• Spending overview
• Policy overview
• Diseases overview

Spending overview

Throughout the past decade, expenditure on healthcare in Ecuador has been extremely low by both regional and developed-country standards. According to the Banco Central del Ecuador (the Central Bank) and the Ministry of Finance, central government spending on healthcare has increased in the past few years, but is still around two-thirds of the Latin American average. The government is responsible for around 40% of total healthcare spending, of which around 15% is from the Instituto Ecuatoriano de Seguridad Social (IESS, the Ecuadorean Social Security Institute), with the rest coming from the Ministry of Public Health. Rafael Correa, the radical left-wing president, has pledged to continue increasing healthcare spending despite the current economic downturn.

In spite of higher spending by Mr Correa, the quality of public healthcare services is likely to remain weak, as the majority of spending continues to go on wage rises rather than service improvements. Given years of underinvestment, structural problems in the healthcare system will be difficult to tackle. As a result, funds will continue to be distributed unequally and overall project selection and execution is likely to remain poor, implying that higher investment will not necessarily improve healthcare access for the country’s poor. The perception that the government is taking a more lenient approach to social spending will increase pressure from public-sector workers for higher wages and better working conditions.

Policy overview

The healthcare system in Ecuador is based on a combination of public, private and volunteer support. The new constitution, which was adopted in September 2008, promises universal healthcare (which would require extensive investment and will take years to be implemented) and gives the executive more control over spending.

The public sector provides healthcare services for around 60% of the population.

The poorest generally receive the least benefit from state healthcare spending because of a lack of coverage. An estimated 20% of the population does not have access to any kind of healthcare treatment. The very low levels of health coverage reflect widespread levels of poverty (both rural and urban) as well as a low participation rate of private insurance companies.

Overall standards of healthcare service are poor, with the exception of a few private clinics in the main cities. Public healthcare workers strike regularly to demand higher salaries and better conditions, leaving patients without access to medical care. In spite of the prevalence of various tropical diseases, there is a huge shortage of medicines, equipment and trained personnel required to treat patients. Limited funding has traditionally been compounded by poor targeting, and a lack of co-ordination between different state agencies. State hospitals are usually overcrowded, waiting lists for surgeries are long and general health infrastructure is poor, particularly in rural areas. The recently expanded Programa de Aseguramiento Universal de la Salud (PROAUS, the Programme for Universal Health Insurance) aims to provide free medical care for the poorest 40% of the population, in an attempt to improve mother and infant mortality indicators. Another key aim is to strengthen the information technology (IT) network within the sector and to strengthen capacity among healthcare suppliers.

Diseases overview

Life expectancy in Ecuador (75.3 years in 2009) is relatively high and the rate of child mortality has declined steadily in recent decades. Ecuador's ranking in the 2008 edition of the Human Development Index of the UN Development Programme (UNDP) has improved strongly since 2007, moving from 89th to 72nd place (out of 179). The World Health Organisation (WHO) classes Ecuador among the top 15 Latin American countries with the highest child and adult mortality rates. There is a relatively high incidence of diseases caused by inadequate nutrition and poor sanitation and housing, especially in marginal urban and rural areas. Piped public water and sanitation reach less than one-half of the population. Periods of flooding have contaminated some local water supplies.

Common diseases include malaria and dengue fever. Acute respiratory infections and diarrheic diseases are widespread and have increased in the last decade. The HIV prevalence rate in adults is estimated at 0.3% of the total population, with most cases concentrated on the coast, in particular in Guayaquil. Urbanisation and the shift of employment towards more sedentary, office-based activities have also led to an increase in those illnesses more prevalent in developed countries, such as heart disease. According to a report by the Ministry of Health in 2007, around 17% of school-age children are overweight or obese, owing to a lack of exercise and unhealthy diet.