Costa Rica

Hospital without Walls

Hospital without Walls is a project that began in 1950 at the Palmares Health Center, emerging as a response to the needs of communities characterized by a relatively low level of education and relatively high rate of infant mortality. This program began in a region of the province of Alajuela, located in the central plateau of Costa Rica. The program was attended by key stakeholders such as teachers and community leaders in the region, strengthening health committees and training hundreds of non-medical volunteers to join the "Hospital without Walls" team and play a key role in the health literacy of the population. The work on health and the communal organization carried out by the "Hospital without Walls" was so relevant that during 1978-82 President Rodrigo Carazo based his Human Promotion Program on the Hospital without Walls scheme of communal participation in health. Among other achievements, the program reached comprehensive health care coverage (primary care) of 100% of the rural population and 80% of the urban population.

Institutional design


Formalization: is the innovation embedded in the constitution or legislation, in an administrative act, or not formalized at all?

Frequency: how often does the innovation take place: only once, sporadically, or is it permanent or regular?

Mode of Selection of Participants: is the innovation open to all participants, access is restricted to some kind of condition, or both methods apply?

Type of participants: those who participate are individual citizens, civil society organizations, private stakeholders or a combination of those?

Decisiveness: does the innovation takes binding, non-binding or no decision at all?

Co-governance: is there involvement of the government in the process or not?

not backed by constitution nor legislation, nor by any governmental policy or program 
Mode of selection of participants
Type of participants
democratic innovation yields no decision  


  • Deliberation
  • Direct Voting
  • E-Participation
  • Citizen Representation


  • Accountability
  • Responsiveness
  • Rule of Law
  • Political Inclusion
  • Social Equality

Policy cycle

Agenda setting
Formulation and decision-making
Policy Evaluation


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Pogrebinschi, Thamy. (2017). LATINNO Dataset. Berlin: WZB.

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