Towards a healthier Managua

16 World Health • 49th Year, No. 1, Januory-Februory 1996 Towards a healthier Managua Fran~oise Barten & Angel Sanchez At present, Nicaragua is one of the poorest countries in Latin America. The dislocation caused by the low-intensity war during the last decade led to massive migration from the countryside, and the population of the capital, Managua, more than doubled in three years. Today, roughly one- third of the country's population live in Managua. This rapid and uncon- trolled growth of the city, combined with a lack of urban planning and increased demand on urban services, has contributed to a crisis situation, with increasing social inequalities and the political polarization of society. Between 1987 and 1994, poverty in Managua increased from 30% to 72.5% and extreme poverty from 15% to 50% - mainly among female-headed households. Unemployment stands at a stagger- A "brigadista de salud" immunizes a child in a poor area of Managua , Nicaragua. ing 62% and malnutrition in children at 68%, while domestic violence and drug abuse among school-aged youth are rapidly rising. The 270 squatter settlements constitute the most unhealthy environments of the city, and more than 300 polluting industries are located in low-income areas. Waste is dumped at 310 illegal tips throughout the city, causing serious health hazards. On the positive side, although the public health budget was reduced by 50% during recent years, the author- ities have developed innovative strategies to meet health needs. The Movimiento Comunal (Communal Movement) in Managua at present has more than 3000 "brigadistas de salud" (health promoters), and owns 60 health posts and some 600 "casas bases" (community health houses) ; it promotes self-reliance and active participation of the community in the improvement of living condi- tions. In July 1995, Managua decided to launch a Healthy Cities project because of the increasing inequity in social and physical living environ- ments; the need to base urban health sector reform on innovative strate- gies developed by civil society; and the lack of intra- and intersectoral collaboration. The possibility of attaining greater social democracy through health helped to raise inter- est in a "Managua, Municipio Saludable" Project. The beginning of the project coincided with the unification by the Ministry of Health of the capital's three district health systems into one municipal district health system. Recognition of the central role played by local govern- ment in health was spurred by the limited capacity of the health sector to control serious epidemics of malaria and dengue. More than 30 different organiza- tions participated in a workshop convened to identify current contri- butions to urban health development upon which a Healthy City project could be based, and to explain the concept and the approach of the WHO Healthy Cities Project. It soon became clear that many different institutions, municipal agencies, community bodies and nongovern- mental organizations were making various separate efforts, often in the same barrios of Managua. Community-based organizations with a long history of participation in local development were recog- nized as crucial resources. It was decided that the School of Public Health would act as the national counterpart of WHO and UNDP and would be the focal point for action during the first phases of the project. In collaboration with WHO, a field study is being con- ducted in order to identify the city's main environmental health problems through direct consultations with the public. The information provided will help to set the agenda for build- ing a Healthy Managua for all its inhabitants. • Or Franr;:aise Barten is the Coordinator of the Nijmegen Urban Health Group, Nijmegen University, P. 0. Box 910 I, code I 03, 6500 HB Nijmegen, the Netherlands. Or Angel Sonchez is with the School for Public Health of Nicaragua (CIES), University of Nicaragua (UNAN), Managua, Nicaragua.