Enhancing qualitative health delivery in primary health services in transition in Nicaragua


Since 2005, the Ministry of Health of Nicaragua is gradually implementing a new model of care in public primary health services (MAIS, modelo de atención integral en salud) that aims towards a more integrated, equal and accessible care. Because of the weaknesses in its implementation and in order to give more support to the reorganization of primary health care, UNAN formulated a demand for a new collaborative project. The idea for this project arose from the concern of UNAN researchers and academics in maintaining the benefits of the anterior projects and other reproductive health programs within the new model of primary health care. Moreover, contacts with primary health centers reflected the concerns of health providers about the lack of information and assessment for the introduction of the new model. The concept of integrated health care and the implementation of a more comprehensive approach would clearly benefit from more and better academic support.    


Development objective: To strengthen the implementation of the model of integrated medicine (MAIS) in primary health care. 

Academic objective:  To increase the role of the UNAN in the implementation and maintenance of the model 

Specific Objective: To enhance the involvement of the university in the quality support of primary health care in the context of the model of integrated care with a focus on sexual and reproductive health.


Methodology is the action research approach. Firstly, a “generic” model will be constructed that guides the process towards a more qualitative health care delivery taking into account the results of the situation analysis. Secondly, this generic model will be tested in the three settings and compared. Thirdly, the outcome and process will be assessed and fed back into the model. It will be the model that guides the actions and the process of change.  The underlying hypothesis is that interventions targeting selected determinants affect positively the overall quality of health care delivery in primary health services.

Following strategic lines will be reflected in all interventions:

1.       Continuous process of training and guiding

2.       Continuous attention for preserving the dynamic and participatory aspects of the implementation process.

3.       Academic input of students and docents

4.       Focus on human, respectful and warm provider-patient interaction

5.       A continuous investigation process


Intermediate result 1: Within the faculty of medicine a scientific team (MAIS team) has been composed and prepared to be actively and critically involved in the implementation process of the model of integrated health care.

Intermediate result 2: The UNAN has carried out a situation analysis and developed an action model for intervention. 

Intermediate result 3: The UNAN team has supported actively the organizational process required for the implementation of the model of integrated care in primary health centers in transition.

Intermediate result 4: The UNAN team has been actively involved in improving technical skills required for a qualitative (sexual and reproductive) health delivery in primary health centers in transition.  

Intermediate result 5: The UNAN team has promoted the model of integrated care as a valid alternative for the vertically structured primary health services

Intermediate result 6: The UNAN team has realized investigations in the context of the implementation of the model.

Intermediate result 7: The results and experiences of the project have been disseminated to the public, stakeholders and scientists.

Extension related result 8: Preliminary advances have been made for the setting up of a department of integrated primary health care or family medicine within the faculty of medicine of the UNAN

Funding agencies



Dr. Peter Decat, Prof. Dr. Marleen Temmerman, Prof. Myriam Deveugele


UNAN (Universidad National Autónoma de Nicaragua, facultad de Medicina); Ghent University, faculty of medicine, Department of Uro-gynaecology; International Centre for Reproductive health (ICRH) Ghent University, faculty of medicine, Department of General practice and primary health


October 01, 2008 - September 30, 2012

Project status

Project closed

Team members

Ms. Marleen Temmerman




Reproductive rights