ABSTRACT
The most important advantage of a NGO SCION is its capacity to effect institutional innovation. Three forms of this are described in this chapter: strengthening of a health care system, formation of regional sub-networks and the survival of NicaSalud as a SCION. Three different approaches to the strengthening of the health care system are described: providing new skills to personnel, working together on joint projects and upgrading the effectiveness of local NGOs. One of the regional sub-networks, Jinotega, was able to put pressure on the Ministry of Health to changes its policies. The steps taken so that NicaSalud could become a permanent member of the health care system are described.
