Envío Digital
Central American University - UCA  
  Number 111 | Octubre 1990



Health Minister Under Fire

Envío team

The far Right within UNO has begun a campaign to remove the President’s health minister, Dr. Ernesto Salmerón. Since the transfer of government, Salmerón has stood out as the most moderate member of the UNO Cabinet—the only one, health ministry (MINSA) employees say, who has put national reconciliation into practice.

When the new UNO Cabinet officially received the different state entities from the outgoing Sandinista government, Salmerón was the only one to acknowledge that his ministry was in good condition and the inventories were in order. And instead of harping on the right wing’s preferred scapegoat—Sandinista mismanagement—he blames the war for the health system's shortcomings. In an interview with Barricada, he said, “Should [the hospitals] be in better shape? Yes, but there shouldn't have been a war for 14 years. In epidemiology, the worst epidemic is called war.” In the same interview, Salmerón expressed his opposition to privatizing the health care system, doubtless an even bigger thorn in the side of the far Right. He said, “Whoever believes that he is going to establish a privatized health system here, under these conditions, is not only headed for assured bankruptcy but also must not have the slightest notion of what is going on in this little world called Nicaragua.”

One step too far

Salmerón's differences with the far Right came to a head in September when he transferred Dr. Carlos Fletes from his post as MINSA director of the Managua region to a position with the Panamanian Health Organization (PAHO). According to health workers, Fletes, a member of the rightwing business association COSEP, was more concerned with replacing the Sandinista-appointed directors of Managua's health care centers and organizing pro-UNO unions within MINSA than resolving the very serious health problems currently facing the capital. His transfer was announced to union leaders during an emergency meeting they had called with the minister to discuss the current epidemics, infant mortality and scarcity of medicines precipitating a serious health crisis in Managua.

Sandinista workers interpret Fletes' dismissal as demonstrating Salmerón's willingness to put health care interests over politics—and to keep his word to the workers. The minister has repeatedly stated that he will not fire health workers for strictly political reasons, as Fletes was apparently doing, but only for poor job performance. While the government formally agreed to do the same during negotiations with Sandinista workers, no other minister has taken the agreement seriously. Salmerón's position is unacceptable to more extreme members of UNO.

COSEP reacted swiftly, launching its Radio Corporaci6n into attack and mobilizing UNO representatives in the National Assembly to call for Salmerón's removal. According to Barricada, Assembly representative Juan Gaitán stated that Salmerón “is not fulfilling the UNO program” and that “his actions are not befitting a state minister.” A delegation from MINSA, headed by COSEP member Aldo Martínez Campos, met with the Assembly's Committee on Health, Social Security and Welfare to call for Fletes' reinstatement. Martínez Campos called Salmerón's action “unjust” and “arbitrary” and claimed that the newly-appointed director will leave “the region in the hands of Sandinismo.” He pointed out that Fletes is the second COSEP member to be removed from a MINSA post, claiming both to be acts to avenge COSEP’s opposition to Salmerón's appointment. The Committee agreed to ask Salmerón for a report on Fletes' dismissal and other of the minister’s actions. If the report is unsatisfactory, said extremist UNO representatives, they will demand Salmerón's removal.

In a press conference, Salmerón stated that Fletes had simply been transferred to a position where his expertise was needed more. But local health center directors who had been fired by Fletes were reinstated after his transfer. And union representatives reported that MINSA Vice Minister Petronio Delgado and others admitted that Fletes was transferred for not following the minister's orientations. Fletes himself told La Prensa, “I consider my transfer to the PAHO being fired from MINSA, because they’re sending me to a practically nonexistent post. This situation hurts my dignity, something that didn't even happen under the previous government.”

Sandinista health workers promised “all their support” to Salmerón on the issue of Fletes' dismissal and in all preventive health care measures, saying that if all Cabinet ministers were like him, national reconciliation would be a reality. What's important, say MINSA workers, is to be able to do their work essential to the survival of the population without discrimination for political reasons or concern over job stability. Both the workers and Salmerón appear to agree that health care is the first priority.

However, in a turn of events just a week after Fletes' removal, the newly appointed Managua regional MINSA director Nelson Salazar reportedly resigned when Salmerón ordered him to begin dismantling the ministry’s regional structure. The centralization of the health system implies that hundreds of smaller health centers and medical posts will be left without resources or support, with grave consequences for the population. A general meeting of MINSA health workers for the Managua region formally rejected both the possible reinstatement of Fletes and the dismantling of the regional structure.

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