Health policy making in a revolutionary context: Nicaragua, 1979–1981

The revolutionary regime in Nicaragua has made great strides toward the achievement of the central goals of equity of access to health services, emphasis on preventive rather than curative services. and encouragement of community participation. Nevertheless, during the first year of the regime choices were made which were inconsistent with the full achievement of these goals. Equity of access increased much more for urban than rural areas and major efforts in hospital reconstruction and education of physicians began. This article suggests that as militant Sandinistas take more important roles in the Ministry of Health, a shift in emphasis is possible—especially if budgetary constraints are taken into consideration.