobilization in support of health services;
• Monitor a network of health allies including MSH, international and local private voluntary organizations, the Ministry of Health, and local communities;
• Improve physical infrastructures.

At the heart of the Prosalud project is MSH's model of the Fully Functional Service Delivery Point (FFSDP). The FFSDP is designed to deliver high-quality services to a known population on a continuous basis. Prosalud identified ten criteria to measure the degree of functionality of service delivery points. The team also created a database for setting priorities among the facilities and for monitoring improvements in as interventions are carried out.

Prosalud is currently working with three subcontractors: Johns Hopkins University/Center for Communication Programs (JHU/CCP), working in the area of demand generation and community mobilization; Funisdeci, a local Nicaraguan organization providing technical assistance and support in community outreach and community development; and PROFAMILIA, which works in family planning, reproductive health, and child survival. Other PVOs working in collaboration with Prosalud include: Save the Children, CARE International, Project Hope, Partners of the Americas, the Adventist Development and Relief Agency, and Project Concern International. Prosalud also collaborates with Nicaragua-based offices of the BASICS and MEASURE projects.