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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Costa Rica has historically been a country deeply
rooted in democratic traditions. However, the last decade has seen increasing
expressions of social discontent with protests against privatization and the
two-party system.
Demography: Costa Rica has a land area of
51,100 km2, and in 2000, an estimated population of 3,824,593. Of
this number, 51.9% lived in urban areas and 50.1% were males. The population
density was 74 per km2, and the annual growth rate fell from 3.2%
in 1994 to 2.6% in 1999. Life expectancy at birth in 1999 was 76.9 years (74.2
for men and 79.2 for women). The largest single group are those 15-64 years
old (65%). The mortality rate is declining, particularly in the 0-4 years age
group, with a rate of 4.3 per 1,000 population in 1999. The general fertility
rate was 2.7 per 1,000 in 1999. The crude birth rate was 20.5 in 2000.
Economy: In both 1998 and 1999, the GDP rose
by 8%, but in 2000 it increased by only 1.5%. Real salaries in the formal sector
remained constant, and per capita income fell. Unemployment increased slightly,
from 5.7% in 1997 to 6% in 1999. Inflation remains around 10%. The central government's
investments declined by 20% in real terms, while the national debt rose to 23%
of GDP. Social aspects: One-fifth of all Costa Ricans were still living in poverty
in the 1990s. In 1999, the proportion of people living in extreme poverty was
6.7%, up from 5.7% in 1997. In urban areas, extreme poverty increased from 3.2%
in 1997 to 4.5 % in 1999, while in rural areas, it rose from 7.6% to 8.5% during
the same period. The literacy rate was 95.3% in 1999.
Mortality: The
general mortality rate for 1995-1999 was 3.9 per 1,000 population (4.4 per 1,000
males and 3.4 per 1,000 females). Of the 15,052 deaths registered in 1999, 58.1%
were in the population aged 65 or older, and 57.8% were in males. Signs, symptoms,
and ill-defined conditions accounted for 1% of all deaths; 83.4% of deaths were
certified by physicians. Diseases of the circulatory system, which took 4,578
lives (130 per 100,000 population), were the leading cause of death in 1999,
followed by neoplasms (3,129 deaths or 90 per 100,000 population) and external
causes (1,798 deaths or 50 per 100,000 population). Infant mortality has fallen
to 10.2 per 1,000 live births in 2000. Neonatal mortality in 1999 was 8.1 per
1,000 live births, and postneonatal mortality, 3.7 per 1,000 live births. Maternal
mortality was 19.0 per 100,000 live births in 1999.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years):In
1998, the population of children under 5 years of age was 10.7% of the total.
Children aged 1-4 years accounted for 10% of consultations and 5% of discharges;
the most frequent diagnoses were intestinal infection, asthma, and bronchopneumonia.
In 1998, the mortality rate was 5.2 per 10,000. Accidents and violence were
the leading cause of death (1.3 per 10,000), followed by congenital anomalies
(1 per 10,000) and diseases of the nervous system.
Schoolchildren (5-9 years) and adolescents
(10-14 and 15-19 years): In 1998, children
aged 5-9 years represented 11.7% of the total population; those 10-14 years,
10.9%; and youths 15-19 years, 9.8%. Children aged 5-9 years had the lowest
mortality rate of the three groups (2.3 per 10,000), followed by those 10-14
years old (2.9 per 10,000), and the highest rate was in the group aged 15-19
years (5.9 per 10,000 population). The leading causes of death were external
causes, followed by neoplasms and diseases of the nervous system.
Adults (20-59 years): In
1998, the population aged 20-59 years was estimated at 50.3% of the country's
total. The mortality rate was 9.3 per 10,000 for 20-24-year-olds and 64 per
10,000 for the group aged 55-59. Adults aged 20-44 years benefited from 36.8%
of emergency services provided, 40% of consultations, and 50% of hospital services.
The most frequent reasons for attention of males in all these services were
injuries and among females, reproduction-related conditions. Adults aged 45-59
years accounted for 9.8% of emergency services, 14 % of consultations, and 8.5%
of hospitalizations. Of women living in stable unions, 96% indicated that they
had used contraception at some time, and the most popular methods were the pill
and the condom. In 1999, more than 90% of all deliveries were attended in public
hospital centers.
The Elderly (60 years and older):In
1998, the population aged 60 years and older was estimated at 271,586 (46.8
% men). This age group represented 7.2% of the total population and was the
most rapidly growing population segment. The mortality rate in 1998 was 34.9
deaths per 100,000 population. For both sexes, the leading cause of death was
cardiovascular diseases, followed by neoplasms and diseases of the respiratory
system.
Workers' health:In
1999, Costa Rica had and economically active population of 1,383,452 , where
males comprised 66.9%, distributed fairly equally between urban and rural areas.
The disabled In 1998, it was estimated that 9.3% of the population was disabled.
Only 29.7% of the 311,359 persons who suffered from some form of disability
were treated in health establishments of the CCSS.
Indigenous groups: Costa
Rica's eight indigenous peoples - the Bruncas, Cabecars, Teribes, Bribris, Huetars,
Malekus, Chorotegas, and Guayamis - number approximately 240,000 and represent
1% of the total national population.
Analysis by type of health problem
Vector-borne diseases:
A total of 6,041 cases of dengue were reported in 1999, and there were 4,889
in 2000, representing an incidence of 434.7 per 100,000. Fifty percent of the
cases occurred in the Pacific Central region in 1999-2000, and 46.2% in the
Huetar Atlántica and Chorotega regions. One case of hemorrhagic dengue was reported
in 1995, another in 1996, and 8 in 1997; then, in 1999, the number soared to
a high of 117 (88.9% in the Huetar Atlantica Region), but by 2000 it was back
down to 5. Six deaths from hemorrhagic dengue were reported during 1996-2000.
In 2000, a total of 1,879 cases were reported (API: 1.38 per 1,000), representing
a reduction of 53.0% relative to the 3.998 cases in 1999. The Huetar Norte and
Huetar Atlantica regions accounted for 67.5% of all cases in 2000. Leptospirosis
rose from 6 reported cases in 1992 to 192 in 2000, after having peaked at 283
in 1999.
Diseases preventable by immunization: Immunization
coverage against measles, mumps, and rubella (MMR vaccine) increased from 82.1%
to 99.9% between 1996 and 2000. The incidence of measles declined: 24 cases
were reported in 1996, 23 in 1999 (4 laboratory confirmed and 19 clinically
diagnosed), and none in 2000. Over that period, a total of 1,387 rubella cases
were reported, 82.9% of them in 1999. The disease has been shifting towards
the 15-44 years age group. The last case of poliomyelitis in the country was
recorded in 1973. Vaccination coverage against diphtheria, pertussis, and tetanus
with 3 doses of DPT vaccine increased from 85% in 1996 to 94% in 2000. During
the same period, the annual average of non-neonatal tetanus was 2 cases (ranging
from 1 to 3). The vaccine against diseases caused by Haemophilus influenzae
(Hib) was introduced in 1998. During the prevaccination period (1994-1997),
there had been annual average of 16 cases of meningitis caused by Hib, whereas
in 2000, when vaccination coverage reached 93.3%, there were only 2 cases.
Intestinal infectious diseases: The
rates for acute diarrheal diseases rose from 2,903 per 100,000 population in
1996 to 3,633 per 100,000 in 1999. In 1999, the mortality rate was 2.8 per 100,000
population.
Chronic communicable diseases: The
incidence of all forms of tuberculosis increased by a factor of 2.2 between
1990 and 1999, from 9.3 to 21.0 per 100,000 population. Tuberculosis is the
second leading cause of death among the infectious diseases, after AIDS, and
in 1999, the death rate was 2.3 per 100,000 population. In 1999, there were
157 registered cases of leprosy and 12 new cases were reported. Acute Respiratory
Infections The 762,912 episodes recorded in 2000 represented an increase of
93.2% compared with the figure of 394,790 in 1996. In 2000, there were 36 deaths
from this cause in children under 5 years (8.7 per 100,000).
Zoonoses: No
cases of human rabies have been reported since 1970. HIV/AIDS Between the start
of the epidemic and November 2000, a total of 2,003 cases of AIDS had been registered
in Costa Rica . From 79 cases of AIDS reported in 1990, the figure rose to 214
in 1995 and then declined slightly to 181 in 1999. Men accounted for 90.5% of
all cases in this period. Sexual transmission accounted for 61% of the cumulative
cases for which the mode of transmission was known. In another 1.5% of cases,
the virus was transmitted perinatally. In April 1998, a general law on HIV/AIDS
and its enabling regulations were enacted. Since then, treatment has been given
to all patients who have needed it.
Nutritional and metabolic diseases: In 1996,
the proportion of preschool children suffering from some degree of undernutrition
was 5.1%, a considerable reduction from 8.6% in 1980. The prevalence of vitamin
A deficiency that year in the preschool population was 8.7%. In 1998, the prevalence
of non-insulin-dependent diabetes mellitus was 2.2% for males and 3.4% for females,
while the prevalence for persons over 40 years old was 9.4% (7.6% for men and
11.0% for women). In 1999, mortality from this cause in the group over 40 years
of age was 26.7 per 100,000 population. Diseases of the Circulatory System Cardiovascular
diseases have been the leading cause of death since 1971. In 1999, 47% of all
deaths from circulatory diseases were caused by ischemic coronary disease and
19% by cerebrovascular disease.
Malignant neoplasms: Malignant neoplasms are
the second leading cause of death after cardiovascular diseases. In 2000, there
were 3,010 deaths from this cause, representing 20.3% of the national total.
In 2000 however, the crude death rate was down slightly, to 76.4 per 100,000
(81.2 in males and 71.5 in females).
Accidents and violence: External causes accounted
for 11.6% of all deaths in 1998 (45.4 per 100,000 population). The highest rate
was in the over-60 group (143.9 per 100,000), followed by the population aged
20-29 (58.5 per 100,000).
RESPONSE OF THE HEALTH SYSTEM National Health Policies and Plans: The
country relies on a National Health Policy 1998-2002, based on guidelines set
forth in the National Plan for Human Development. It is based on health needs
and is consistent with the General Law on Health and the sectoral reform process.
Health policies cover a wide spectrum related with integral health and establish
principles for intersectoral action and social production in health. There also
exists the National Health Plan 1999-2004. Both instruments are oriented to
ensure continuity in the processes of sector reform formally initiated in 1994,
as well as sectoral stewardship in the short and medium terms.
Health sector reform strategies and programs:
Reform of the health sector began in the 1990s,
and in 1994, the process was institutionalized on the basis of a formal proposal
that specified four components: Ministry of Health leadership, restructuring
of the care model, modification of the resource allocation system, and strengthening
of the CCSS. Sectoral reform is already bringing about major changes in the
public health system. Its main objectives have been to maintain universal health
insurance coverage, create greater equity in access to services, guarantee the
quality of care, and improve the efficiency of resource utilization. As a first
step within the framework of the reform, the Ministry of Health completed the
revision of its functions and implemented its structural reorganization. In
the second stage, it adjusted its resources and adapted its processes. These
changes led to the transfer of 1,700 of its staff to the CCSS and the health
care programs. The emphasis has been on institutional development, in connection
with which the various organization manuals have been rewritten and functions
have been deconcentrated to the regional and local levels. As part of the reform
process, an integrated care model has been proposed that incorporated prevention
and health promotion activities, increased social participation, and a primary
care strategy with integrated basic health care teams (EBAIS). With regard to
new modalities for the allocation of resources, starting in 1998 funds have
been transferred to CCSS health areas and establishments under "managerial commitments".
The health system: The
national health system comprises the Ministry of Health, which provides leadership
for the sector; the CCSS, which delivers care in the event of disease and maternity;
the National Insurance Institute (INS), which offers protection against work-related
and transportation accidents; and the Costa Rican Institute of Water and Sewerage
Systems (AyA), which regulates the supply of water for human consumption and
the management of wastewater. The public institutions receive a budgetary allocation
from the State treasury, and the CCSS is funded with contributions from employers,
workers and the State. In 1999, 11 % of the population had no health insurance.
Organization of regulatory actions -
Health care delivery: The
Ministry of Health is comprised of three subsystems covering health services,
health supplies and the environment. Under the Ministry of Health, there is
a national program for the qualification and accreditation of public and private
health services. In the area of pharmaceutical regulation, the Ministry of Health
maintains a list of proprietary and generic as well as over-the-counter drugs.
Per capita expenditure on drugs was US$ 15.6 and the proportion of public health
spending that went for drugs was 7.7%.
Environmental quality:There
continued to be problems related to water pollution, solid waste management,
air pollution in some urban areas, soil erosion due to inappropriate use of
the land, and deterioration of the forest reserve. Industrial pollution from
the processing of coffee, which in the early 1990s amounted to 21% of all pollution,
was down to 5% in 1998. Air pollution in the San José metropolitan area has
declined since 1995. It is estimated that 75% of all air pollution comes from
the transportation sector. Costa Rica ranks among the top users of pesticides
in the Americas . Organization of Public health care services -
Health promotion: Since
1995, the Ministry of Health has had a National program for Health Promotion
and Protection, which encourages social participation and ties this in with
education and mass communication. Programs have been carried out in connection
with the creation of "healthy spaces". The elderly have received greater attention
since 1998, after creation of the National Council on Older Adults.
Disaster preparedness: The
country is highly vulnerable to earthquakes and floods.
Vaccination program: The
Expanded Program on Immunization (EPI) is executed by the CCSS, while epidemiological
surveillance and case finding are the responsibility of the Ministry of Health,
with participation by the CCSS through interinstitutional boards. In 2000, the
Ministry of Health created the Bureau of Epidemiology, while the CCSS inaugurated
its Epidemiological Surveillance Unit. Also, interinstitutional surveillance
committees were established to improve coordination between the Ministry of
Health, the CCSS, the AyA, and municipal governments. The Ministry of Health
is responsible for vector surveillance and control. The Public Health Laboratory
Network comprises 85 CCSS and private laboratories, a national reference center,
and the Costa Rican Institute for Research and Education in Nutrition and Health
(INCIENSA).
Potable water, excreta disposal, and sewerage
services:Water supply service attained coverage
of 97.5% in 1999. Coverage with sanitary sewerage and in situ excreta disposal
reached 96.1% of the population. However, sewage disposal via sanitary sewerage
lines was 26%, and only 4% of the sewage received sanitary treatment.
Solid waste services:Forty-seven
percent of municipalities disposed of their refuse in sanitary landfills, and
the remaining 53% used open dumps.
Food aid programs: National
food aid programs are directed toward mothers and children at risk. Organization
of individual health care services: Outpatient, emergency and inpatient services:
At the end of 2000, the CCSS had 670 EBAIS supported by teams from the 83 health
areas. The secondary level of care is made up of 10 clinics, 13 peripheral hospitals,
and 7 regional hospitals. At the tertiary level, there are six specialized hospitals
and three general hospitals that serve the entire country and offer highly specialized
care.
Auxiliary Diagnostic Services and Blood Banks:
The health services are supported by a network
of laboratories, some of which use very advanced technology. INCIENSA acts as
a reference center. There is a network of 25 public and 3 private blood banks.
Specialized services: The
CCSS has the following specialized services: the National Psychiatric Hospital
, the Dr. Roberto Chacón Paut Hospital for psychiatric care, the Blanco Cervantes
National Hospital for geriatric care, and the National Women's Hospital. For
rehabilitative care, there is a national network of CCSS services.
Health supplies: The
Ministry of Health has a bureau of Registration and Control, which is responsible
for regulating drugs, food, and other products for human use. The public sector
has 1.6 hospital beds per 10,000 population. The CCSS sets aside 4.4% of its
operating budget for maintenance, and 55% of its personnel in this area are
technically trained.
Human resources: The
number of personnel in almost all categories has increased, but CCSS shows that
the proportion of physicians fell from 85% in 1990 to 51.9% in 1999. With no
policy regulating the formation and training of human resources in the health
sector. The proportion of private sector workers in the health labor market
has grown from 9.9% in 1990 to 24% in 1999.
Health research and technology:
In Costa Rica , the Ministry of Health is responsible for guiding health research,
which is primarily carried out at the Health Research Institute and the Clodomiro
Picado Institute, which is part of the University of Costa Rica .
Health sector expenditure and financing:
The country's expenditure on health as a percentage of GDP declined from 7.6%
in 1996 to 5.7% in 2000. In 1999, the CCSS contributed 95.5% of the health sector's
income, while the remaining 4.5% came from other institutions.
External technical cooperation and financing: Technical
cooperation for Costa Rica fell 17.6% between 1990 and 1999, while nonreimbursable
technical cooperation dropped 12.6 % in the same period. The United Nations
system, USAID, and cooperation from Sweden funded most of the technical cooperation
projects at the beginning of the decade. Support from the IDB accounted for
35.7% of all cooperation during 1990-1999, and in 1999, it accounted for 52.4%.
