Nicaragua 1998

International staff :13 National staff: 67 Health services need support The provision of medical services in Nicaragua is poor. As state hospitals lack medicines, even in emergencies the poorest have to buy from private pharmacies. MSF has a well-established programme supporting health services in the Nueva Segovia department in Northwest Nicaragua. This includes community pharmacies (partial cost recovery) for the 70,000 inhabitants of Ocotal, Murra and Quilali, and training for midwives and health educators (including STD/HIV/AIDS). There are also clean water and hygiene (latrines and waste disposal), and health education (including in schools) projects. The El Cau Bocay project, refurbishing health centres/posts, training local personnel and ensuring community pharmacies, was completed in December. In Managua, MSF continues to provide technical and financial support for primary health care and medical equipment, and for establishing community pharmacies ensuring access to reasonably priced quality drugs. Medicines are supplied from Managua to public health structures and other NGOs outside the capital. MSF works with national and local organisations on these urban programmes. In August, a new programme began targeting the growing number of glue-sniffing street-children. A mobile team works in Managua's main markets, where this group tends to congregate, and basic health care is provided in a number of public and private institutions. Training is given to team members and educators working with the partner NGO. MSF also supports groups working to raise awareness of this issue and persuade public opinion that restrictions should be placed on the sale of these glues and their toxic content replaced by a non-addictive substance.