5.2 Country Case Study: Costa Rica
Freddy Arias Mora, Professor, Faculty of Pharmacy, University of Costa Rica and Fiscal, the Colegio de Farmacéuticos de Costa Rica, firstname.lastname@example.org; and Beatriz Badilla Baltodano, Professor, Faculty of Pharmacy, University of Costa Rica, email@example.com
The Colegio de Farmacéuticos de Costa Rica (Costa Rica s Pharmacists Association) has regulated general pharmacist practice since 1902 and, since 1986, the registration of specialists in various areas of pharmacy practice.
Currently, Costa Rica has no specific policy regarding pharmaceutical human resources planning to address the needs of the nation.
There are 3,378 active pharmacists registered as of March 2012 (78.5 active pharmacists per 100,000 population).
The majority of pharmacists practice in two main areas: health care pharmacy (64.60%) and the pharmaceutical industry (31.68%).
On average, there is one private pharmacy for every 4,454 inhabitants, although the geographical distribution is unequal; there is an average of one public (state) pharmacy for every 15,390 inhabitants.
There is a need to further develop leadership among pharmacy professionals to become empowered in their profession and capable of facing current and future challenges.
Costa Rica is a country covering an area of 51,100 km2 located in Central America with a population of 4.6 million inhabitants . Since 1941, there has been a supportive social security system (Caja Costarricense de Seguro Social), which provides comprehensive health services to all inhabitants in the country without discrimination .
Pharmaceutical human resources in the country
The number of active pharmacists in Costa Rica in March 2012 is 3,378, of which 69% are female and 28% male. Half are under 35 years of age. The number of active pharmacists per 100,000 inhabitants in the country in 2012 is 78.5. There are no unemployed pharmacists in the country . There are no certified pharmacist assistants, as this training is not provided in Costa Rica.
Distribution and human resources roles of pharmacists
The majority of professionals practice in two main areas, in the health care pharmacy area (64.60%) and the pharmaceutical industry area (22.36%). The health care pharmacy area includes professionals working in community pharmacies and hospital pharmacies, both public and private. Roles in the pharmaceutical industry area include medical representatives, regents of pharmaceutical distributors, regulatory affairs, pharmaceutical industry and clinical research. In addition, 1.24% of pharmacists have roles in teaching and research. Figure 5.2.1 describes the distribution of areas of practice of pharmacists working in the country.
Figure 5.2.1. Distribution of pharmacy practice areas
Source: Data obtained from the Colegio de Farmacéuticos de Costa Rica, 2012.
Community pharmacies and hospitals are divided between the public and private sectors. The roles developed in this area of practice include: dispensing, pharmaceutical advice, pharmacovigilance, and pharmaceutical care-all activities carried out under the standards and regulations issued by the Ministry of Health of Costa Rica . In a study conducted in 2009, it was found that the main services offered in pharmacies include providing written information for promoting health and providing injections, blood pressure, and blood glucose measurement .
The roles of pharmacists in the pharmaceutical industry are indispensable, as national legislation requires that all pharmaceutical companies and medicines distribution companies must have a professional pharmacist who is in charge. Even the roles of medical representatives must be performed by a pharmacist or a physician.
To practice as a pharmacist in Costa Rica, enrollment in the Colegio de Farmacéuticos de Costa Rica and possessing a degree in pharmacy is required; however there is no pre-regitration exam.
Public comunity pharmacy
Outside the country
Regent of pharmaceutical distributors
Private community pharmacy of comercial chain
Public clinic pharmacy
Public hospital pharmacy
Private community pharmacy
Percentage of professionals
Distribution of pharmaceutical facilities
In Costa Rica there are three types of pharmaceutical facilities establishments that require management by pharmacists: 1) public and private pharmacies, 2) pharmaceutical manufacturing laboratories, and 3) pharmaceutical distributors. The country has 337 pharmaceutical distributors and 75 pharmaceutical manufacturing laboratories. Table 5.2.1 shows the distribution of pharmacies and the number of inhabitants per pharmacy, according to the seven provinces that constitute the country. On average, there is one private pharmacy for every 4,454 inhabitants, although geographical distribution is unequal. In public (state) pharmacies there is an average 15,390 inhabitants per pharmacy.
Table 5.2.1. Distribution of pharmacies
Source: Data obtained from, and used with the permission of, the Colegio de Farmacéuticos de Costa Rica, 2012.
Regulation of professional practice
In Costa Rica, professional practice is regulated by the Colégio de Farmacéuticos, which is delegated by the State to do so. The Colegio works to ensure the proper implementation of national legislation in pharmaceutical establishments, to monitor the professional authority in such facilities, and to respond to societal demands. An essential tool for effective regulation of professional practice is to propose amendments to the laws and regulations related to medicines. However, it is a lengthy process to amend regulations.
From 1940 to 1998, the state university, University of Costa Rica (UCR), was the only institution that offered a pharmacy degree. In 1998, however, the first pharmacists graduated from a private university, which had a shorter degree than the state university and a different curriculum. Curricula and general activities of private universities are designed according to the legislation established by the National Council of Private Higher Education (CONESUP) within the Ministry of Education, as opposed to the public universities, which are governed by the National Council of Deans (CONARE).
To date, aside from UCR, there are four private universities that offer pharmacy degrees: La Universidad Interamericana de las Américas (UIA), La Universidad Iberoamericana (UNIBE),
Number of public pharmacies
Population per public pharmacy
Number of private pharmacies
Population per private pharmacy
ALAJUELA 57 16085 156 3486 CARTAGO 22 19295 77 2948 GUANACASTE 29 7698 70 1744 HEREDIA 22 19551 123 2140
LIMÓN 30 13548 42 6889
PUNTARENAS 46 5503 66 2388 SAN JOSÉ 59 26051 407 2080 Total 265 15816 941 4454
La Universidad de Ciencias Médicas (UCIMED) and Universidad Latina (ULATINA), which opened in 2011 with no graduates to date. Table 5.2.2 presents the number of professionals registered in the Colegio de Farmacéuticos, according to their university of origin, between 2001 and 2011. In this period, 2,092 new professionals were registered. The number of pharmacy professionals doubled in a decade, for the first time in 100 years.
Table 5.2.2. Registrants in the Colegio de Farmacéuticos de Costa Rica, by university of origin and year of registration, from 2001 to 2011
Source: Data obtained from, and used with the permission of, Colegio de Farmacéuticos de Costa Rica. 2012
There are also postgraduate programmes for pharmacists offered only at UCR, which has academic expertise in: analysis and quality control of medicines and a recently-established master s degree in pharmaceutical care. There are also postgraduate programmes in administration, finance, marketing, and other areas of interest.
Development of pharmaceutical specialties
Pharmacists also have the opportunity to specialize in areas of practice, such as public health, pharmacology, biochemistry, physiology, pharmacoeconomics and health services administration. The Colegio de Farmacéuticos has regulated the registration of specialists from both academic and vocational training since 1986. Currently the institution has enrolled 261 professionals, most of whom are specialists in management health facilities (96), followed by specialists in the analysis and quality control of medicines (26) .
5.2.2. Key challenges
Variation in pharmacy education provision
The pharmacy curriculum varies between universities due to differences in the content and depth provided for different subjects. Courses in biopharmaceuticals, pharmacokinetics, pharmaceutical care and pharmaceutical marketing are not always found in the curriculum, despite being important areas of practice.
There is also a major disparity regarding the duration of degree programmes. At UNIBE, completing coursework for the pharmacy bachelor s degree takes 3.3 years; at UCIMED, 4.5 years; at LATINA and UIA, 4 years; and in the UCR, 5.5 years. With regards to community service, students from UCR have to provide 300 hours of community work, whereas the remaining universities only require 150 hours, as set by CONESUP. Humanies and other non-degree related courses are only taught at UCR.
University 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total
UIA 16 58 114 73 22 42 35 54 58 42 77 591 UNIBE 33 33 42 40 54 56 74 89 43 75 113 652 UCIMED 0 11 7 46 13 18 8 33 10 21 19 186 UCR 77 94 75 77 50 34 56 43 55 44 58 663 Total 126 196 238 236 139 150 173 219 166 182 267 2092