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Health Policy and Planning; 15(3): 312-318
© Oxford University Press 2000

From State to market: the Nicaraguan labour market for health personnel

Gustavo Nigenda1 and Maria Helena Machado2

1 Senior Researcher, Centre for Health Systems Research, National Institute of Public Health, Mexico and
2 Senior Researcher, National School of Public Health, Osvaldo Cruz Foundation, Rio de Janeiro, Brazil

Few countries in Latin America have experienced in such a short period the shift from a socialist government and centrally planned economy to a liberal market economy as Nicaragua. The impact of such a change in the health field has been supported by the quest for reform of the health system and the involvement of external financial agencies aimed at leading the process. However, this change has not been reflected in the planning of human resources for health. Trends in education reflect the policies of past decades. The Ministry of Health is the main employer of health personnel in the country, but in recent years its capacity to recruit new personnel has diminished. Currently, various categories of health personnel are looking for new opportunities in a changing labour environment where new actors are appearing and claiming an influential role. It may take more than political willingness from the government to redefine the new priorities in the field of human resources for health and subsequently turn it into positive action.


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