Formative Research for Ecuador’s Health Reform
The beginning of the administration of President Rafael Correa faced a health sector that has serious long -term consequences as a result of the neoliberal policies of the 1990s and the democratic instability of the early 2000s with gradual budget cuts. And health management mechanisms that involve direct costs of users’ services, transfer without providing services to municipalities, lack of investment in infrastructure, labor and loss of leadership, leading to coverage and poor quality of thepublic services. And so on, pocket expenses, which mainly affect the poorest population. Intervening in the health sector means rescuing an institution from a deep crisis that required two basic conditions: a great economic effort to close quality gaps and access to high quality care, and political power to recover sovereignty. Reform of the regulatory and institutional frameworks of savings in the country’s health authority, especially the Ministry of Public Health.
Change and investment of the minimum to what is necessary
This huge investment has been the cause of the adaptation, expansion and renewal of the hospital network in the structure it had and in the necessary equipment, as well as the construction process of 18 new hospitals. The investment also aims to guarantee fair preparation care, reduce the costs of 115.000 to 35.000 by ambulance and connect it to ECU-911, which supervises emergency care throughout the country. Since 2012, after completing the standards of the Integral Public Health Network (RPIS) and the First Level Health Center, construction has been completed in 171 new records. In addition to increasing operating costs to cover salary and personnel increases, a great investment in staff training has been made. Ecuador has granted more than 2.750 scholarships to various health professionals. Similarly, the cost of medicines has increased from just over $ 100 million in 2007 to more than $ 380 million in 2013. All this investment means a significant improvement in people’s access to public services. In 2006 the figure was 14.372.2251, while in 2013 it was 38.388.410.
Ministry of Public Health in command: provides public benefits to the government
The political-strategic definition of the reform is based on the creation of a national health system, whose main element is the existence of a national health authority led not only by the provision of health services, but also by what the do theHealth Agents of the National Health Center. Which should be established as a government structure to ensure long -term domain of the public interest on the private sector. This represents the leadership rescue process of the MSP, which is explained in two ways: the implementation of a regulatory framework and an institutional framework that supports and implements this regulatory framework. These two aspects are identified in the reform axes.
Comprehensive Public Health Network
Ecuador’s health system, as many countries in our region, is a dispersed system that consists of the MSP Public Health Services, the Ecuadorian Social Security Institute (IESS), Social Security Institute of the Armed Forces (ISSFA)and some services with less coverage than local governments and other ministries, in addition to providing private services, working with budgetary systems, human resources policies, acquisitions and more. However, in the early 2000s there were advances in the construction of the SNS, such as the Law of the National Health System (2002) and then the Organic Health Law of 2006. And in 2008 in the Constitution it was mentioned, the Comprehensive Health Public Network will be part of the National Health System and will be made up of the articulated set of state establishments, social security and with other suppliers that belong to the State.
Strengthen human resources
One of the main concerns of the reform is the deterioration of human resources in public networks but mainly in the MSP. With large gaps in the number of specialists required, at all levels of the system, low salaries and job instability increase. An aspect of prioritization is the training of personnel. For doctors, for example, this means an average increase of around 80% at the time of prescription. On the other hand, labor policy is designed to ensure the equitable distribution of human resources in the national territory. An interesting program for the call, Healthy Ecuador, I return for you, which in 2013 managed to involve more than 760 health professionals and repel them abroad.
Primary Health Care System: Prevention and Promotion of Advertising
Although initially it was about closing the gaps in the hospital, it was always clear that the SNS had to have the support of the APS. Therefore, the relocation of public investment in health infrastructure and human resources at the first level is of representative action.
Thus it would be possible to obtain a system that prevents the disease, in order to avoid the use of resources excessively and unnecessary.
Financial stability
One of the current concerns of the MSP and the Government is the financial sustainability of this reform process. This cost control is provided by a predominantly public service provider, and this strengthens the National Health Authority to properly control the efficiency of services provision and formulate policies that affect health determinants, public interest;The fact that the SNS is based on APS prioritizes preventive and promotional aspects. And this financing must be fair, supportive, sustainable and efficient.
All these actions have focused on the objective of obtaining financial sustainability, and good enough for the reform that has been applied.
conclusion
Finally, it can be said that the reforms made at the beginning of the former president’s government have been in any way in which they can be seen, very significant. All this marking a before and after in the health care systems throughout the country, thus leaving a high legacy, and helping all people to have an entry to basic health services, at least in theory.
All changes, both financial and human and political resources tend to improve the health system in relation to the way to present it to the Ecuadorian people.
However, there has been no way to completely ensure the quality of the health service provided to people, since until today you cannot have a direct access, either due to lack of information towards the Ecuadorian people,or so simply because of the lack of resources.
Since everything in terms of the health that occurs publicly, it is not one of the best that exist, and although the necessary investment has been given, it can be said that there was a possibility of giving a greaterinvestment, since they have not ceased to exist failures.
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