Costa Rica has seen significant progress and achievements in human development and social security through decades of strong public investment in health systems as well as education, housing, employment, and environment. Today, life expectancy in Costa Rica is among the highest in the Americas region and Costa Ricans have “near universal access” to comprehensive healthcare services [1]. Despite these exemplary policy and health achievements, health inequities persist for several groups, including indigenous populations. Indigenous peoples comprise 2.4% of the population and are disproportionately affected by poverty and marginalization [2]. Around the world, COVID-19 brought preexisting health inequities and the unequal distribution of resources and power to the forefront. Therefore, Indigenous peoples bore an unequal burden of vulnerability and were more likely to be exposed to and contract the virus [3]. In this context, PAHO/WHO Country Office (PAHO/WCO) Costa Rica took the leadership role to address the urgent need to support Indigenous communities against COVID-19.

The government of Costa Rica initiated the request for support from the United Nations system. In collaboration with the UN Resident Coordinator Office, the PAHO/WHO Country Office, was tasked with developing and supporting the implementation of part of the national plan to address COVID-19 in Indigenous Territories. In addition to the technical support, PAHO/WCO led the collaboration and coordination efforts with stakeholders at all levels, which was crucial for community engagement and advocacy.

Starting early on in the process, PAHO/WCO engaged the Ministry of Health, the Costa Rican Social Security Fund as well as the National Emergency Commission and the Emergency Committees in the Indigenous Territories. This ensured that the response was coordinated at the national, regional, and local levels. Local governments were also key collaborators in the process. Connecting with municipalities was crucial, as they helped to connect with local institutions and community leaders, and to facilitate public dialogues. Through close ties with these networks, PAHO/WCO increased the efficiency and effectiveness of the distribution of personal protective equipment and disinfecting supplies; PAHO/WCO targeted its resource contributions in areas with outbreaks. Ties with the localities made the distribution much more efficient and responsive to reach the families that were most affected.

Most importantly, the PAHO/WCO went through a long and thorough process to identify and hire local indigenous health care professionals to act as health promoters. They would develop and implement the response plans for their own communities, whereas PAHO/WCO’s role would be more so to provide managerial support and technical guidance. In recognizing the diversity of indigenous populations, knowledges, and cultures, PAHO/WCO and staff members approached each community with an open and flexible agenda, which was only shaped into a strategy and working plan after hearing their particular needs and experiences. As a result, no two interventions were alike and the communities were put at the centre of the implementation of the Project. Accordingly, the five response plans (for a total of nine Indigenous Territories) comprised different priorities and opportunities identified through the needs assessment conducted by members of the local communities themselves, in collaboration with local and national institutions. The true impact of PAHO/WCO’s engagement can only be fully captured through the foundation of trust that has been established with communities. This trust has sustained positive working relationships well into 2021, beyond the immediacy of the pandemic and into the recovery stage.

While differences and diversity in culture and languages can often get defined as ‘barriers’ to care, PAHO/WCO approached Indigenous cultures as an essential element of sustainable development and recognized traditional practices and knowledge as a ‘global good.’ PAHO/WHO has supported the Government of Costa Rica in the preservation and development of health in indigenous populations, rooted in community perspectives and ancestral knowledge. This approach enabled the effective mobilization of these resources to improve public health during the pandemic: for many Indigenous communities, family is not limited to the immediate family—it extends to the entire community. This meant that communication campaigns were focused on coping as a community and emphasized realistic ways to encourage the community to adopt COVID-safe practices in interactions.

PAHO/WCO Costa Rica’s efforts on this project is a unique and important illustration of a response to the COVID-19 pandemic that incorporates the much-needed emphasis on equity and prioritization of Indigenous cultures and knowledges.

This Project was an adaptation of the work the PAHO/WCO had planned for the 2020–2021 biennium to address health inequities and target the social determinants of access to health services for Indigenous peoples in Costa Rica. It was aligned with the broader PAHO’s Strategy and Plan of Action on Ethnicity and Health 2019–2025.

[1]. OECD (2017), OECD Reviews of Health Systems: Costa Rica 2017, OECD Publishing, Paris. http://dx.doi.org/10.1787/9789264281653-en

[2]. PAHO (n.d.). Costa Rica (Health in the Americas). Paho.org. https://www.paho.org/salud-en-las-americas-2017/?p=2656

[3]. Eijkemans, Solar & Lanzagorta (2020), Guidance for implementing non pharmacological public health measures in populations in situations of vulnerability in the context of COVID-19. Pan American Health Organization. Washington D.C. https://iris.paho.org/bitstream/handle/10665.2/53078/PAHOIMSFPLCOVID-19200021_eng.pdf?sequence=5&isAllowed=y

Photo caption: Don Samuel López, Mayor Bribri and great connoisseur of his culture in the community of Watsi, Talamanca.

Photo credit: WHO