May 29, 2024

Towards a more equitable, gender-focused and community-led primary health care in Costa Rica

Costa Rica is an upper middle-income country with notable progress in human development largely attributable to its successful establishment of universal health care, education and social protection programmes. Nevertheless, the country faces a series of challenges, including elevated degrees of inequality, intensified and escalated by the socioeconomic impact of the COVID-19 pandemic.

During the COVID-19 pandemic, PAHO/WHO supported the Government of Costa Rica in implementing a community participation and intersectoral action approach to boost Primary Health Care (PHC) whereby communities identified areas for action. The approach was successful and is being extended, in tandem with development partners, to further accelerate progress towards health-related SDGs in the country. The Global Action Plan for Healthy Lives and wellbeing (SDG3 GAP) is being used as a platform to facilitate inter-agency exchange of expertise and information leading to an overall increased impact of support to the country.

Building on existing collaborations to maximise impact

Led by local government, intersectoral committees were established to identify and prioritize social determinants of health that are affecting the community, several of which were enhanced by the pandemic. Intersectoral action plans are being developed and implemented to address those challenges using a PHC-led approach. One central focus of the initiative has been ensuring the integration of health care services, which are mainly delivered by the Costa Rican Social Security Fund and the Ministry of Health.

With the help of catalytic funds provided through SDG3 GAP, workshops were held to train community leaders on community mental health, GBV and self-care for non-communicable diseases (NDCs). The GBV element of the project was developed in the context of previous collaboration with UNFPA and the UN Interagency Group on Gender, which is housed under the Costa Rican UN Resident Coordinator Office and includes UNICEF, UNFPA and UNDP.

Consequently, around 150 new community leaders from areas prioritized by the Ministry of Health were trained to identify and address GBV and mental health issues, which add to those trained in previous iterations of the initiative. The initiative provided community leaders with the necessary tools to disseminate information and collaboratively create action plans with and for the communities. The project works closely with the Ministry of Heath to ensure alignment with national strategies and plans.

“I take away lots of information on domestic and gender-based violence. That within each there can be a solution, support, to raise one’s voice, to not remain silent and to say ‘no more domestic violence and gender violence,'” (1) says Kristel, Bahía Ballena, one of the trained community leaders.

Empowered women participants engage in the Mental Health Workshop held on August 18, 2023, in Altamira de Biolley, Buenos Aires, Costa Rica
Empowered women participants engage in the Mental Health Workshop held on August 18, 2023, in Altamira de Biolley, Buenos Aires, Costa Rica. Photo credit:  Mercedes Alvarez Rudin

Several communities were chosen to create support networks to prevent GBV. This helped the Ministry of Health and the Costa Rican Social Security Fund to further connect with local communities, thus increasing the capacity to respond and adapt to the needs of the community.

Another round of catalytic funding was released by SDG3 GAP signatory agencies in early 2023 to further strengthen collaboration among stakeholders and establish additional inter-sectoral committees and train more community leaders on mental health and GBV issues. This resulted in an overall strengthened capacity to respond to the needs of the local communities in combating mental health and GBV issues. One of the key components of this project is the incorporation of a Trainer of Trainer model, which allows the community leaders to continue the training independently to ensure sustainability.

Empowered women participants engage in the Mental Health Workshop held on August 18, 2023, in Altamira de Biolley, Buenos Aires, Costa Rica

Empowered indigenous women participants engaged in a Mental Health Workshop held on August 4th, 2023, in the indigenous territory of La Casona in Coto Brus, Costa Rica. Photo credit:  Mercedes Alvarez Rudin

Creation of synergies and efficiency gains through the Inter-agency Group on Gender

To sensitize more people on GBV, the UN Resident Coordinator’s office is supporting inter-agency collaboration through the Inter-agency Group on Gender.  The Pan American Health Organization (PAHO)/WHO has joined forces with Mujeres Unidas en Salud y Desarrollo (MUSADE, a local community organization), UNDP and the UN Human Rights Office to produce awareness campaigns against GBV, including a series of podcasts which were released in the UN 16 Days of Activism against Gender-Based Violence in 2022 which called out to: ‘Unite to end violence against girls, adolescent girls and adult women’.

In 2023, along with MUSADE and UNDP another radio series regarding myths and stereotypes of hegemonic masculinities and the role of men in putting an end to violence against women and femicide was released.

Family violence accounted for 10% of all emergency calls during 2022 in Costa Rica. It climbed to the third position, after occupying the fourth in previous years. There were 123,167 reported incidents of family violence in 2022, on average 10,264 per month equating to nearly 15 calls per hour. Partners or ex-partners and the immediate family are the main source of aggression in the country’s households[1]. According to national data available in Infosegura, by 2021 women were the main victims of domestic violence: 8 out of 10 victims are women and 4 out of 5 aggressors are men (source:, State of the Nation Report 2023).

The radio programs developed are considered an effective means of communication with free access in households where domestic and gender-based violence is most prevalent. The communication campaign has facilitated access to information for families, as well as sensitized men to the need to redefine their masculinity in society.

UN Resident Coordinator in Costa Rica states “Certainly, this significant campaign not only conveyed a powerful message to a broad audience to prevent violence against women but also serves as a clear model of how collaboration in working groups, such as the Gender group, can optimize efficiency in resource utilization and strengthen action to advance the 2030 Agenda and human rights in Costa Rica.”

What is the SDG3 GAP?

The Global Action Plan for Healthy Lives and Wellbeing for All (SDG3 GAP) is a set of commitments by 13 agencies that play significant roles in health, development and humanitarian responses to help countries accelerate progress on the health-related SDG targets.  The added value of the SDG3 GAP lies in strengthening collaboration across the agencies to take joint action and provide more coordinated support aligned to country owned and led national plans and strategies.

(1) “Me llevo mucha información sobre la violencia intrafamiliar y de género. Que en cada una puede haber solución, de ayuda, de levantar la voz y no quedarse callada y decir no más violencia intrafamiliar y violencia de género”

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