In Costa Rica: integrating public health and primary care

In Part Two of our Costa Rica series, Dr. Tara Kiran takes you inside an EBAIS (Equipos Básicos de Atención Integral de Salud) clinic on the Nicoya Peninsula in Costa Rica to see what it actually looks like to deliver primary care beyond clinic walls. Costa Rica organizes primary care around geography. Each clinic is accountable for a defined population — and community health workers play a central role in making sure no one is missed. They visit households, provide education on prevention and chronic condition management, deliver vaccines, identify risks early, and act as a bridge between public health and clinical care. It isn’t a perfect system. But it is an ambitious one. And it offers a powerful contrast to Canada’s often fragmented approach to primary care and public health — reminding us that building a system where everyone has care is not just a matter of funding, but of design.Further reading:Listen to Part 1 of our series on Costa Rica with Dr. Madeline PesecTake a look at the research article that first introduced me to Madeline (co-authored by Dr. Atul Gawande) Explore this brief Commonwealth Fund case study on the Costa Rican primary care system or dive deeper into this more detailed case study from Ariadne Labs Read the article “Costa Ricans Live Longer Than We Do. What’s the Secret?” in the New Yorker magazine by Dr. Atul GawandeRead the BBC article Tara mentioned about how Nicoya Peninsula is home to a large number of centenariansLearn more about rising violence in Costa Rica related to femicide and gang violenceMAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. More about Primary Focus:Subscribe to our Substack newsletterVisit our website at primaryfocus.caLearn about the OurCare StandardDo you have an idea for an episode? Email [email protected] Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com