Current Market Trends
Procurement & Tenders
Population: 6 Million
GDP: 13.4 billion
After decades of inadequate medical facilities and expertise, Nicaragua has begun significant investments to improve and modernize the country’s health care sector. As a result of several new and renovated hospitals, specialized centers, a growing focus on oncology care, and additional investments by the public sector and multilateral donors, there are multiple large-contract opportunities for U.S. companies. Specialized and diagnostic equipment, pharmaceutical products, and hospital equipment all have growth potential in the country.
The use of agents and local distributors is the most common way to export U.S. medical equipment, products, and services. Face-to-face meetings are generally required to establish business relationships, and U.S. companies should visit potential partners or agents prior to entering into a relationship.
A local lawyer should be consulted to determine the pros and cons of various types of agency or representation agreements. U.S. firms should check the bona fides of potential partners before establishing a formal business relationship, and extra due diligence should be applied before entering into any contractual or partnership arrangement.
Nicaragua offers universal healthcare for its citizens through a network of public hospitals and decentralized clinics. Services offered through the public network are limited, however, and a parallel network of private institutions supplements the country’s public sector. Some private clinics, particularly in large urban areas such as Managua, provide care at U.S. standards. In response to a growing clientele of tourists, retirees, and Nicaraguans seeking health services to supplement those provided by the government, these facilities are expanding diagnostic and treatment capabilities.
The Government of Nicaragua is increasing investments in the healthcare sector significantly. The World Bank is funding a $60 million project to strengthen the public health sector performance by 2020. Additional funds are focusing on improving the country’s emergency response and ambulance services and increasing the number of hospitals in the country. A $50 million project funded by the Inter-American Development Bank and South Korea aims to expand Nicaragua’s broadband network and connect 276 health centers throughout the country and augment information technology capabilities of the Ministry of Health by 2021. The Government of Nicaragua has also prioritized improving the country’s limited oncology services and is planning to develop new radiology and diagnostic centers in the next 3-5 years. These larger investments are generally bid out as turnkey projects, and therefore often require construction and health service providers to collaborate.
Nicaragua has a very limited domestic healthcare manufacturing sector, and nearly all pharmaceuticals and medical equipment are imported. Low-cost Asian manufacturers are major competitors in the market, but there is a growing demand for higher quality products with more reliable after sale service.
Demand for preventative care, oncology services, diagnostic equipment, information technology systems, training and human resource management, and project management are all growing with the country’s developing infrastructure. Estimates suggest that the healthcare sector in Nicaragua will continue to grow in line with the country’s economy at around 5-10% annually.
The Ministry of Health, Pharmaceutical Office, issues import permits for medicines, cosmetics and hygiene products. Importers must present documentation demonstrating safety and effectiveness and pay fees to obtain a sanitary registration, as well as fees for laboratory analysis.
The Ministry of Health also requires that pharmaceutical products be packaged and labeled in Spanish for retail distribution and that their dosages be clearly indicated.
For companies interested in participating in government tenders, sample products must be submitted with the required labels in Spanish. To determine fee amounts and other registration processes, please contact the Ministry of Health.
Nicaragua does not have a traditional health insurance market, and there is no reimbursement process. Some private clinics and hospitals offer two-tiered pricing and discounts based on an annual premium that functions in some ways like insurance. However, nearly all services are provided on a cost basis at the time of service.
The U.S. Embassy receives numerous reports from U.S. businesses that the Nicaraguan Customs Authority regularly subjects shipments of commercial goods to bureaucratic delays and arbitrary valuation. Importers and exporters report that customs officials regularly assess exorbitant fines for minor administrative discrepancies. In some cases, shipments are held for weeks or months with no justification provided by customs agents. Other issues include arbitrary denials of import permits for products with no justification. The U.S. Embassy rarely has success obtaining information from the Nicaraguan Customs Authority concerning these cases.
The Government Procurement Chapter of the United States-Central America-Dominican Republic Free Trade Agreement (CAFTA-DR) requires that Nicaragua apply fair and transparent procurement procedures and rules and prohibits the Nicaraguan government and its procuring entities from discriminating in purchasing practices against goods, services, and suppliers from the United States.
CAFTA-DR applies to most central government entities for goods and services valued above $58,550, and construction services valued at $6,725,000 or more. The threshold for municipalities and other decentralized government entities is $477,000 for goods and services, and $6,725,000 for construction services. Purchases wholly or partially financed by foreign governments or international organizations are conducted according to the procedures of the donor organization.
The Government Procurement Law (amended 2010/737) and the Municipal Procurement Law (2007/622) provide detailed procurement procedures, including rules for open bidding, qualified bidding, limited tendering, and purchase by quotation. The Ministry of Finance Procurement Office operates an electronic portal for central government and municipality procurement, NICARAGUACOMPRA.
The Government Procurement Law establishes safeguards to encourage open competition among suppliers bidding on government contracts. It states that in order for the Nicaraguan government to purchase goods and services, it must allow suppliers to compete under equal conditions. All government purchases must be planned and approved by procurement committees within each public entity.
The law allows foreign contractors to bid on projects on equal terms with locally registered companies. While foreign companies need not register locally in order to take part in the bidding process, they must present documentation from their home countries in order to prove that they are qualified bidders. If a foreign company wins a bid, it will need to register with the Nicaraguan government.
Healthcare spending (including investment)
... as percent of GDP
Hospitals, Procedures, Healthcare Professionals UN:
Number of hospitals
Number of hospital beds
... available beds per capita
8 per 10,000
0.91 per 1,000
Life expectancy men/women
73.2 years (overall)
71.1 years (men)
75.5 years (women)
19 deaths/1,000 live births
Percent of population older than 65
5.1 deaths/1,000 population
U.S. Commercial Service Contact Information
Name: Lilliam Baez
Position: Commercial Specialist
Phone: +505 2252-7100 ext. 7371
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