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close this bookThe Nutrition and Health Transition of Democratic Costa Rica (INFDC, 1995, 228 p.)
View the document(introduction...)
View the documentContributors to this volume
View the documentIntroduction
close this folder1. Health policies and strategies
View the document(introduction...)
View the documentA brief description of Costa Rica
View the documentPublic health development
View the documentThe decade of the 1970s
View the documentThe decade of the 1980s
View the documentFinal reflections
View the documentReferences
close this folder2. Development of the social security institute
View the document(introduction...)
View the documentBackground
View the documentSocial security in Costa Rica
View the documentThe extension of direct insurance
View the documentExtension of insurance to the family
View the documentThe financial crisis
View the documentThe constitutional amendment
View the documentToward universalization
View the documentDevelopment of human resources
View the documentThe integration
View the documentThe new health care models
View the documentFinal comments
close this folder3. Development and characteristics of health and nutrition services for urban and rural communities of Costa Rica
View the document(introduction...)
View the documentIntroduction
View the documentBackground information on community outreach programs
View the documentMethodological characteristics of the Costa Rican health programs
View the documentNutrition programs
View the documentImpact of the programs on the health of children living in rural areas
View the documentConclusions
View the documentReferences
View the documentBibliography
close this folder4. Evolution of an epidemiological profile
View the document(introduction...)
View the documentIntroduction
View the documentStages of a process
View the documentThe first four decades of the century
View the documentThe period between 1940 and 1970
View the documentThe decade of the 1970s
View the documentThe decade of the 1980s
View the documentThe last decade of the century
View the documentFinal comments
View the documentReferences
close this folder5. Socioeconomic factors for the understanding of health policy during the 1970s
View the document(introduction...)
View the documentIntroduction
View the documentRecognition of social demands and the regulation of the conflict during the 1930s and 1940s
View the documentThe social government in the new development strategy of Costa Rica during the 1950s and 1960s
View the documentThe consolidated social government
View the documentFinal reflections
View the documentAcknowledgement
View the documentReferences
close this folder6. Problems and challenges of the health sector during the 1980s
View the document(introduction...)
View the documentIntroduction
View the documentSome problems of the health sector in the 1980s
View the documentBalance of the 1980s and perspectives for the 1990s in the health sector
View the documentReferences
View the documentAppendix 1 - Glossary
close this folderAppendix 2 - Supplementary reading list
View the document(introduction...)
View the documentEnglish-language supplementary reading list
View the documentSpanish-language supplementary reading list
View the documentSupplementary reading list - INCAP publications
close this folderAppendix 3 - Health conditions in Costa Rica 1994
View the documentGeneral information
View the documentSpecific health problems


Most countries in the world have set themselves the goal of expanding health services to all their people. However, few have achieved this goal or shown any substantial progress. There is no question that Costa Rica belongs to these few privileged countries. In the early half of the 1970s, Costa Rica had developed health services in the cities, but did not have any in the rural areas. At that time, not even 20% of the rural population had access to minimal health services. By the end of that decade, however, health services covered more than 90% of the country's population, and all health indicators improved significantly nationwide.

During this period, approximately 400 health posts were established in rural zones. In the urban areas, health centers oriented their activities toward the identification of priority and high-risk areas - called Community Health Areas - thus merging the extramural and intramural work of auxiliary health staff. Additionally, more than 500 urban and rural nutrition centers were built. All these facilities serve to implement a health and nutrition program covering dispersed population groups in the rural areas, as well as deprived urban groups. They also manage a community-based environmental program, run by auxiliary personnel, which uses socially acceptable, low-cost technologies.

This chapter analyzes the main methodological characteristics, strategies, and results of the following health and nutrition programs, all of which were begun or were strengthened in the first half of the 1970s:

· The Rural Health Program (for rural communities);

· The Community Health Program for underprivileged urban population groups;

· Two Rural Health Programs implemented in specific geographic areas: the Hospital Without Walls program of San Ramnd the Rural Health Program of San Antonio de Nicoya;

· The nutrition program targeting children under six years of age, school children, and pregnant and breast-feeding mothers.

These programs, each one with methodological and financial differences, are the foundations of primary health care in Costa Rica. The staff of the Costa Rican Ministry of Health has coordinated and implemented all of them, with the exception of the one in San Antonio de Nicoya. The structuring of the Rural Health Program was started in 1972, and that of the Community Health Program in 1974. The nutrition program had its inception in the 1950s and was strengthened in 1975, when it started to receive substantial national and international financial resources.

All the programs are in agreement with the 1974-1980 Costa Rican National Health Plan, which defined the following key concepts in health (Ministerio de Salud, 1973a):

· The right of the population to health care and the obligation of the government to organize and provide health services.

· Holistic health care, taking into account health promotion and prevention, as well as the cure of disease and rehabilitation.

· Regionalization and decentralization of health services.

· Expansion of health services to all the population.

· Outpatient care as a priority.

· Promotion of educational and training activities in the area of health.

· Compatibility of health expenditures with the country's economic capabilities.

Parallel to the Community Outreach Program, encompassing health and nutrition in rural and underprivileged urban populations, a more complex process started to develop within the health services. As of 1974, and during the following three years, all hospitals managed by the Ministry of Health and the Costa Rican Banana Company were transferred to the Costa Rican Social Security Institute (CCSS). In this manner, 25 hospitals, ranging from highly sophisticated to small rural hospitals, were transferred to the CCSS. During the 1970s, social security coverage increased to 80%. Thus, low-income population groups stopped receiving charity health care and obtained the right to health care on the basis of social security.