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Corporate influence in policy and decision-making is an important public health concern. This Health Policy paper reviews Ecuador's child malnutrition strategy instruments, approved between 2020 and 2023, to identify how private interests are becoming legally integrated into the public sector. Evidence indicates that recent changes are enabling corporations to promote their brands, gain tax deductions, oversee public policy and set priorities, allocate resources, and decide on implementation of the country's child malnutrition strategy. Further, corporate representatives are active members of an advisory council, free from scrutiny or accountability, while being privy to undisclosed government information. Moreover, a UN agency (the World Food Program) engaged in corporate promotion of highly processed foods, illustrating the breadth of Ecuador's corporate influence scheme. Improved regulations should set clear limits to the influence of food and beverage industries in national nutrition policy, while following transparency laws in the composition and operation of Ecuador's child malnutrition strategy and related efforts.

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Venezuela's ongoing economic and political crisis has forced >6 million people to emigrate from the country since 2014. In the Andean region, Ecuador is one of the main host countries for Venezuelan migrants and refugees. During the coronavirus disease 2019 (COVID-19) pandemic, specific measures were implemented in the country to control the spread of the disease and its associated impacts. In this context, we conducted a scoping review to understand how policies implemented by the Ecuadorian government during the pandemic impacted Venezuelan migrants' right to health. The literature search focused on scientific and grey publications between 2018 and 2022 in electronic databases and institutional websites, complemented by snowball sampling and expert advice. Our thematic analysis revealed discrepancies between the rights granted to migrants in Ecuador's legal framework and their practical implementation during the pandemic, with several instances of policy and programmatic infringement. The disruption of services further complicated migrant's options for regularization. Some measures, like border closures, negatively impacted migrants' health, including increased exposure to abuse and violence. While migrants were included in the country's COVID-19 vaccination plan, they were excluded from other national aid programmes. There are indications of an increase in xenophobia and discrimination stigmatizing migrants as 'disease carriers' and 'resource takers', resulting in a prioritization of services for the Ecuadorian population. We found limited research on the emergent topic of migrants' vulnerability and related health system challenges. Future research should include working in border zones, consider socioeconomic factors and further explore the poor implementation of Ecuador's legal framework towards upholding migrants' right to health.

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Primary health care is at the core of health systems that aim to ensure equitable health outcomes. With an estimated 36% of rural population, Ecuador has a service year programme (created in 1970) for recently graduated doctors to provide primary care services in rural and remote communities. However, little has been done to monitor or evaluate the programme since its inception. The aim of this study was to assess Ecuador's rural medical service implementation with a focus on equitable distribution of doctors across the country. For this purpose, we analysed the distribution of all doctors, including rural service doctors, in health-care facilities across rural and remote areas of Ecuador in the public sector at the canton level for 2015 and 2019, by level of care (primary, secondary and tertiary). We used publicly available data from the Ministry of Public Health, the Ecuadorian Institute of Social Security and the Peasant Social Security. Our analyses show that two of every three rural service doctors are concentrated at the secondary level, while almost one in five rural service doctors, at the tertiary level. Moreover, cantons concentrating most rural service doctors were in the country's major urban centres (Quito, Guayaquil, Cuenca). To our knowledge, this is the first quantitative assessment of the mandatory rural service year in Ecuador in its five-decade existence. We provide evidence of gaps and inequities impacting rural communities and present decision makers with a methodology for placement, monitoring and support of the rural service doctors programme, provided that legal and programmatic reforms come into place. Changing the programme's approach would be more likely to fulfill the intended goals of rural service and contribute to strengthening primary health care.

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This study analyzes the conditions and possibilities of sustainability of the Salud al Paso program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of the implementation of this initiative, focused on the prevention of noncommunicable diseases (NCDs), was based on the program's user database, the information gathered on the perspectives of operational staff, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the on-demand activities included in the program and limit activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elder care programs, and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived as a project with an insufficient vision of its sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of NCDs requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral coordination articulation, especially with the Ministry of Public Health and other service networks.

El presente estudio analiza las condiciones y posibilidades de permanencia del programa Salud al Paso de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.

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[ABSTRACT]. This study analyzes the conditions and possibilities of sustainability of the Salud al Paso program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of the implementation of this initiative, focused on the prevention of noncommunicable diseases (NCDs), was based on the program’s user database, the information gathered on the perspectives of operational staff, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the on-demand activities included in the program and limit activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elder care programs, and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived as a project with an insufficient vision of its sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of NCDs requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral coordination articulation, especially with the Ministry of Public Health and other service networks.

[RESUMEN]. El presente estudio analiza las condiciones y posibilidades de permanencia del programa Salud al Paso de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.

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Global shifts toward a disease-oriented, vertical approach to health has involved limiting the right for communities to participate in decision-making. Ecuador's authoritarian legacy has forced civil society and social organizations to adopt 'coping strategies', while large protests recently derived into violent struggles. The country has been severely hit by the COVID-19 pandemic amid corruption scandals involving hospital and food purchases by government during the response. This study critically examines how Ecuador's government took into consideration 'community participation' as a value and tenet of health promotion. Our systematic textual analysis focuses on 53 consecutive resolutions by the National Emergency Operations Committee (EOC) leading the decision-making processes, which, explicitly requires community participation. Results show that the 'lifecycle' of the central government's evolving policy framing centered on law enforcement and the private sector, followed by the social sector. Further, there is no evidence of stakeholders from civil society or organizations taking part in decision-making. Having legitimized the exclusion of community participation in Ecuador's response to the COVID-19 pandemic, it is possible that the government will fail to consider the wider social implications of its impact. In particular, the limits to local governments becoming informed and making decisions without mediation by the National EOC will further impede community participation in health decision-making in the future. This implies that local knowledge and experiences will also not inform health policy.

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ABSTRACT This study analyzes the conditions and possibilities of sustainability of the Salud al Paso program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of the implementation of this initiative, focused on the prevention of noncommunicable diseases (NCDs), was based on the program's user database, the information gathered on the perspectives of operational staff, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the on-demand activities included in the program and limit activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elder care programs, and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived as a project with an insufficient vision of its sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of NCDs requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral coordination articulation, especially with the Ministry of Public Health and other service networks.

RESUMEN El presente estudio analiza las condiciones y posibilidades de permanencia del programa Salud al Paso de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.

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This study analyzes the conditions and possibilities of sustainability of the "Salud al Paso" program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of this implementation, focused on the prevention of noncommunicable diseases, was based on the program's user database, the information gathered on the perspectives of operational personnel, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the free demand activities included in the program and limit the activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elderly care programs and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived more as a project with an also insufficient vision of sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of noncommunicable diseases requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral articulation, especially with the Ministry of Public Health and other service networks.

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[RESUMEN]. El presente estudio analiza las condiciones y posibilidades de permanencia del programa “Salud al Paso” de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.

[ABSTRACT]. This study analyzes the conditions and possibilities of sustainability of the “Salud al Paso” program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of this implementation, focused on the prevention of noncommunicable diseases, was based on the program’s user database, the information gathered on the perspectives of operational personnel, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the free demand activities included in the program and limit the activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elderly care programs and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived more as a project with an also insufficient vision of sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of noncommunicable diseases requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral articulation, especially with the Ministry of Public Health and other service networks.

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En mayo de este año, la Revista Panamericana de Salud Pública dedicó un número especial a promover el proceso más reciente de reforma de salud en Ecuador como un caso exitoso en la región. En el artículo editorial, la directora de la Organización Panamericana de la Salud (OPS), Carissa Etienne, plantea que los “sistemas de salud deben hallar modos innovadores para organizar y financiar los servicios de salud para poder progresivamente extender la cobertura, incrementar el acceso equitativo al cuidado, y proveer protección financiera, especialmente para los grupos poblacionales más vulnerables” (traducción propia). En principio, llama la atención que se presente una visión sesgada del proceso de reforma, donde priman opiniones de funcionarios del gobierno y consultores del Ministerio de Salud Pública (MSP) y la OPS, en detrimento de contribuciones desde la academia y organizaciones de la sociedad civil. Adicionalmente, los autores plantean la atención primaria de salud (Modelo de Atención Integral de Salud, MAIS) como estrategia de reforma...

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IMPORTANCE: Regular ocular care is critical to early detection and prevention of eye disease and associated morbidity and mortality; however, there have been relatively few studies of ocular health care utilization among Hispanics/Latinos of diverse backgrounds. OBJECTIVE: To examine factors associated with ocular health care utilization among Cuban, Central American, and South American Hispanics/Latinos in a cohort study. DESIGN, SETTING, AND PARTICIPANTS: An ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) evaluating ocular health, knowledge, risk factors, and health care use was conducted with 1235 HCHS/SOL participants (aged ≥40 years) at the Miami, Florida, study site. Data were collected from October 17, 2011, to September 30, 2013, and analyses were conducted from May 28, 2014, to March 18, 2015. Descriptive and multivariable logistic regression analyses were performed for 3 ocular health care outcomes. Regression models were built sequentially with variables conceptually grouped according to Andersen's Behavioral Model of Health Services Use. MAIN OUTCOMES AND MEASURES: Ever having an eye examination, having an eye examination performed within the past 2 years, and difficulty obtaining needed eye care in the past year. RESULTS: Of the 1235 participants, 478 were men and 757 were women, and they had a mean (SD) age of 53.6 (8.1) years. Those who never had insurance were less likely to have had an eye examination (with data reported as odds ratios [95% CIs]) ever, 0.19 (0.07-0.53) and in the past 2 years, 0.22 (0.15-0.33) and were more likely to have had difficulty obtaining needed eye care in the past year (3.72 [1.75-7.93]). Those with less than excellent or good self-rated eyesight were less likely to ever have had an eye examination (0.26 [0.12-0.56]) and more likely to have had difficulty obtaining care (3.00 [1.48-6.11]). Men were less likely to ever have had an eye examination (0.31 [0.18-0.53]). Older (55-64 years) Hispanics/Latinos (3.04 [1.47-6.31]) and those with a high school degree or general educational development certification (2.06 [1.02-4.13]) or higher levels of education (4.20 [2.12-8.30]) were more likely to ever have had an eye examination. Finally, those living in the United States for more than 15 years (0.42 [0.21-0.82]) were less likely to have had difficulty obtaining care. CONCLUSIONS AND RELEVANCE: Our findings suggest that increasing insurance coverage, decreasing the costs of care, and increasing the availability of care for Hispanics/Latinos with poor self-rated eyesight are relevant issues to address to improve ocular health care use among Hispanics/Latinos of diverse backgrounds.

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OBJECTIVE: The present study was aimed at analysing socioeconomic inequity regarding the use of health services in Ecuador, inequity regarding the geographic distribution of healthcare-related human resources and reflecting on the challenges concerning equity which the Ecuadorian health system is currently facing. METHODS: The Ecuadorian Demographic, Maternal and Infant Health Survey (2004) was used as the main data source, as its sample was representative of the Ecuadorian population. Multilevel multivariate analysis (MLWiN 2.02 statistical software) and spatial data analysis regarding health resources (GeoDa 1.0.1) were used for estimating the effects of using health services. RESULTS: It was found that social, economic and geographic inequity limited access to health services in Ecuador. People living in low economic resource households or indigenous housing and people living in rural areas (many of them having all three characteristics at the same time) had less possibility of using health services. In spite of a marked concentration of health-service providers in urban areas, it was found that the presence of healthcare personnel (excluding doctors) in rural public entities increased the possibility of using preventative and curative services. CONCLUSIONS: Efforts at transforming the Ecuadorian health system must be aimed at reducing social, cultural and financial barriers and inequality regarding the distribution de healthcare-related human resources, particularly in rural areas. Community and family orientation of the services and increasing spaces for citizen participation are necessary for reducing such inequity.

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Migrant and seasonal farmworkers face many health risks with limited access to health care and promotion services. This study explored whether fear of deportation (as a barrier), and church attendance (as an enabling factor), were associated with medical and dental care use among Mexican-origin farmworkers. Interviews were conducted with 179 farmworkers who attended mobile services provided by a local federally-qualified health center (FQHC) in partnership with area churches, during the 2007 agricultural season. The majority of respondents (87 %) were afraid of being deported, and many (74 %) attended church. Although about half of participants reported poor/fair physical (49 %) and dental (58 %) health, only 37 % of farmworkers used medical care and 20 % used dental care during the previous year. Fear of deportation was not associated with use of medical or dental care; while church attendance was associated with use of dental care. Findings suggest that despite high prevalence of fear of deportation, support by FQHCs and churches may enable farmworkers to access health care services.

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OBJECTIVE: To examine the relationship between migration and migrant remittances and health care utilization in Ecuador, and to identify any potential equalizing effects. METHODS: Using data from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN), a multilevel multivariate analysis was conducted to assess the relationship of two migrant predictors (households with an international migrant; use of migrant remittances) with use of preventive care, number of curative visits, hospitalization, and use of antiparasitic medicines. Relevant predisposing, enabling, and need factors were included following Andersen's Model of Health Care Utilization Behavior. Interaction terms were included to assess the potential equalizing effects of migration and remittances by ethnicity, area of residence, and economic status. RESULTS: Migrant predictors were strongly associated with use of antiparasitic medicines, and to a lesser extent, with curative visits, even after adjusting for various predisposing, enabling, and need factors. Interaction models showed that having an international migrant increased use of these services among low-income Ecuadorians (quintiles 1 and 2). No significant relationship was found between migrant predictors and use of preventive services. CONCLUSIONS: Migration and remittances seem to have an equalizing effect on access to antiparasitic medicines, and to a lesser extent, curative health care services. Health care reform efforts should take into account the scope of this effect when developing public policy.

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