Abstract

PIP: Costa Rica's general health conditions have improved considerably in recent years. During the 1970s, for example, infant mortality fell from 61.5 to 19.1 deaths/1000 livebirths; prinatal mortality declined from 32.9 to 20 deaths/1000 livebirths; communicable disease mortality plummeted from 1.36 to 0.16 deaths/1000 inhabitants; and generalmortality dropped from 6.6 to 4.u deaths/1000 inhabitants. These trends can be attributed in part to 2 programs, a Rural Health Program and a Community Health Program, respectively designed to extend health services coverage into underserved rural and marginal urban areas. The Community Health Program, which is the subject of this article, began functioning officially in 1976. Its basic strategy consisted of defining small specific areas to be served, assigning especially trained auxiliaries to those areas, and having the auxiliaries work principally through house-by-house visits to the residents of each area. The mission of these auxiliaries has been to apply simple treatment methods and to make referrals to higher healthcare levels in case of need. The auxiliaries, in turn, have received regular supervision and have been provided, to the extent possible, with the coordinated support of all health service facilities and resources. At present, there are 247 community health areas within the program, under the jurisdiction of 54 health centers. Within these areas, the program provides health services coverage for roughly 70% of Costa Rica's marginal urban population. Overall, the results obtained thus far indicate that the program has been extremely useful and that the approach employed is worth publicizing--not only so that useful ideas and information may be spread, but also so that constructive criticism capable of yielding future improvements can be heard.