Community health and primary health care: the value of home visitation (3)

7 September, 2021

Dear Dr. Perry,

Thank you for sharing the article [ ] and for contributing to the CBIO system.

According to the NY Times article "Third, every Costa Rican would be assigned to a local primary-health-care team, called an ebais (“eh-by-ees”), for Equipo Básico de Atención Integral en Salud, which would include a physician, a nurse, and a trained community-health worker known as an atap (Asistente Técnico en Atención Primaria)".

"When you work at a hospital, patients come to you. In a public-health unit, you have to go to them."

This implementation is incredible. It essentially eliminates the issue of patient compliance during primary prevention such as administering vaccines and during the treatment of chronic diseases such as Diabetes and Hypertension. Elderly patients with impaired cognition who have to rely on their family members to take them to the hospital are receiving healthcare in comfort of their own homes!

"In 1973, the social-security administration was charged with upgrading the hospital system, including in Alajuela and other rural regions."

"When he enrolled at the University of Costa Rica, then the country’s sole public university, he imagined he’d return to Atenas to practice one day. "

This effectively adds an incentive for the healthcare workers for example Dr. Salas mentioned in the NY Times Article to return to their own community to serve the population group they know best. The upgrade of health system seems to be one of the crucial step as well, from experience in Nepal, working in a primary health care center with no means for basic investigations and basic life supporting medications is extremely depressing and there is a relative paucity of staff who want to work in situations like that.

Perhaps its time for all of us to move from physician driven clinic based model of primary care to a mobile health team model that has a public health personnel who can make policies for more census based impact-oriented service.

Best Regards,

Subarna Bhusal, M.B.B.S


HIFA Country Representative, Nepal

HIFA profile: Subarna Bhusal is a medical doctor with interests in medicine, health information, and using technology to enhance healthcare information delivery in low to middle income countries. He is a HIFA country representative for Nepal.

Email: drsubarnabhusal AT