During the 2024–2025 biennium, PAHO played a key role in the implementation of the Social Determinants of Health Strategy in Costa Rica through a territorial approach led by the Ministry of Health and the Costa Rican Social Security Fund, with particular emphasis on the Brunca region.
Costa Rica made decisive progress in institutionalizing digital transformation in health, supported by sustained technical cooperation from PAHO. During the biennium, the country designed and implemented a long-term national policy for digital transformation, prioritized at the highest level of the Ministry of Health, which included the establishment of a Directorate for Digital Transformation with dedicated staff and resources. PAHO provided strategic technical assistance in the development of the road map, the regulatory design, and the initial implementation, ensuring alignment with regional standards and institutional sustainability.
Within the framework of the Better Care for NCDs initiative, Costa Rica formally incorporated the HEARTS clinical pathway into the first level of care, as a result of close technical cooperation between PAHO and the Costa Rican Social Security Fund.
With technical support from PAHO, Costa Rica made substantial progress in developing its national agenda toward 2030 for the elimination of communicable diseases and related conditions, within the framework of the PAHO Disease Elimination regional initiative. During the biennium, the country consolidated a national road map aligned with the National Health Policy 2023–2033, enabling the prioritization of diseases based on their epidemiological status, the definition of integrated strategic actions, and the strengthening of governance and surveillance.
In the area of health emergencies, Costa Rica systematically strengthened its preparedness and response capacities for respiratory viruses with technical support from PAHO, within the framework of the global Pandemic Influenza Preparedness framework.
| Outcome Indicator | Baseline/Target | Rating |
|---|---|---|
| 01.a. Number of countries and territories that show a reduction of at least 10% in hospitalization for ambulatory care sensitive conditions | Baseline 2019 | Discrepancy |
| 01.b. Number of countries and territories that have implemented strategies to strengthen the response capacity of the first level of care | Target 2025 | Achieved |
| 02.e. Number of countries and territories with capacity to implement and monitor national policies or strategies to improve the health and development of young children that are informed by the WHO/UNICEF framework Nurturing Care for Early Childhood Development | Baseline 2019 | Achieved |
| 03.a. Number of countries and territories with capacity to prevent care dependence | Baseline 2019 | Achieved |
| 07.a. Number of countries and territories that have reduced the density gap with respect to physicians, nurses, and midwives, achieving at least 25 health workers per 10,000 population in underserved areas, keeping in mind the global target of 44.5 by 2030 | Target 2025 | Achieved |
| 07.b. Number of countries that have an interprofessional health team at the first level of care, consistent with their model of care | Target 2025 | Achieved |
| 08.a. Number of countries that ensure that products listed on the essential medicine list are available without out-of-pocket expenditure at the point of care | Baseline 2019 | Achieved |
| 08.b. Number of countries and territories with regulatory systems that reach level 3 under the WHO Global Benchmarking Tool (GBT) | Target 2025 | Not achieved |
| 08.c. Number of countries that increase the number of units of blood available for transfusion per thousand inhabitants (UBAT) by at least 5% per year to reach the target of 30 UBAT | Target 2025 | Discrepancy |
| 08.d. Number of countries and territories that have regulations and oversight that ensure access to quality and safe radiological services | Target 2025 | Achieved |
| 08.e. Number of countries and territories that have regulations and oversight that ensure availability of quality pharmaceutical services | Target 2025 | Discrepancy |
| 08.f. Number of countries and territories that have implemented institutional frameworks, strategies and/or legal frameworks for the assessment, selection and rational use of medicines and other health technologies including antibiotics | Target 2025 | Discrepancy |
| 09.b. Number of countries and territories that have reached at least 60% of their capacity to implement the essential public health functions | Target 2025 | Discrepancy |
| 10.b. Number of countries and territories that have allocated at least 30% of the public expenditure in health to the first level of care | Target 2025 | Achieved |
| 11.a. Number of countries and territories that have decreased by 20% the percentage of population in households experiencing out-of-pocket catastrophic health spending | Target 2025 | Discrepancy |
| Outcome Indicator | Baseline/Target | Rating |
|---|---|---|
| 04.f. Number of countries and territories with capacity to conduct integrated surveillance of arbovirus cases | Target 2025 | Achieved |
| 04.g. Number of countries and territories reporting at least 95% coverage at the national level of the second dose of measles and rubella containing vaccine (MRCV) | Baseline 2019 | Partially achieved |
| 04.h. Number of countries and territories reporting at least 95% coverage of 3 doses of diphtheria, pertussis, and tetanus -containing vaccine (DPT3) in 80% of municipalities | Target 2025 | Discrepancy |
| 04.i. Number of countries and territories reporting at least 95% coverage at national level of 3 doses of pneumococcus-containing vaccine at national level | Baseline 2019 | Achieved |
| 04.j. Number of countries and territories that have incorporated HPV vaccines in their national vaccination program | Target 2025 | Achieved |
| 12.c. Number of countries and territories with increased antimicrobial resistance (AMR) surveillance capacity to guide the public health interventions for decreasing the risk and preventing the spread of multidrug-resistant infections through intersectoral action | Baseline 2019 | Achieved |
| 12.d. Number of countries and territories that have adequate mechanisms in place to prevent or mitigate risks to food safety | Target 2025 | Not achieved |
| 17.b. Number of countries and territories with >80% of malaria cases investigated and classified in areas targeted for elimination or prevention of reestablishment | Baseline 2019 | Achieved |
| 17.c [b]. Interruption of transmission of neglected infectious diseases (NID) in countries, following WHO criteria and guidelines [Chagas Disease] | Baseline 2019 | Discrepancy |
| 17.c [c]. Interruption of transmission of neglected infectious diseases (NID) in countries, following WHO criteria and guidelines [Dog-mediated human rabies] | Baseline 2019 | Partially achieved |
| 17.c [e]. Interruption of transmission of neglected infectious diseases (NID) in countries, following WHO criteria and guidelines [Lymphatic filariasis] | Baseline 2019 | Achieved |
| 17.d. Number of countries and territories with established capacity and effective processes to eliminate human rabies transmitted by dogs | Baseline 2019 | Discrepancy |
| Outcome Indicator | Baseline/Target | Rating |
|---|---|---|
| 05.c. Number of countries and territories with cervical cancer screening programs that achieve at least 70% coverage of screening in women aged 30-49 years, or for the age group defined by the national policy | Target 2025 | Discrepancy |
| 05.e. Number of countries and territories whose surveillance systems have the capacity to report on key indicators of the Global Monitoring Framework for Noncommunicable Diseases | Baseline 2019 | Achieved |
| 05.f. Number of countries and territories that have tertiary care centers that provide rehabilitation services with multi-disciplinary teams for complex injuries | Target 2025 | Achieved |
| 05.h. Number of countries and territories that have increased the rate of persons admitted with mental disorders to general hospitals | Baseline 2019 | Not achieved |
| 05.i. Number of countries and territories that have increased the rate of persons receiving treatment interventions (pharmacological, psychosocial, and rehabilitation and aftercare services) for substance use disorders in the health service network | Baseline 2019 | Achieved |
| 06.b. Number of countries and territories that provide comprehensive post-rape care services in emergency health services, consistent with WHO guidelines | Target 2025 | Achieved |
| 13.d. Number of countries and territories that have eliminated industrially produced trans fatty acids | Target 2025 | Not achieved |
| 15.a. Number of countries and territories with an operational advisory committee or lead agency on road safety that supports the development and/or implementation of a national road safety strategy | Baseline 2019 | Achieved |
| 15.b. Number of countries and territories that have a national or multisectoral plan addressing violence that includes the health system | Baseline 2019 | Achieved |
| 16.a. Number of countries and territories with ongoing collaboration between government mental health services and other departments, services, and sectors | Baseline 2019 | Achieved |
| Outcome Indicator | Baseline/Target | Rating |
|---|---|---|
| 18.a. Number of countries and territories with capacity to implement and monitor policies to address social determinants of health | Target 2025 | Achieved |
| 18.b. Number of countries and territories with capacity to prevent key occupational diseases | Target 2025 | Achieved |
| 18.g. Number of countries and territories with capacity to address health in chemical safety (including human health exposure to metals and/or pesticides) | Baseline 2019 | Achieved |
| 18.h. Number of countries and territories with capacity to address the health-related effects of climate change | Target 2025 | Achieved |
| 19.a. Number of countries and territories that implement the Health in All Policies framework to improve health equity as well as health and well-being | Target 2025 | Achieved |
| 19.b. Number of countries and territories that have integrated health promotion into health services based on the principles of primary health care | Target 2025 | Discrepancy |
| 26.a. Number of countries and territories with institutional responses and accountability mechanisms that are advancing health equity, gender and ethnic equality in health, and human rights | Target 2025 | Discrepancy |
| Outcome Indicator | Baseline/Target | Rating |
|---|---|---|
| 20.a. Number of countries and territories that implement integrated interoperable information systems for health that include subnational disaggregation | Target 2025 | Achieved |
| 21.a. Number of countries and territories with functional governance for generating and using evidence integrated into health systems | Target 2025 | Achieved |
| 21.b. Number of countries and territories that generate, analyze, and use data and information according to health priorities, disaggregated by geopolitical and demographic strata, as appropriate to the national context | Target 2025 | Achieved |
| 22.b. Number of countries and territories that have ethical standards for conducting research with human subjects | Baseline 2019 | Achieved |
| Outcome Indicator | Baseline/Target | Rating |
|---|---|---|
| 23.a. Number of countries and territories that meet or exceed minimum capacities to manage public health risks associated with emergencies | Baseline 2019 | Achieved |
| 23.b. Number of States Parties meeting and sustaining International Health Regulations (IHR) requirements for core capacities | Target 2025 | Achieved |
| 24.a. Number of countries and territories with installed capacity to effectively respond to major epidemics and pandemics | Target 2025 | Not achieved |
| Outcome Indicator | Baseline/Target | Rating |
|---|---|---|
| 27.a. Proportion of countries and territories where the national health authority reports satisfaction with PAHO/WHO’s leading role on global and regional health issues | Target 2025 | Achieved |
| 27.b. Number of countries and territories for which there is alignment between the national health policy, strategy, or plan and the outcomes defined in the PAHO Strategic Plan 2020-2025 | Target 2025 | Achieved |
1. Access to comprehensive and quality health services
2. Health throughout the life course
3. Quality care for older people
4. Response capacity for communicable diseases
5. Access to services for NCDs and mental health conditions
6. Response capacity for violence and injuries
7. Health workforce
8. Access to health technologies
9. Strengthened stewardship and governance
10. Increased public health financing
11. Strengthened financial protection
12. Risk factors for communicable diseases
13. Risk factors for noncommunicable diseases
15. Intersectoral response to violence and injuries
16. Intersectoral action on mental health
17. Elimination of communicable diseases
18. Social and environmental determinants
19. Health promotion and intersectoral action
20. Integrated information systems for health
21. Data, information, knowledge, and evidence
22. Research, ethics, and innovation for health
23. Health emergencies preparedness and risk reduction
24. Epidemic and pandemic prevention and control
26. CCTs: equity, gender, ethnicity, and human rights
27. Leadership and governance
| Output (OPT) Indicator | Baseline/Target | Rating |
|---|---|---|
| 01.1.a. Number of countries and territories with frameworks in place for integrated health service delivery networks (IHSDN) to improve the resolution capacity of the first level of care and integrate priority programs, including NCDs and the elimination agenda | Target 2025 | Achieved |
| 01.2.a. Number of countries and territories implementing strategies and/or plans of action to improve quality of care in health service delivery | Target 2025 | Achieved |
| 02.2.a. Number of countries and territories that measure percentage of women of reproductive age who have their need for family planning satisfied with modern methods, disaggregated by age, race/ethnicity, place of residence, and income level | Target 2025 | Not achieved |
| 02.2.b. Number of countries and territories that measure percentage of pregnant women who received antenatal care four or more times, disaggregated by age, race/ethnicity, and place of residence | Baseline 2023 | Partially achieved |
| 02.2.c. Number of countries and territories implementing regular maternal and perinatal death reviews and audits | Baseline 2023 | Achieved |
| 02.2.d. Number of countries and territories that conduct periodic developmental assessment as part of their services for children | Baseline 2023 | Achieved |
| 02.2.e. Number of countries and territories implementing strategies to increase access to responsive and quality health services for adolescents | Baseline 2023 | Achieved |
| 02.2.f. Number of countries and territories developing specific and integrated interventions and/or actions at primary care and/or community level focused on optimizing the health and well-being of men | Target 2025 | Achieved |
| 02.2.g. Number of countries and territories that have set equity-based targets for access and coverage in at least one population living in conditions of vulnerability | Baseline 2023 | Achieved |
| 03.1.a. Number of countries and territories that implement comprehensive assessments of older persons at the first level of care | Baseline 2023 | Achieved |
| 07.2.a. Number of countries and territories with a norm that defines the capacities and scope of practice of inter-professional teams at the first level of care | Baseline 2023 | Achieved |
| 08.1.a. Number of countries and territories with updated national policies and/or strategies on access, quality, and use of medicines and other health technologies | Baseline 2023 | Achieved |
| 08.1.b. Number of countries and territories with policies and/or strategies on research and development, innovation, and/or manufacturing to promote access to affordable health products | Baseline 2023 | Achieved |
| 08.2.a. Number of countries and territories that have established an institutional development plan to improve regulatory capacity for health products based on the assessment of their national regulatory capacities by the Global Benchmarking Tool | Target 2025 | Achieved |
| 08.3.a. Number of countries and territories with a comprehensive strategy on multisource/generic medicines | Target 2025 | Partially achieved |
| 08.4.a. Number of countries and territories implementing a national plan to strengthen access to radiological services and radiation safety | Target 2025 | Achieved |
| 08.4.c. Number of countries and territories implementing national strategies/mechanisms to improve access, quality, safety, or rational use of blood in their services | Baseline 2023 | Achieved |
| 08.4.d. Number of countries and territories implementing a national plan to strengthen access to transplant services | Baseline 2023 | Achieved |
| 08.7.a. Number of countries and territories with mechanisms for health technology assessment and evidence-based incorporation, selection, management, and rational use of medicines and other health technologies | Baseline 2023 | Achieved |
| 09.1.a. Number of countries and territories implementing a strategy and/or plan of action to improve the essential public health functions as the basis for building resilient health systems | Target 2025 | Achieved |
| 09.3.a. Number of countries and territories implementing regulatory frameworks for the provision and financing of integrated people-centered health services | Target 2025 | Achieved |
| 09.4.a. Number of countries and territories that have established, reviewed, and/or updated health-related legislation and regulatory frameworks in the last five years in support of universal access to health and universal health coverage, the realization of the right to health, and other health-related matters from a human rights perspective | Baseline 2023 | Achieved |
| 09.5.a. Number of countries and territories implementing interventions and actions to promote and protect the health and well-being of the migrant population within national health policies, plans, and programs | Baseline 2023 | Achieved |
| 10.1.a. Number of countries and territories implementing equitable health financing strategies and reforms to sustain progress toward universal health, including specific strategies to progressively increase public expenditure in health in a sustainable manner | Target 2025 | Discrepancy |
| 11.1.a. Number of countries and territories implementing specific strategies to eliminate or diminish direct payments at the point of service | Target 2025 | Discrepancy |
| Output (OPT) Indicator | Baseline/Target | Rating |
|---|---|---|
| 04.1.a. Number of countries and territories implementing national norms, standards, and tools aligned with PAHO and WHO guidelines on TB, HIV, STIs, and VH, with emphasis on key and vulnerable populations | Target 2025 | Achieved |
| 04.2.a. Number of countries and territories implementing the new arboviral disease guidelines for patient care in the Region of the Americas | Target 2025 | Discrepancy |
| 04.3.a. Number of NID-endemic countries and territories that implement PAHO recommendations on integrated interventions to reduce the burden of NIDs through their health systems | Target 2025 | Partially achieved |
| 04.4.a. Number of countries and territories that implement PAHO/WHO recommended policies and inter programmatic approaches related to malaria | Baseline 2023 | Achieved |
| 04.5.b. Number of countries and territories generating evidence to support decisions on the introduction or post-introduction of new vaccines | Baseline 2023 | Discrepancy |
| 04.6.a. Number of countries and territories that have conducted Integrated Management Strategy arbovirus evaluations | Target 2025 | Discrepancy |
| 12.5.a. Number of countries and territories reporting participation of communities in the response to HIV, TB, STIs, and viral hepatitis | Target 2025 | Achieved |
| 12.6.a. Number of NID-endemic countries and territories that use the framework of the WHO WASH-NTD strategy as part of their national or subnational approach to tackle NIDs | Target 2025 | Discrepancy |
| 12.8.a. Number of countries and territories that have programs to prevent or mitigate zoonotic diseases and snake/arthropod envenoming | Target 2025 | Achieved |
| 17.1.a. Number of countries and territories implementing PAHO/WHO-recommended interventions in active foci and areas at risk of reestablishment of malaria | Baseline 2023 | Achieved |
| 17.2.a. Number of countries and territories implementing PAHO policies and frameworks for diseases targeted for elimination as recommended in the Elimination Initiative | Target 2025 | Partially achieved |
| 17.3.a. Number of countries and territories that administer hepatitis B vaccine to newborns during the first 24 hours | Baseline 2023 | Achieved |
| 17.5.a. Number of countries and territories that have maintained their status as free from both wild poliovirus and circulating vaccine-derived poliovirus | Baseline 2023 | Achieved |
| 17.8.a. Number of countries and territories implementing plans of action to strengthen prevention, prophylaxis, surveillance, and control for the validation of the elimination of rabies transmitted by dogs | Baseline 2023 | Achieved |
| Output (OPT) Indicator | Baseline/Target | Rating |
|---|---|---|
| 05.1.a. Number of countries and territories that are implementing evidence-based national guidelines/protocols/standards for the management of NCDs (i.e. cardiovascular disease, cancer, diabetes, and chronic respiratory disease) | Baseline 2023 | Achieved |
| 05.3.a. Number of countries and territories with comprehensive mental health services integrated into primary health care in at least 50% of primary health care facilities | Target 2025 | Partially achieved |
| 05.4.a. Number of countries and territories that collect, analyze, and report a core set of mental health indicators within the national health information systems | Baseline 2023 | Achieved |
| 06.1.a. Number of countries and territories that have a single emergency care access number with full national coverage | Baseline 2023 | Achieved |
| 06.2.a. Number of countries and territories that are implementing national standard operating procedures, protocols, and/or guidelines for the health system response to violence, aligned with PAHO and WHO guidelines | Baseline 2023 | Achieved |
| 13.1.a. Number of countries and territories implementing population-based policy measures to reduce the harmful use of alcohol in line with PAHO and WHO resolutions | Baseline 2023 | Achieved |
| 13.1.b. Number of countries and territories implementing a national policy or strategy on physical activity | Baseline 2023 | Achieved |
| 13.1.c. Number of countries and territories implementing policies to reduce salt/sodium consumption in the population | Baseline 2023 | Achieved |
| 13.1.d. Number of countries and territories implementing policies and/or actions to regulate unhealthy food and drink products | Target 2025 | Partially achieved |
| 13.1.e. Number of countries and territories covered by best-practice policies to eliminate industrially produced trans-fatty acids in the food supply | Target 2025 | Partially achieved |
| 14.1.a. Number of countries and territories that are implementing national policies consistent with the WHO Global Targets 2025 for maternal, infant, and young child nutrition and the nutrition components of the Sustainable Development Goals | Baseline 2023 | Achieved |
| 15.2.a. Number of countries and territories that have a national multisectoral coalition/task force to prevent and respond to violence that includes the health sector | Baseline 2023 | Achieved |
| 16.1.a. Number of countries and territories implementing policies and legislative frameworks to promote and improve mental health in line with global human rights instruments | Baseline 2023 | Achieved |
| 16.2.a. Number of countries and territories with national multisectoral strategies and plans aimed at the prevention of suicide across the life course and addressing its main risk factors and social determinants | Baseline 2023 | Achieved |
| Output (OPT) Indicator | Baseline/Target | Rating |
|---|---|---|
| 18.1.a. Number of countries and territories that have developed national, subnational, or local health policies, plans, programs, and/or projects that address the social determinants of health and inequities | Baseline 2023 | Achieved |
| 18.2.b. Number of countries implementing plans, policies, programs, and/or interventions to increase climate resilience and environmental sustainability of health care waste management practices, following WHO Guidelines | Target 2025 | Achieved |
| 18.2.d. Number of countries and territories implementing plans, policies, programs, and/or interventions to reduce health risks associated with hazardous chemical exposures, following the WHO Chemicals Road Map, the Minamata Convention, and other chemical-related policies and programs | Target 2025 | Achieved |
| 18.3.a. Number of countries and territories that have initiatives to prevent, diagnose, and record chronic kidney disease of nontraditional causes and/or pneumoconiosis | Baseline 2023 | Achieved |
| 19.2.a. Number of countries and territories that build capacities of local-level governments to integrate health promotion in their planning | Baseline 2023 | Achieved |
| 19.3.a. Number of countries and territories that have established an intersectoral mechanism at national or subnational and local government levels to address the determinants of health, applying the Health in All Policies approach | Baseline 2023 | Achieved |
| 19.4.b. Number of countries and territories implementing mechanisms that facilitate the participation of community organizations and leaders in public health programs | Baseline 2023 | Achieved |
| 26.2.a. Number of countries and territories implementing policies, plans, and strategies to advance health equity | Baseline 2023 | Achieved |
| 26.3.a. Number of countries and territories implementing policies, plans, and programs to advance gender equality in health | Baseline 2023 | Achieved |
| 26.4.a. Number of countries and territories implementing policies, plans, and programs to advance ethnic equality in health | Baseline 2023 | Achieved |
| Output (OPT) Indicator | Baseline/Target | Rating |
|---|---|---|
| 20.1.a. Number of countries and territories that have developed and implemented a plan to strengthen information systems for health based on PAHO’s IS4H maturity assessment model | Target 2025 | Achieved |
| 20.2.a. Number of countries and territories implementing an updated plan of action for strengthening the quality and coverage of vital statistics | Baseline 2023 | Achieved |
| 20.3.a. Number of countries and territories implementing digital health strategies or roadmaps, aligned with the regional policy and global strategy | Target 2025 | Achieved |
| 21.1.a. Number of countries and territories integrating scientific evidence on health into practices, programs, or policies, using standardized methodologies including evidence-informed clinical and public health guidelines, norms, and standards | Baseline 2023 | Achieved |
| 21.2.a. Number of countries and territories with mechanisms (policies, standards, tools, etc.) in place for the generation, dissemination, and preservation of, and access to, scientific and technical data, information, and evidence for health | Baseline 2023 | Achieved |
| 21.3.a. Number of countries and territories that generate and disseminate health analyses and/or health intelligence reports on relevant public health topics, including SDG 3 progress monitoring and health equity analyses | Baseline 2023 | Achieved |
| 22.2.a. Number of countries and territories with the national health authority enabled to address ethical issues and establish effective mechanisms for ethics oversight of research | Baseline 2023 | Achieved |
| Output (OPT) Indicator | Baseline/Target | Rating |
|---|---|---|
| 23.1.a. Number of States Parties completing annual reporting on the International Health Regulations (2005) | Baseline 2023 | Achieved |
| 23.1.b. Number of countries and territories that have evaluated disaster and emergency preparedness capacities in the health sector | Target 2025 | Not achieved |
| 23.2.a. Number of States Parties with national action plans developed for strengthening International Health Regulations (2005) core capacities | Target 2025 | Discrepancy |
| 23.2.b. Number of countries and territories with full-time staff assigned to health emergencies | Baseline 2023 | Achieved |
| 23.3.a. Number of States Parties that have conducted simulation exercises or after-action review | Target 2025 | Not achieved |
| 23.4.a. Number of countries and territories that include safe hospital criteria in the planning, design, construction, and operation of health services | Baseline 2023 | Achieved |
| 24.2.a. Number of countries and territories with strategies and/or plans in place to detect and respond to high-threat and emerging pathogens, including emerging zoonotic pathogens | Baseline 2023 | Achieved |
| 24.3.a. Number of countries and territories with access to established expert networks and national laboratory policies to support prediction, detection, prevention, control, and response to high-threat and emerging pathogens, including emerging zoonotic pathogen | Baseline 2023 | Achieved |
| 24.3.b. Number of countries and territories performing regular monitoring/auditing of infection prevention and control practices in referral care facilities | Baseline 2023 | Achieved |
| 24.3.c. Number of countries and territories with operational integrated surveillance systems and pandemic preparedness plans for respiratory viruses, including influenza and COVID-19 | Baseline 2023 | Achieved |
| Output (OPT) Indicator | Baseline/Target | Rating |
|---|---|---|
| 27.1.a. Number of countries and territories with a current Country Cooperation Strategy | Baseline 2023 | Achieved |