Reaching the millennium development goal for child mortality: Improving equity and efficiency in Ecuador's health budget

Rob Vos, J Cuesta, Mauricio León , Ruth Lucio, José Rosero

Research output: Working paperAcademic

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Abstract

Healthcare in Ecuador has improved substantially over the last 30 years but
spending remains low compared to other countries in the region and there are severe
inequalities in the system, particularly in access to healthcare for the indigenous
population, the poor and those living in rural areas. The 1990s saw a series of health
sector reforms, but many of the proposed measures remain to be implemented,
hindered by institutional weaknesses and a series of economic crises. The main focus
of this paper, however, is on how to reduce infant mortality rates, particularly for
marginalized groups. The recommendations aim to help the country achieve the
Millennium Development Goal (MDG) of reducing child mortality by two-thirds in
the period 1990–2015. For many better-off sectors of the population this target is
already in sight. The analysis shows that with the right health spending priorities that
are almost budget-neutral, the MDG is within reach for the whole population. The
related recommendations for health policies go some way in addressing the broader
problems in health service delivery, including low access to services, inequalities
across population groups and geographical areas, and low quality of services. The
recommendations are to protect the immunization program that has suffered recent
budget cuts and expand the Free Maternity Program (guaranteeing free access to free
pre-natal and delivery to all women). In the long-term the government could consider
a universal health insurance system as a means of improving equity and efficiency in
delivering healthcare, especially to the poor. However, current financial constraints
make that option impractical at present. The analysis uses an innovative combination
of econometric modelling techniques aimed at finding the most cost-effective ways to
achieve the desired results.
Original languageEnglish
Place of PublicationDen Haag
PublisherInternational Institute of Social Studies (ISS)
Number of pages37
Publication statusPublished - Jun 2005

Publication series

SeriesISS working papers. General series
Number411
ISSN0921-0210

Series

  • ISS Working Paper-General Series

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