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The open road to health.


 The Hospital without Walls Programme was established in 5 cantons of Costa Rica's Alejuela province 15 years ago; it spanned 1500 square kilometers with a population of 100,000 fairly homogenous people. This report describes how this people participation health program has had to contend with population growth, changing age distribution, the dependence on monoculture, the development of new industries, and an acute economic crisis. This health program tried to encourage the involvement of the people in health matters as a part of an integrated social development program with a single administrative system and democratic participation at all levels. Since the people were involved, they became more educated in health care and issues. When serious economic hardship hit this region, the people had to attempt new and extra forms of income which left less time for volunteers to do their health duties. The report warned of the danger of allowing professionals alone to resolve the health problems, because their leadership undermined the volunteer democratic nature that fuels the program. The report suggests a multidisciplinary panel of professionals who work with the volunteer system and plan a fair, scientific, health community.
