Methodology

This work builds on a desk review of academic and gray literature on the Costa Rican health system and the practices it adopted to respond to the COVID-19 emergency while sustaining the provision of essential health services. The team reviewed local newspapers and government documents and identified other relevant qualitative or quantitative data about the COVID-19 pandemic and maintenance of essential health services in Costa Rica.

Through this process, the team (at INCAE Business School) identified two crucial sources^1,2 on the country’s response to COVID-19 and several newspaper articles and papers published by the Central American Population Center (Centro Centroamerican de Población) available online.³ Quantitative information came from CCSS’s Annual Statistical Books (Anuarios Estadísticos)^4,5,6 and its Actuarial Statistics Department (Estadísticas Actuariales).⁷

The team carried out qualitative data collection via semi-structured interviews with a representative set of key informants from the health sector in Costa Rica. We conducted the selection process of the interviewees to ensure they represented different and crucial points of view—all levels of care (primary care, clinics, and specialized hospitals), sectors (public, private, and organized civil society), and work roles during the response (strategic, operational, and tactical, including directors of health areas, clinics and hospitals, doctors, and coordinators). At the beginning of each interview, we briefed interviewees about the goal of the research project and the confidentiality terms. At the end of each interview, we asked them to recommend other key actors who could provide relevant information regarding the response. In all, we conducted 21 roughly hourlong interviews with 26 key informants.

After completing the qualitative data collection process, we analyzed the interview transcripts and audios using Atlas.ti qualitative analysis software. This software helped streamline the process and automated time-consuming elements. The analysis included general trends and specific actions that characterized the outbreak response and excerpts from the interviews that exemplified actions taken by different actors during the pandemic.