Table 4

Strategies for implementing PHC model

Implementation strategyDescriptionReform
Governance restructuringGeographic empanelmentMultidisciplinary teams
Create technical working groupsMultidisciplinary groups of key stakeholders met to make decisions about each of the reforms.···
Engage communitiesHealth leaders engaged communities at every level during each stage of the reform.···
Sign a formal agreementFormal agreement between MOH and CCSS leaders solidified commitment to the model.·
Foster professional relationshipsRelationships between MOH and CCSS staff were intentionally fostered after governance restructuring was final.·
Build capacityHealth leaders prioritised training all health personnel in the new model.··
Use existing resourcesWhenever possible, health leaders used existing resources to save time and build on existing knowledge.··
Apply an equity lensHealth leaders implemented the new model by prioritising the most vulnerable communities at the outset of the programme.··
  • CCSS, Costa Rica Social Security Administration; MOH, Ministry of Health; PHC, primary healthcare.