Good health care is accessible and affordable in Managua. I don't know about the rest of the country because I have had no experiences elsewhere. Getting a recommendation from someone who has lived in Nicaragua a while is a good start. There are excellent specialists here in optometry, dental, osteo, cardio, immuno, pediatrics, etc. However, I think that just as in a city in the States, you may have to conduct a wider search to find a "less usual" specialist if you need one. Diagnostic equipment and labs are also very good for many health care needs. Moreover, you can usually get an appointment to see a specialist within 24 hours and once you arrive. My experience has been that the doctors here are extremely professional, courteous, and treat their patients with respect.