Abstract
Aim
To analyze the effects that the reform of the public health model of Ecuador has had on the deployment of a comprehensive health care system, taking into special consideration its capacity to respond to social inequalities in health.
Methods
We carried out a systematic review of the literature following the PRISMA checklist in the Scopus and Google Scholar databases. Screening identified 20 documents for inclusion in the review.
Results
Health reform in Ecuador has promoted the creation of a primary care model with a special focus on vulnerable groups and health inequities. However, a history of a dispersed and fragmented health care system, the geographical distribution of health professionals, the tradition of biomedical models of health practices, and structural inequities remain important challenges.
Conclusions
We found evidence of substantial improvements in the structure and coverage of the health system towards a model of unified health care that prioritizes comprehensive primary care. The political and social changes of the last decade and the reform of the health model in Ecuador have provided a framework for the construction of a socially committed health caresystem. However, there are significant shortcomings and challenges that need to be resolved in order to reduce the conditions of notorious social inequality in health still found in Ecuador.
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This systematic review focused on the process of change produced in Ecuador’s health system, where the State plays an essential role in guaranteeing the health of its population and as a response to the previous situation produced by neoliberal logic. The review allows us to understand the efforts made and the future challenges to guaranteeing an effective production of equitable public health policies. Although the review captures the analyses carried out at the academic and institutional levels, it fails to capture the local experiences present in non-scientific and non-institutional literature. Going deeper into the local literature (e.g., news, stories, etc.) would allow us to complement the findings with concrete experiences where the improvements, failures and challenges of this change in health model materialize.
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Santoro Lamelas, V. Model of health and social inequalities in Ecuador: progress and challenges. A systematic review. J Public Health (Berl.) 29, 775–785 (2021). https://doi.org/10.1007/s10389-019-01183-0
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DOI: https://doi.org/10.1007/s10389-019-01183-0