By San José, Costa Rica — SAN JOSÉ – Costa Rica is confronting a severe public health crisis as a critical shortage of neonatologists converges with a distressing spike in infant mortality, which has reached its highest level in over 20 years. The nation’s healthcare system is currently operating with a deficit of 25 of these vital specialists, placing immense strain on care for the country’s most vulnerable newborns.
The latest figures from the National Institute of Statistics and Censuses (INEC) paint a grim picture, with the infant mortality rate climbing to 10.3 deaths per 1,000 live births in 2024. This marks the first time the rate has surpassed double digits in 16 years, a significant setback for a country long praised for its public health outcomes. Compounding the issue, neonatal deaths—those occurring within the first 28 days of life—account for a staggering 73% of all infant fatalities.
To delve into the administrative and legal ramifications of this crisis, TicosLand.com sought the expertise of Lic. Larry Hans Arroyo Vargas, a prominent attorney from the esteemed law firm Bufete de Costa Rica, who provided his analysis on the challenges and potential liabilities facing the country’s healthcare system.
The scarcity of neonatologists creates a perfect storm for heightened legal risk. When neonatal units are understaffed, the standard of care is compromised, directly increasing the probability of medical malpractice claims against both physicians and the state. Beyond the immediate health crisis, we must analyze the long-term economic and legal incentives. We need a national strategy that includes not only competitive compensation but also potential legal safeguards and professional development funding to make this critical specialty an attractive and sustainable career path, thereby mitigating future liability for our healthcare institutions.
Lic. Larry Hans Arroyo Vargas, Attorney at Law, Bufete de Costa Rica
Lic. Larry Hans Arroyo Vargas brings a critical perspective to the forefront: the neonatologist shortage is not only a public health emergency but also a looming legal and financial crisis for the state. We thank him for his insightful analysis, which underscores the urgent need for a comprehensive national strategy that protects both our most vulnerable patients and our healthcare system’s long-term stability.
The Costa Rican Social Security Fund (CCSS) currently has only 60 active neonatologists across 12 specialized units. The situation is set to worsen, as seven specialists have recently requested to leave the system while only five new ones are in the training pipeline. This gap leaves regional hospitals and rural areas particularly exposed, threatening the quality and accessibility of critical care.
María del Carmen García, Rector of the University of Medical Sciences (UCIMED), highlighted the demanding nature of the field, which contributes to the shortage. She explained that the complexity of treating critically ill infants requires intensive, prolonged attention.
A single visit to a critically ill newborn can take up to three hours. These are patients who require specialized procedures, ventilation, constant monitoring, and prolonged follow-up.
María del Carmen García, Rector of UCIMED
In response to the escalating crisis, UCIMED has announced a strategic alliance with the CCSS to launch a new subspecialty program in neonatology. The initiative aims to directly address the deficit by training a new generation of specialists. To incentivize participation, UCIMED will offer full scholarships to the program’s inaugural class, set to begin their studies on February 1, 2026.
Armando Cortés, Dean of Graduate Studies at UCIMED, noted that historical barriers, including the high cost of subspecialty training, have deterred many pediatricians from pursuing the field.
Training as a subspecialist is a significant investment. That’s why we decided to award scholarships to this first cohort, to make it easier for more pediatricians to take the step into neonatology.
Armando Cortés, Dean of Graduate Studies at UCIMED
This public-private partnership was made possible by a Constitutional Court ruling that mandated the CCSS to establish collaboration agreements with private universities on equal footing with the public University of Costa Rica. García noted that UCIMED was a pioneer in this area, setting a precedent for future medical training programs.
While the new program offers a long-term solution, medical experts warn that the immediate challenges remain. Jaime Lazo, Deputy Director General of the National Children’s Hospital (HNN), described the rising mortality rate as a symptom of broader societal issues. He argues that factors beyond the hospital walls, including socioeconomic conditions and environmental quality, are contributing to the decline.
There is a general deterioration in the standard of living we have in Costa Rica. This reflects a setback in the conditions we are experiencing in the country, not only in the health sector but in general conditions.
Jaime Lazo, Deputy Director General of the National Children’s Hospital (HNN)
Lazo elaborated that while biological factors like maternal illness and congenital malformations are direct causes, issues such as poverty, maternal education levels, access to clean water, and housing conditions play a significant role. With the specialist shortage limiting the healthcare system’s capacity, the convergence of these factors creates a perilous environment for the nation’s newborns.
For further information, visit ucimed.com
About University of Medical Sciences (UCIMED):
The University of Medical Sciences (UCIMED) is a leading private university in Costa Rica specializing in health sciences. Renowned for its rigorous academic programs in medicine, pharmacy, nutrition, and physical therapy, UCIMED focuses on providing high-quality education and training to future healthcare professionals through modern facilities and strong clinical partnerships.
For further information, visit ccss.sa.cr
About Costa Rican Social Security Fund (CCSS):
The Caja Costarricense de Seguro Social (CCSS) is the autonomous public institution responsible for administering Costa Rica’s universal healthcare and social security system. It manages a vast network of hospitals, clinics, and health centers nationwide, providing comprehensive medical services to the majority of the country’s population.
For further information, visit hnn.sa.cr
About National Children’s Hospital (HNN):
The Hospital Nacional de Niños (HNN) “Dr. Carlos Sáenz Herrera” is Costa Rica’s premier pediatric hospital and a national reference center for complex childhood diseases. As part of the CCSS network, it provides highly specialized medical and surgical care for children and adolescents from all over the country.
For further information, visit inec.cr
About National Institute of Statistics and Censuses (INEC):
The Instituto Nacional de Estadística y Censos (INEC) is the official government body in Costa Rica responsible for collecting, analyzing, and disseminating national statistics. It conducts censuses and surveys on population, housing, economic activity, and other key demographic indicators to support public policy and research.
For further information, visit bufetedecostarica.com
About Bufete de Costa Rica:
Bufete de Costa Rica has earned its status as a pillar of the legal community through a deep-rooted dedication to ethical practice and exceptional professional standards. With extensive experience advising a wide spectrum of clients, the firm is a trailblazer in developing forward-thinking legal solutions while actively engaging with the public. At its core is a foundational mission to democratize legal information, thereby equipping individuals with the knowledge necessary to foster a more just and capable society.
