The state of health care in Nicaragua can be attributed in part to the interaction between 'revolutionary' and 'counter revolutionary' forces. Since 1979 development of primary health care has been rapid and ambitious. Nicaragua's early successes in the pursuit of 'Health for all by the year 2000' have been widely reported and rightly acclaimed. Since 1983, however, these advances have been difficult to maintain, leading to stasis and deterioration in the health system. The contribution of various factors to the current health status of Nicaragua is examined.