Estrategia nacional para el envejecimiento saludable basado en el curso de vida 2022-2026

Objectives

Costa Rica’s National Strategy for Healthy Ageing Based on the Life-Course Approach covers 2022–2026 and adapts the World Health Organization’s healthy-ageing agenda to the national context. It seeks to improve older people’s wellbeing, autonomy, functional ability, participation and quality of life, while enabling people to reach older age with the greatest possible functional capacity.[1][2][3]The framework is rights-based, person-centred, equitable, inclusive, gender-sensitive and intercultural, recognising health as shaped by experiences and inequalities across the life course.[4][5]

• Promote multisectoral commitment by embedding healthy-ageing actions, human-rights protections and life-course perspectives in institutional policies, plans and interventions.[6][7][8]
• Develop healthy and inclusive environments that remove physical and social barriers, support autonomy and participation, foster intergenerational solidarity, and enable safe, accessible and affordable communities.[9][10][11]
• Align integrated, person-centred health and primary-care services with older people’s needs, including prevention, self-care, functional-capacity assessment, geriatric care, immunisation and workforce development.[12][13][14]
• Establish sustainable, equitable and needs-based long-term care and support services that maintain intrinsic capacity, uphold dignity and human rights, and support formal and informal carers.[15][16][17]
• Strengthen research, technological development and communication so that older people, institutions and decision-makers have timely evidence, information and tools for healthy-ageing decisions.[18][19][20]

The strategy also reflects the four World Health Organization action areas: change attitudes and behaviours towards age and ageing; ensure communities foster older people’s capabilities; provide integrated, person-centred care and age-responsive primary healthcare; and ensure access to long-term care for those who need it.[21][22][23]It explicitly addresses ageism, discrimination, social isolation, violence and abuse, gender inequities, disability, mental health, cognitive decline, access to justice and the inclusion of older lesbian, gay, bisexual, transgender and other gender-diverse people.[24][25][26][27]

Implementation

Implementation is organised through an intersectoral action plan with strategic actions, activities, responsible institutions, baselines, targets and indicators.[28][8][22]The Ministry of Health leads stewardship, follow-up and coordination, including through the National Commission for Healthy Ageing, while implementation is shared among public institutions, the Costa Rican Social Security Fund, municipalities, universities, civil-society organisations, community services and private-sector partners.[29][30][6]

• Coordinate institutions and social actors through the National Commission for Healthy Ageing, institutional commitments and locally delivered projects, while integrating healthy-ageing measures into existing legal, policy, health-service and community structures.[29][31][32]
• Deliver community-based action through municipalities, day centres, long-stay homes, educational settings, recreational programmes, intergenerational activities, age-friendly cities and communities, and local networks for physical activity and health.[9][33][34]
• Strengthen health-service delivery through Integrated Care for Older People screening and implementation, functional-risk identification in primary care, geriatric-service expansion, age-responsive vaccination, integrated-care standards and health-worker training.[13][14][35]
• Develop long-term-care capacity by mapping services and training providers, accrediting and certifying carers, supporting home and community care, updating service standards, and providing psychosocial support and training for carers.[36][37][17]
• Promote inclusive environments by adapting public spaces, health and care facilities, day centres and long-stay homes; applying universal design; and incorporating differentiated support for older people in local emergency and disaster plans.[38][39][40]
• Generate and communicate evidence through studies, researcher databases, health-risk analyses, age-disaggregated emergency data, periodic health reporting, technological applications, virtual education and public information campaigns.[19][41][42][43]

The strategy was developed through diagnosis, formulation and follow-up phases, using the Ministry of National Planning and Economic Policy methodology.[44]Its update drew on the previous 2018–2020 strategy, institutional commitments, focus groups, consultations with social actors and virtual consultations involving people aged 45–65.[31][45][3]The Pan American Health Organization and World Health Organization supported the diagnosis and formulation phases with technical and financial resources, although no amounts are specified.[44]

Monitoring and evaluation are intended to cover actions, targets and indicators, support decision-making, identify implementation deviations and enable adjustments or discontinuation of ineffective activities.[22]The Ministry of Health’s Sectoral Planning Unit and Evaluation Unit are tasked with preparing supporting monitoring and evaluation documentation, including technical indicator sheets.[22]Across the action plan, monitoring commonly uses output and coverage measures such as activities completed, institutions or people reached, standards formalised, services established, training delivered and policies or guidance produced.[46][47][39]Specific reporting intervals, independent evaluation methods, audit processes and sanctions for non-performance are generally not specified in the supplied material.[22][11]

Monitoring & Evaluation

The strategy establishes a results-oriented monitoring and evaluation approach for the 2022–2026 healthy ageing action plan. It combines strategic actions, assigned institutions, activities, baselines, targets and indicators, with the Ministry of Health responsible for follow-up, monitoring and evaluation.[28][44][8]

• Apply a monitoring and evaluation system across actions, targets and indicators to inform decision-making, identify implementation deviations and adjust, discontinue or add actions where necessary.[22]
• Develop technical monitoring sheets for each target and publish the monitoring process in a separate document.[45]The Sectoral Planning Unit and Evaluation Unit within the Ministry of Health Planning Directorate are responsible for developing this monitoring and evaluation documentation, including technical indicator sheets.[22]
• Assign implementation and dissemination responsibilities to participating institutions and organisations, which committed to specific targets through the National Commission for Healthy Ageing.[6]
• Review fulfilment of commitments from the 2018–2020 strategy, using unfinished targets, limitations, deficiencies and non-compliance affecting older people’s rights to determine whether targets should continue or be revised.[44]
• Measure delivery largely through output and coverage indicators, such as the number of activities, facilities, participating people, trained personnel, guidance documents, research outputs, services and institutional processes completed.[47][48][34]
• Track selected service and system targets, including screening 300 older people using Integrated Care for Older People by 2026, establishing eight geriatric services in regional hospitals by 2026, and reaching at least 90% coverage for each vaccine and target group by 2026.[49][14][50]
• Monitor long-term care through indicators for training-institution mapping, carer accreditation and certification, day centres applying the Integrated Care for Older People model or a similar tool, people reached through the Integrated Care model of the Joint Institute for Social Assistance, and carer-training courses.[36][16]
• Generate evidence for policy adjustment through research, age-, gender- and culturally disaggregated data, health-risk analysis, local health situation analyses, and periodic reports on older people’s health.[15][18][41][51]
• Prepare a list of indicators for monitoring the health response to older people’s needs by 2023 and produce a periodic older people’s health report every two years through 2026 in coordination with the Pan American Health Organization.[41][51]
• Use existing surveillance and administrative data, including mandatory disease-notification records, Costa Rican Social Security Fund service records, mortality statistics and population estimates, to describe morbidity, mortality, service use and functional risks among older people.[52][53][54]

The action plan therefore provides an operational accountability basis through named responsible bodies, indicators, baselines and time-bound targets.[8][55]However, the available material does not specify a unified reporting calendar, indicator definitions, data-collection protocols, independent evaluation arrangements, audit procedures, sanctions or corrective-action requirements for non-performance.[39][11]

Costing & Financing

Costing and financing are largely unspecified for the National Strategy for Healthy Ageing Based on the Life Course 2022–2026. The extracts identify substantial service, workforce, infrastructure, research and care ambitions, but do not provide an overall strategy budget, costing methodology, financing framework, funding gap or economic assumptions.[28][22][17]

• Recognise a general economic rationale for healthy ageing: adapting to population ageing may minimise associated costs while maximising older people’s contributions to families, communities and the economy.[56]
• Note that multimorbidity is associated with increased functional impacts, health-service utilisation and health expenditure, reinforcing the resource implications of integrated care and long-term care.[57]
• Identify an expected need for additional specialised health and hospital resources as population ageing increases.[58]
• Record that the Pan American Health Organization and World Health Organization provided technical and financial resources for the diagnosis and formulation phases, although no amount, currency or financing terms are given.[44]
• Record reported social-protection support from the Joint Institute for Social Assistance: individual benefits for 11,468 older people totalled 4,410,897,370 colones, alongside a group grant of 195,890,660 colones to the Association for Assistance to Older Persons of Upala.[59]
• Record that the Young Persons Council allocates 22.5% of its institutional budget to projects of Cantonal Committees for Young Persons; the extract does not provide the underlying budget amount or period.[60]

No explicit monetary allocation is provided for action-plan activities such as geriatric-service expansion, vaccination, workforce training, facility adaptation, carer accreditation, long-term care, research, communications or technology development.[14][36][19][61]The source also does not identify recurrent funding sources, resource-mobilisation mechanisms, unit costs, affordability analyses or quantified funding gaps.[16][62]