The 1990s health sector reforms in Costa Rica also initiated a process to transform the
supply-side steered system into one directed by demand (not yet completed) and to
strengthen the role of the Health Ministry as the national health system’s steward. Since
1989, stewardship in Costa Rica is defined in terms of the social production of health, i.e.
taking a multi-sectorial approach and acknowledging the importance of tackling the
social determinants of health.