“Political Will” and Community Participation in Costa Rican Primary Health Care

This article criticizes the concept of “political will” by analyzing Costa Rica's experience with community participation in health between 1973 and 1985. Despite a long‐standing state commitment to social welfare programs, Costa Rica has been unable to achieve active, sustained participation in the government's rural health programs, partly because of partisan conflicts over implementation. It is unlikely that “political will” can succeed in countries where the state's commitment to social welfare is less obvious than in stable, democratic Costa Rica. This article identifies three problems with the concept of “political will”: (1) by focusing on individual countries, it shifts attention from the international health agencies that so often determine poor countries' health policies; (2) it implies that states are monolithic entities, comprised of unified coalitions, rather than competing groups involved in a constant struggle over policy; and (3) it diverts the analytic gaze from global inequalities and relations of international dependency that contribute to poverty and ill health. Rather than blaming poor countries for their supposed “lack of political will,” international health organizations should examine what factors led them to rescind their commitment to community participation in health.