San José, Costa Rica, since 1956

Costa Rica's public health care in crisis

Workers in Costa Rica’s government-run health care system attempted this week to bring the institution to a halt with weeklong strikes that began Tuesday. But the government says only 10 percent of employees participated.

Union leaders claim higher numbers, but most public hospitals were operating at near-full capacity, except for canceled appointments.

Still, Caja employees continue to demand the government not enforce an order by the Attorney General’s Office that would stop considering payments to Caja employees on sick or maternity leave as part of their salaries. That decision would affect how Christmas bonuses are calculated, and would also have an impact on pensions.

Members of the Caja board of directors say they have no choice but to comply with the legal ruling.

Both sides have maintained a chilly distance since Monday afternoon, when unions and Caja officials left negotiations without making progress. Nationwide strikes began the next day.

Disputed Strike Numbers

On Tuesday, doctors, nurses, psychologists and other employees of the public health system began an indefinite strike that has lasted all week. During its first day, the strike set out to freeze delivery of health care to patients in all major public medical centers, including San José’s Hospital Mexico and Hospital San Juan de Dios.

While some patients at public hospitals experienced delays and canceled appointments, or the most part major problems       were avoided.

Also on Tuesday, Caja Executive Director Ileana Balmaceda said the institution’s lawyers decided to initiate proceedings to declare the strike illegal and determine that strikers could be fired.

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A Nation Divided:  Patients wait to be seen by medical personnel outside the Calderón Guardia Hospital in San José. Public health workers on Tuesday began an indefinite strike demanding better working conditions.


Costa Rican law states that a strike can be declared illegal if less than 60 percent of those working for the same employer join the movement.

However, union leaders claimed that more than 90 percent of Caja employees joined the strike, and they accused government officials of providing false information to the press.

“I am not in the streets today but I support the struggle of my colleagues,” said María Acuña, an anesthesiologist at Calderón Guardia Hospital in downtown San José. “It is important to defend our labor rights and I will work only in emergency situations.”

Oldemar Siles, a nurse carrying a protest sign in front of the Caja headquarters, said he would stay in the streets for as long as necessary. “We health workers have the right to strike, and if the government does not agree, then they should negotiate with us,” he said.

Around 8:30 p.m. the same day, after the Caja issued several press statements that said only a small percentage of workers supported the strike, the National Medical Union called other union members, environmentalists and workers associations to hold a march Thursday morning. That march drew hundreds of supporters to the streets of San José.

On Wednesday, Caja officials issued more information on the strike. According to information obtained from medical centers countrywide, the support rate of the strike had decreased to 5 percent, as most doctors and nurses decided to go back to their jobs.

“Many protesters are giving up on the strike because they are losing money,” said Balmaceda. “We will continue deducting the paychecks of non-workers.”

Caja officials also estimated that the cost of the first day of strike reached $800,000:  $600,000 for cancelled appointments and $200,000 for services and supplies, including the laundering of 11,000 pounds of clothing.

“This is an enormous amount of money we hadn’t included in our yearly budget, and it will affect our financial health negatively,” Balmaceda said.

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A public health worker holds a sign that reads, “I am the Costa Rican people.”


Alberto Font

During the rest of the day, staff at clinics and hospitals reportedly continued to work on an almost normal basis, except for the Tony Facio Hospital, located in the Atlantic province of Limón, where some protesters tried unsuccessfully to block the entrance to hospital facilities at 2 p.m.

One hour later, strikers working for Hospital México, located in the northwest San José district of La Uruca, blocked trucks transporting hospital laundry.

In response, Health Minister María Luisa Ávila issued an order to allow police officers to intervene.

“I respect the right of people to protest,” Ávila said. “But strikers must also respect the right of people to receive medical attention. Patients in hospitals need clean clothes, and no social unrest should interfere with that.”

 “We just want the government to take urgent measures to save the Caja,” said Amaral Sequeira, secretary general of the Union of Medical Science Professionals. “We will protest as long as it is required so government officials commit to invest capital in our Social Security System.”

On March 6, an internal audit released by the Caja revealed that the institution is facing serious financial hardship that could drive it to bankruptcy without urgent action (see story on Page 7).

By Thursday, the ongoing strike grew in numbers. At 9:30 a.m., hundreds of marched down the capital’s Second Avenue, reaching the Caja headquarters at noon.

At least seven unions participate, including the University of Costa Rica Workers’ Union and the National Association of Public and Private Employees.

At 11 a.m., protesters demanded the resignation of Balmaceda and the entire Caja board of directors.

“We have noticed a slight increase in the strike’s support, Caja official Ubaldo Carrillo said. “We believe that about 4,000 workers are protesting, and all of them will have their paychecks reduced.”

According to Carrillo, $1.4 million will be deducted from the payroll of strike attendees. At press time, there was no sign of an agreement.

Stirring Up the Political Scene

On July 18, a few hours before the strike began, lawmakers voted to create a special commission to investigate whether Caja employee demands are valid. “There are direct perpetrators in the Caja case, and they should be in jail,” said Carmen Granados, a congresswoman from the Citizen Action Party. “Some people will have to explain how chaos affecting social security started.”

One of the most important consequences of the conflict between strikers and the government happened on Wednesday morning, when Eduardo Doryan, then head of the Costa Rican Electricity Institute, resigned his post after receiving harsh criticism for the Caja’s fiscal woes.

Doryan was executive director of the Caja during the second administration of President Oscar Arias (2006-2010), and according to a recent report by the Pan American Health Organization, the Caja’s financial problems worsened under his leadership.

President Laura Chinchilla announced Doryan’s resignation during a press conference in which Doryan was absent. The Tico Times tried to contact Doryan, but he did not answer calls to his cellphone.

Former Environment Minister Teófilo de la Torre replaced Doryan as head of ICE.

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