Health governance: country illustrations from Costa Rica and Georgia (Chapter 7)

"Chapter 7 of the report “Implementing the primary health care (PHC) approach: a primer” captures country illustrations from Costa Rica and Georgia on health governance.

The case study from Costa Rica provides an overview of the integrated PHC model in Costa Rica, based on multiprofessional teams called Equipos Basicos de Atencion Integral de Salud (EBAIS). These teams have been in place since the 1990s and provide most primary care services, including public health, preventative and curative services. The teams are integrated in the community, monitor patient’s health and are helped by support teams with more experienced professionals to complement their work as needed. Health professionals also receive basic management training and go through a mandatory one-year social service. The country was able to face challenges like limited financial resources, insufficient infrastructure and shortages of health workers with that kind of system in place.

The case study from Georgia provides an overview of primary care service integration in response to health system decentralization then fragmentation after gaining independence from the Soviet Union. After acknowledgement of previous failures to integrate primary care with multiple different health programmes without strong government vision, a major reform is in process. The plan is to encourage multidisciplinary primary care teams by reinforcing a new costing and payment model and engaging key national stakeholders in the implementation process.