To the People of Nicaragua and the World Report on COVID-19 and a Unique Strategy: White Paper, May 2020

This is the Executive Summary of a White Paper the Nicaraguan Government released May 25, 2020 in response to international criticisms of the Pan American Health Organization (PAHO), the Costa Rican government, and other nations to what they describe as a lack of adequate response of the Nicaraguan government to the health crisis caused by COVID-19. In addition there has been widespread national criticism of the government´s response, including six former Ministers of Health of Nicaragua, the Civic Alliance for Justice and Democracy, COSEP and over 700 Nicaraguan doctors and health care professionals.

To the People of Nicaragua and the World

Report on COVID-19 and a Unique Strategy

White Paper

May 2020

[original Spanish document]


We present to the Nicaraguan people and the international community the “NICARAGUA WHITE PAPER IN THE FACE OF THE COVID-19 PANDEMIC: A UNIQUE STRATEGY”, which has an analysis of the public policies, presenting a vision of the health care model of Nicaragua as a unique model in the world, based on the reality and conditions of the country, which responds to a preventive approach to people, families and communities with proactive actions. Within this model we have a strategy of balance between the Pandemic and the Economy, vigorously fighting Coronavirus and COVID-19 without closing down our economy. The policy is based on the fact that 40% of the population lives in the countryside, and 80% of the workers in the urban area belong to the informal sector and earn their daily sustenance. At the same time, we are defending the economic recovery of an economy weakened by the coup attempt of April 2018, that continues under attack by false news (“fake news”) campaigns and disinformation, as well as illegal coercive measures.

The country has been well prepared for this fight against COVID-19, due to:

1) The strengthening of the health care system (2007-2020);

2) Preparation since January 2020, two months prior to the appearance of the first case;

3) The entirety of the actions undertaken.

Strengthening health care 2007-2020

It presents how Nicaragua is in a better position today, compared to the sixteen years of the neoliberal period, to face the pandemic, with more modernized health care infrastructure (18 new hospitals), more trained personnel (36,649 health workers in 2020 compared to 22,083 in 2006; 6,045 doctors in 2020 compared to 2,715 in 2006) and flagship and solidarity programs that make manifest the sacred commitment of the Government of Reconciliation and National Unity (GRUN) to restore the rights of the population (Everyone with voice, Love for the smallest, Operation Miracle), since the organization of the Family and Community Health Care Model (MOSAFC), working jointly with the community network and a larger budget investment (US$ 468. 6 million dollars in 2020 compared to US$111.9 million in 2006.

Preparation for COVID-19

When the COVID-19 outbreak happened in Wuhan, China on January 21, the Ministry of Health (MINSA) held a press conference to warn the population about the risk, and to communicate prevention measures. This was almost two months before the presentation of the first case in Nicaragua on March 18.

Since the declaration of the World Health Organization on COVID-19 as a Public Health Emergency of International Importance on January 30, 2020, Nicaragua established an Inter-institutional Commission to ensure a comprehensive approach.

On February 9 MINSA released a “Preparation and Response Protocol in the face of the Risk of Coronavirus (COVID-19) in Nicaragua” to ensure the monitoring and early detection of suspicious and confirmed cases. Preventive measures were established to reduce the transmission of the virus, and an ongoing communication plan was implemented, directed to the population, and educational and border control actions have been carried out, always based on the Protocols of the WHO/PAHO.

The Protocol also designated 19 Hospitals to be specialized in COVID-19, one of them, the Nicaraguan German Hospital, exclusively for respiratory diseases; it included more preparation for the primary treatment units to address the respiratory symptoms on the national level, the training of public and private personnel, and the acquisition of protection equipment. Nicaragua also had established a capacity for contact tracing. In this way Nicaragua was prepared before the appearance of the first case of COVID-19 in the country on March 18.

Actions in the face of COVID-19

As part of the Protocol designed by MINSA in response to the Coronavirus and COVID-19 pandemic, in Nicaragua 470 people suspected or who have had contact with confirmed cases in the country, have been treated and provided responsible and careful follow up.

Likewise, more than 42,000 international travelers were the object of monitoring for 21 days to detect possible cases of COVID-19.

This follow up provided to travelers, suspicious cases and contacts of positive cases, includes doing daily control by the closest Health Post or Health Center to their homes, based on which the medical staff daily decide about the pertinent actions: continuation of the monitoring, hospitalization, or release, depending on the case.

More than 4.6 million multiple educational house-to-house visits were carried out in a country of 6.2 million people, by 98,224 volunteers to promote family and community health.

In addition to an intensive informational campaign in the media about the prevention measures, the publication of the symptoms and behavior in the face of the disease, a National Information Center has been created that has a free telephone line where prepared staff and doctors clarify any questions that the population may have and appropriately direct them about how to act in the face of the pandemic.

In addition, there is a program for the disinfection of public transportation units, collective (buses) as well as selective (taxis); popular markets, governmental buildings and schools at all levels, preschool, primary, secondary and public universities.

The Ministry of Education and the National University Council, in coordination with the Ministry of Health, in addition have adapted their physical installations, designed prevention protocols, and have adapted their study programs to include talks on preventive health and reinforcement of healthy habits for all their students.


In synthesis, Nicaragua, the second poorest country of Latin America and the Caribbean, has been prepared to face the COVID-19 pandemic and any other similar one, as well as it has been prepared to face natural disasters due to the climate, like hurricanes and droughts, or to geological phenomena, like earthquakes or volcanic eruptions, principally for reasons of its own health response model, which is a highly preventive nature based on the active participation of the family and the community, but also because it has invested a fundamental part of its scarce resources in the construction of new health units and the modernization of existing ones, as well as in the numerical growth and ongoing improvement of its medical, nursing and technical staff, in addition to their more equitable distribution throughout the national territory.

In addition, in the face of the appearance itself of COVID-19, the responses provided by the Government of Nicaragua have been carried out in coordination with the regional entities of SICA and in addition with the cooperation of sister nations like Taiwan, Cuba and South Korea.


Nicaragua ratifies, then, its confidence in the success of its policies based on the defense of the health and lives of families and communities, with their active participation in the prevention of epidemic and non-epidemic diseases, but also in the protection of the family, community, local and national economy, which has allowed for and will continue allowing for new accomplishments in the fight against poverty and for the human development of the country, even in the adverse times of economic crisis and climate change, even in times of COVID-19.

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