World Bank2016-01-112016-01-112015-06-14https://hdl.handle.net/10986/23608The evolution of Costa Rica’s social sectors over the past decade has been dichotomous. On the one hand, economic growth has remained relatively high, however poverty and inequality have not declined (moreover, they have increased), and persistent employment challenges remain. On the other hand, the country has continued experiences advances in many social indicators, such as pre-primary and tertiary enrollment rates, access to improved sanitation, and labor force participation, though not in others (secondary school completion, immunizations, employment). Higher economic growth and (to a lesser extent) revenues seem to have allowed a substantial increase in public social spending. Looking forward, the key challenges Costa Rica faces are related to continuing improving the quality and efficiency in the social sectors, while improving targeting to serve the most in need, in a tight and severe fiscal context. To expand coverage of excluded population, priority will have to be given to reallocations and improvements within the spending envelope for the social sectors to maximize impact. With a fiscal deficit of more than 6 percent of GDP, further expanding public social spending is no longer an option and budget cuts are looming. Improvements in public spending management and budget execution, including the need of institutional reform to consolidate programs and improve coordination among executing agencies is equally important. In a country that has long been the champion in expanding universal welfare state, sustainability concerns will imply that hard fiscal decisions would need to be made to increase the social returns of budget allocation.en-USCC BY 3.0 IGOSANITATIONRISKSWORKFORCEECONOMIC GROWTHBASIC EDUCATIONQUALITY OF SERVICESNATIONAL DEVELOPMENT PLANFORMAL EDUCATIONSOCIALIZATIONPEOPLEOLD AGESKILLED WORKERSSOCIOECONOMIC STATUSINFORMATION SYSTEMHUMAN IMMUNODEFICIENCY VIRUSPUBLIC EDUCATIONPREVENTIONLAWSLIVE BIRTHSCOMMUNITY HEALTHLEVELS OF EDUCATIONRESOURCE ALLOCATIONLABOR FORCEHEALTH INSURANCEPUBLIC SERVICESPRENATAL CARENATIONAL DEVELOPMENTHEALTH CAREPUBLIC SECTOR EXPENDITURESHEALTHDROPOUTCOMPREHENSIVE CAREINFORMATION TECHNOLOGIESHYPERTENSIONRURAL POPULATIONFUTURE GENERATIONSSOCIAL SCIENCESINFORMATION SYSTEMSLONGER LIFEHOSPITALPUBLIC HEALTHLIFE EXPECTANCYACCESS TO EDUCATIONMATERNAL MORTALITYHEALTH SECTORKNOWLEDGESET OF RECOMMENDATIONSDIABETESLABOR MARKETCOMMUNITY DEVELOPMENTMINISTRY OF HEALTHMILLENNIUM DEVELOPMENT GOALDISEASESTRAININGIMMUNIZATIONPATIENTSPATIENTSOCIAL EXCLUSIONEDUCATIONAL ATTAINMENTINTERVENTIONPOPULATION DIVISIONHEALTH INDICATORSFAMILY HEALTHPUBLIC HOSPITALSAGINGDEMOGRAPHIC PROJECTIONSSECONDARY SCHOOLCHILD DEVELOPMENTFERTILITY RATEHEALTH CARE SERVICESADOPTIONTETANUSMARKETINGHOUSEHOLD INCOMEHOUSEHOLD SURVEYSMORTALITY RATESOCIAL SECURITYTEACHER SALARIESTUBERCULOSISSOCIAL RETURNSSERVICE DELIVERYPLACE OF RESIDENCESOCIAL EXPENDITURESGROSS DOMESTIC PRODUCTMORTALITYHEALTH CARE SYSTEMRISK GROUPSELDERLYRESPECTPROGRESSUNEMPLOYMENTCHILDBIRTHINFANT MORTALITYPOPULATION TRENDSHUMAN CAPITALINFANTDIPHTHERIAINVESTMENT IN EDUCATIONWORKERSWHOOPING COUGHSURGERYSOCIAL SECTORPOLICIESLABOR CODEAGEDSOCIAL SERVICESPATIENT SATISFACTIONCHRONIC DISEASEHIVBASIC NEEDSIMMUNODEFICIENCYPENSIONSIMPACT ON HEALTHPUBLIC HEALTH EXPENDITUREMEDICAL SERVICESSOCIAL POLICYMINISTRY OF EDUCATIONHEALTH OUTCOMESINTERPERSONAL SKILLSLONG-TERM CAREPOPULATION DENSITYURBAN AREASSTRESSEARLY CHILDHOODIMMUNIZATIONSMANDATESDECISION MAKINGCHEMOTHERAPYNUTRITIONMEASLESPOPULATIONSPOLICYPRIMARY HEALTH CAREWORLD HEALTH ORGANIZATIONDEMOGRAPHIC TRENDSLIFESTYLESCHILD MORTALITYHEALTH SYSTEMSOCIAL SECTORSSEXGOVERNMENT POLICIESCOMMUNICABLE DISEASESPREGNANT WOMENWORLD POPULATION PROJECTIONSTEACHER RATIOCHILDRENLEVEL OF EDUCATIONCLINICSWORLD POPULATIONHEALTH PROVIDERSRURAL AREASPOPULATION PROJECTIONSISOLATIONENDOCRINE SYSTEMDISABILITYCIRCULATORY SYSTEMNUMBER OF DEATHSSCHOOL YOUTHPOPULATIONHOSPITAL BEDSSTUDENTSINSTITUTIONALIZATIONNOURISHMENTDIGESTIVE SYSTEMMATERNAL MORTALITY RATESTRATEGYSOCIOECONOMIC DIFFERENCESPRIMARY EDUCATIONFERTILITYFAMILIESWOMENMEDICINESHOSPITALSMATERNAL MORTALITY RATESHEALTH INTERVENTIONSPUBLIC SERVICEINFANT MORTALITY RATESECONDARY EDUCATIONTERTIARY EDUCATIONSOCIAL WORKERSHEALTH SERVICESIMPLEMENTATIONPREGNANCYAT RISK GROUPSDEMAND FOR SERVICESNURSINGHUMAN DEVELOPMENTSANITATION FACILITIESReportWorld Bank10.1596/23608