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Silvana Alaniz, a participant in the 5th cohort of the CAHI Fellows Program, is a business administrator and entrepreneur with extensive experience in finance. Her skill for innovation led her to becoming responsible for developing new projects at the Hospital Metropolitano Vivian Pellas in Nicaragua. One of those projects was developed during her time as a CAHI Fellow, as described below.


After four years working in the health sector, Silvana started the CAHI Fellows Program in 2018, with the commitment to improve healthcare in her home country, Nicaragua. She proposed and developed a project for a prepaid health program called “MediMas,” creating a way for people and families without other access to healthcare services to access medical services at an affordable cost. 

“I realized that in Nicaragua there are many opportunities, and those opportunities are not only about setting up a new company, but can be generating new entrepreneurship within an organization, just as I did in the Hospital.”

The project Silvana developed marks a milestone in the country: the creation of a private network of primary healthcare clinics. Silvana says that it has not been easy to make this project work. They have tried several times and on at least two previous occasions they have been forced to close or take a break because it became financially unsustainable.

“We had to close the clinic repeatedly throughout a period of four years, but the idea persisted. We were sure that by creating primary care clinics with accessible prices and proactively attending to the main causes of early death in the country, such as diabetes and heart problems, would benefit a majority of the population. Many times I thought it would be impossible. ”

The project provides a relevant and necessary option for the country's population. In Nicaragua, more than 80% of the population is not covered by public or private health insurance. This translates into at least 5 million people who do not have access to any medical care. Quality is another important aspect, because even the comparatively small percentage of the population that are able to use the public health system do not receive quality services. 


Through the CAHI Fellows Program, Silvana had the opportunity to carefully analyze the design of the project and make the significant changes and try again, with a greater understanding of the variables. In October 2018, after many analyses and refinements of the project, “MedMas” prepaid healthcare was launched. The program offers individual and family memberships for a fee. Members receive access to very low cost diagnostic services, general consultation and referrals to specialists in cardiology, pediatrics, gynecology, dentistry and general surgery.

In the first 5 months of operation, MediMas attracted 1,500 members. By April 2019, the number grew to more than 2,000 and more than 600 consultations with specialists have been provided, mostly in gynecology and pediatrics. The medical staff identified conditions such as prediabetes in children, and made early diagnoses of gynecological conditions. These are just two examples of the benefits of providing access to affordable preventative primary care. 

Cheif among the factors that contributed to the success of this project was that it was designed during the CAHI Fellows Program and benefitted from high-level professional consultations by INCAE professors. Additionally, Silvana had the constant and dedicated support of the Hospital Metropolitano Vivian Pellas, the most important private hospital in Nicaragua. Lastly, there was a high level of motivation on the part of the participating doctors and specialists to offer services to patients who have never before had access to quality health services. 



Silvana was introduced to the CAHI Fellows Program by her mother, also a health worker and CAHI Fellow who participated in the first cohort of the program. 

Before her acceptance into the CAHI Fellows Program, the Hospital had been trying to implement the Primary Care Clinics project (now known as MediMas) for 4 years without success. However, they did not give up on the idea, because of the great social welfare potential of providing quality medical care at very low costs. This philosophy aligns directly with the philosophy of CAHI.

From the beginning of the program, Silvana was excited for the great opportunity to share ideas with people with different backgrounds, knowledge, and experiences. The network provides opportunities to broaden one’s understanding of the region and generate meaningful learning through multiple, varied interactions.

“When we started working together and sharing our projects, I saw that there were similarities in our visions, that many of my colleagues have impressive experience, such as hospital directors in different countries. I also had the opportunity to learn from people with NGO backgrounds and other entrepreneurs. All of this allowed us to have a more complete vision and understanding of the health sector in Central America.”

She knows that in the CAHI Fellows Network she has a group of colleagues she can count on, and, in fact, they have all helped each other with contributions to the development of their respective projects. 

“CAHI is achieving a lot with its network by promoting change agents and entrepreneurs in the area of ​​health. I feel part of a community, of a movement. The CAHI Fellows program trains us as leaders to transform our reality.” 

By way of example, she had the opportunity to visit a hospital in Panama and obtain first-hand information through its director, Dr. Rafael De Gracia, also a CAHI Fellow; she also collaborated with Dr. Sergio Flores, from Honduras, who has been developing another similar project, creating a network of private medical care at affordable costs in Honduras.

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