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Since then, public spending on health care, education and pensions has increased. 42. (...) In 2007, the Government introduced a medical insurance programme for the poorest 20 per cent of the population; in 2013, it established a State- funded universal health programme, which provides a basic package of primary health-care services, covering also emergency medical care in outpatient and inpatient settings. (...) Long-term care can be both medical and non-medical; it comprises a large spectrum of care services, which include primary, secondary and tertiary care, public health services and emergency services.

Traditional healers are often the first recourse for people facing a health emergency. In addition, a very small part of the population is covered by private health care, mainly concentrated in the big cities.31 71. (...) Older persons living in rural areas face larger distances, particularly in cases where more specialized health care is required, and have more limited transport options. 73. (...) While geriatric care is included in the training of health workers, insufficient specialized knowledge on the part of staff and the lack of equipment and medication resu lt in health staff often being unprepared to address the health concerns of older persons.

MOH has also developed various modules, guidelines, SOPs to train health care providers on provision of quality, comprehensive adolescent friendly health services. (...) Medical Personnel at all health facilities shall provide care to all patients according to their clinical status. (...) The GOM does not condone discrimination and violence towards anyone seeking health care services; including prevention, testing and care.

:INDIGENOUS ISSUES : WRITTEN SUBMISSION / SUBMITTED BY THE WORLD HEALTH ORGANIZATION (WHO)

Approximately 97 per cent of older persons have health insurance despite the fact that only 80 per cent of them have some form of income, though many of them get their health insurance indirectly through a family member.27 The Social Insurance Fund of Costa Rica has been the institution responsible for providing public health-care services since the 1970s, after taking over from the Ministry of Health, which is tasked with monitoring the execution of essential health-care functions and ensuring sectoral governance. 47. The health-care system provides three levels of care. The first consists of health posts, centres and clinics, which have Basic Comprehensive Health-Care Teams (EBAIS) and serve about 94 per cent of the population.

The Special Rapporteur is concerned about the limited accessibility and affordability of health services61 due to the policy of imposing “user fees” in the public health-care system. (...) A/HRC/23/36/Add.1 GE.13-13725 16 insurmountable barrier to accessing health-care services, especially as this cost comes on top of transportation and other indirect costs that they have to bear to reach health centres. (...) The inequality in the enjoyment of the right to health is also reflected in the severe gaps in institutional capacity as well as the shortage of skilled health-care professionals, particularly in rural by comparison with urban areas.62 There is a disproportionately large number of health-care facilities and health workers in urban areas as compared to rural areas (76 per cent of doctors work in urban areas as compared to 24 per cent in rural areas).

The only provision regulating this matter is article 143 of the Law on Health Care, which allows in vitro fertilization. (...) The regional bodies for guardianship and custody are composed of representatives of local authorities and NGOs, and take decisions on support benefits for children and their families, and the placement of children in alternative care settings such as foster care and small group homes. 43. (...) She welcomes the adoption of government resolution No. 66 of 15 January 2014 on technical regulations on approval of child care standards, which apply to day-care centres and childcare institutions, such as small group homes, that provide 24-hour services to children.

In November 2015, it created the National Care System, which includes both existing policies on health, education and social security, and new policies for priority populations, in particular older persons with specific care needs, persons with disabilities and young children. (...) While it provides for the establishment of a national mental health-care oversight commission, the Commission for the Control of Mental Health Care, it does not provide for that commission to have a sufficiently independent status. (...) It has also made significant progress with the National Integrated Health System, which aims at ensuring universal coverage and codifying older persons’ right to care.

However, it is not then authorized to look for the reasons of malfunctioning of public health care system in insufficient financing from the source. (...) According to Principle 8 (PoA ICDP) States should take all appropriate measures to ensure, on a basis of equality of men and women, universal access to health-care services, including those related to reproductive health care, which includes family planning and sexual health. (...) Since 2005 The National Health Fund has been financing the pre-natal testing programme included in the basic benefits package in the field of health care programs.

It complements provincial and territorial health-care programmes as well as other First Nations and Inuit community-based programmes and services. (...) Many persons with disabilities, particularly children and older adults, are sent to long-term care facilities far from their communities to receive health-, residential or palliative care services that are not culturally appropriate. (...) Nevertheless, deaf, deafblind and hard-of-hearing persons reported difficulties in obtaining sign language interpretation or assistance to access services such as education, health care and legal aid, or to attend public events.