Abstract
I 1 5 documented (1-3). Many of these conflicts are examples of what is termed, in military parlance, "low intensity conflict" (LIC) -a conflict short of conventional war, where it is not a nation's military structures that are targeted but "its clinics and classrooms, its power and transportation systems, its livelihood, and its possibilities... ." (4). Shortly before the recent elections, I visited Nicaragua, where counter-revolutionary or Contra forces have waged such a conflict against the government for almost a decade. In the aftermath of the recent electoral defeat of the Sandinista government, and the likely end to hostilities, it is worth reflecting on some of the health consequences specific to this type of conflict in Nicaragua. Perhaps the greatest tragedy of the escalation in Contra hostilities during the I98os was the gradual erosion of the remarkable early achievements of the Sandinista health care system. In 1979, the Sandinista revolutionary government inherited a legacy of health indices which were amongst the worst in Latin America. The Nicaraguan Ministry of Health (MINSA) promptly developed an ambitious and innovative national health programme, characterized by the provision of universal health coverage and an emphasis on community-based primary care, all within the context of regionalized health services and popular community participation in health activities. In 1977 the proportion of the government budget devoted to health was 7.5 % and by I 9 8 I had risen more than 50 percent (5). This commitment was reflected in some exceptional results. For example, infant mortality decreased by 30 percent overall, and by an even greater amount in the rural areas. Polio, previously endemic in Nicaragua, has not been reported since I98 2 despite intensive
Published Version
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