Costa Rica implemented a “Program for results to strengthen Universal Health Insurance” and one of the program’s disbursements linked indicators (DLI-4) focuses on the design and implementation of Integrated Networks for the Provision of Health Services (RIPSS for its acronym in Spanish). The Costa Rican Social Security Fund (CCSS for its acronym in Spanish) defined the Huetar-Atlántica Region as a demonstration area for the implementation of the RIPSS, which began in 2019.In 2021, as part of the project requirements, the World Bank requested the assessment of the implementation of the RIPSS. The first step in the evaluation was the mapping of the RIPSS’ processes and was conducted using a Program Impact Pathways (or PIP) approach. The results showed that the RIPSS is a complex and synergistic system that requires different components to work correctly and in harmony to achieve the expected changes. The components of the RIPSS implementation were detailed in 6 PIPs: 1) needs assessment; 2) governance and management; 3) ambulatory surgery; 4) outpatient management (i.e., day hospital; 5) remote specialized care; and 6) integrated management and organization of type 2 diabetes (T2D) services.Aim The aim of this report is to document the fidelity of the implementation of the RIPSS in the Huetar-Atlántica Region in Costa Rica. Implementation fidelity seeks to assess the extent to which an intervention is implemented as planned and, for this, the PIPs were contrasted with what was implemented in practice. The assessment identified the following: (i) gaps in the implementation that require subsequent actions, and (ii) the core elements for the sustainability and scale-up of the RIPSS.