The main objective of this research is to analyse the effectiveness, efficiency and equity of integral health prevention and promotion at the primary health level in Costa Rica, i.e. following the Basic Equipment of Integral Health (BEIH). The methodological framework proposed by Scha et.al. (2013) was used to analyse the structure, processes and results in order to best comprehend the degree of promotional and prevention initiatives at this primary level. This research was limited to a general study of the South Central Regional Direction which is integrated by 45 health areas and 367 BEIHs. The data was obtained by qualitative instruments: in-depth interviews, surveys and an expert panel session.
The main findings of this research regarding management deficiencies in health promotion and disease prevention at the primary health care level are the following. Firstly, the operationalization of the diverse international and national laws concerning an integral health perspective is an ongoing challenge for the Costa Rican health system. The identified deficiency is explained by three main aspects: a) misuse of concepts, establishing the same concept for both health prevention and promotion, b) implementation of promotional activities as part of prevention programs, c) limited conceptualization of health promotion.
Secondly, a problem regarding the concept of health was identified. Indeed, health culture has tended to be curative. Thirdly, this research reveals that health services from the CSSF should be based on an integral care model, but to date, preventive programs have more support and priority than promotional programs, and the “integral” dimension of the concept has been grossly neglected. Moreover, it was argued that planning processes do not respond to the approach of health promotion and is limited to prevention only.
Fourthly, there is a great deficiency in health promotion projects. There are no financial or human resources and the available capital is oriented towards the implementation of preventive programs. The resistance of doctors to promotional programs prevails. In addition, many of the professionals assigned to the management level do not possess the necessary skills to allocate resources and manage them appropriately.