Healthcare is one of the most important social services that a country provides for its citizens. Healthcare systems in middle-income countries can be planned in ways that allow for successful improvements to be made, including an increase in the quality and accessibility of healthcare. Costa Rica, a middle income country, has created a highly successful healthcare system, which can act as a model for similar countries – such as Brazil – which can implement these same changes to potentially reach high quality healthcare.
Brazil is one of the largest countries in Latin America, and has been characterized as a developing country with a high poverty rate of 13% in 2020. In 1994, Brazil began implementing the Programa Saúde da Família (PSF) (“Family Health Program.”) The program aims to provide primary health care to villages with small groups of community health agents. The program has shown some promising success since its implementation in 1994; however, there have been various issues relating to health disparities that have hindered its progress and the path toward sustainable development. Most notably, the PSF has not been implemented on a national scale. Majority of the PSF teams have been working in the North and Northeast regions of Brazil, and even within these regions, the healthcare is not fully accessible to all municipalities. There has been much research done on the PSF model that shows proper coverage leads to improvements in determinants in child health especially, as well as decreasing financial barriers. Unfortunately, investment in primary care and PSF has been relatively small compared to other countries such as Costa Rica. One of the issues that creates health disparities for Brazilians is the presence of private health care. As a result of PSF not being implemented on a national level, many citizens have to rely on private health care. Not only are many citizens having to pay for their healthcare, there have also been instances of potentially avoidable deaths in government-contracted private hospitals in large urban areas which were found to have lower quality care.
To understand how Brazil’s disparities in primary health care undermines the transformative ability of sustainable development, Costa Rica provides an interesting example of how developing countries can implement successful healthcare models. As of 2022, Costa Rica has a life expectancy of 80.75 years, almost four years older than the United States. Although Costa Rica is a developing country, proper primary health care has been implemented successfully and has resulted in prospering sustainable development. Costa Rica has been able to overcome healthcare disparities by investing in a primary healthcare system with their Equipo Básico de Atención Integral de Salud (EBAIS or basic integrated health care team) model that was launched in 1995. Costa Rica has divided the entire country into 7 health regions, each health region has 104 health areas, and within each health area there are 10 EBAIS teams . Each team is made up of a physician, a nurse, a technical assistant (similar to a community health worker), a medical clerk, and a pharmacist. Members of the community are able to make appointments, many seeing healthcare professionals the same day they make appointments, and the technical assistants carry out scheduled home visits. There are many factors that demonstrate the success of primary health care in Costa Rica, including death from communicable disease dropping from 65 individuals per 100,000 to 4.2 per 100,000 from 1990 to 2010, infant mortality rate dropping 8%, with Costa Rica in addition spending less on healthcare than the global average.
It is clear that Costa Rica’s commitment to improving primary health care has allowed the countries’ citizens to have access to their right to healthcare and has helped improve the country’s health and wellbeing. Compared to Costa Rica, Brazil demonstrates the issues that arise when primary healthcare is not structured in the most beneficial ways. Costa Rica provides a helpful structure that other middle-income countries like Brazil can look to adopt in the future.
Edited by Liz Bredt
Olivia is in her fourth year at McGill University. Since transferring from the B.Ed. kindergarten and elementary program she is currently majoring in International Development studies with a minor in Education. As a staff writer she publishes articles on issues relating to international development, with a particular interest in human rights, climate change, and health care.