Costa Rica: Adjustment to Population Health Needs

Regardless of the process for priority setting, robust local data are crucial for informing these exercises, and thus capacity for data collection, analysis, and use is necessary. In Costa Rica, community health workers regularly collect local data during routine community visits.1 After data are transferred from community health workers to clerks (Registros de Salud or REDES), they are sent to and analyzed by the Costa Rican social security agency (Caja Costarricense de Seguro Social) and eventually returned to the Health Area Teams (akin to district health management teams) where they are used to set priorities for the coming year.2 For a brief time, these data were also used to negotiate bonus compensation for the health area. However, this was system was antithetical to many values held by providers in Costa Rica and was eventually abolished.2 Regardless, this system of data collection and feedback has established a systematic approach to priority setting and re-evaluation of priorities that is grounded by local data collection and supported by functioning analytic systems and clear communication. 


  1. Macinko J, Harris MJ. Brazil’s family health strategy--delivering community-based primary care in a universal health system. N Engl J Med. 2015 Jun 4;372(23):2177–81. 
  2. Pesec M, Ratcliffe HL, Karlage A, Hirschhorn LR, Gawande A, Bitton A. Primary health care that works: the costa rican experience. Health Aff (Millwood). 2017 Mar 1;36(3):531–8.