Challenges to effectiveness in public health organizations: The case of the Costa Rican Health Ministry

This case provides a setting to analyze organizational problems impeding effective execution in public health organizations in Latin America. This teaching case describes the conditions leading to the weakening leadership of the Costa Rican Health Ministry (CRHM) by the end of September 2014. The document was written based on a combination of interviews with key decision-makers and published/archival data. Students are expected to assume the role of CRHM's General Director, Priscilla Herrera, and propose organizational changes that will improve effectiveness in the ministry's operations. A widespread assumption is that politicians and top-level bureaucrats, due to vested interests or poor judgment, are the root cause of ineffectiveness in the public sector. This case presents a broader picture by suggesting excessive centralization of functions, weak authority lines, conflicting agendas at different organizational levels and regulation rigidities as significant factors affecting public healthcare operations.