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Strengthening the National Health Authority
Main component of the Health Sector Transformation process in Ecuador

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Indigenous mothers and child waiting at a public health center in Ecuador

The Ministry of Public Health (MPH) of Ecuador identified the challenges for strengthening health system performance in that country namely, lack of leadership, institutional segmentation, fragmentation of services, inadequate model of care, limited state investment in health, insufficient management capacity, inadequate coverage, and low quality of care. As a result, 27% of the population does not have access to care, the public coverage only reaches 49% of the population, and 44.3% of the health expenditure comes directly from households and is higher among poorer sectors of the population, which spend nearly 10% of its annual income on health.

In order to confront these challenges, in the period 2007-2008, the MPH embarked on a process of Health Sector Transformation, which identified the strengthening of the Steering Role of the National Health Authority (NHA) as one of its main strategic areas. The transformation proposal called for improving the competencies and capacity of the Ministry of Public Health for health policy-making; strengthening sectoral management and regulation; defining and implementing a quality assurance system; enhancing public health surveillance; integrated management of national and international cooperation resources; promoting technological research and development in health; and implementing a National Information System. The proposal also emphasized the need for restructuring the MPH, including strengthening its organizational structure, developing human resources, and improving strategic management.

In an effort to support the implementation of the Health Sector Transformation process, PAHO, with USAID assistance, has been providing technical cooperation to the Ministry of Public Health for the evaluation and strengthening of the steering role of the NHA, and the identification of the attributes necessary for integrating services and building comprehensive local health networks anchored on Basic Health Teams. As part of this effort, the tools and methodologies developed within the framework of the PAHO-USAID cooperation agreement have been crucial in helping the Ministry identify the gaps that need to be addressed.

The National Constitutional Assembly of Ecuador welcomed the text of the Health Sector Transformation proposal that will be submitted for national consultation, establishing health as a right and defining the state’s responsibility through the National Health Authority to formulate national health policy and steer, regulate and control all health-related efforts and actors. The consolidation of the NHA as the sector’s steering entity, along with the reorganization of the MPH, constitutes a prerequisite for the successful implementation of the proposal.

Building Integrated Delivery Networks in Ecuador

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A Basic Health Team making visits in Ecuador.

The Constitution of the Republic of Ecuador, approved in September 2008, determines in Art. 360 that the National Health System shall be organized with a Primary Health Care (PHC) approach and that it shall function through integrated networks that offer universal and equitable health services, under the leadership of the national health authority. This entails a challenge for the Ministry of Public Health (MPH) of Ecuador. In order to build integrated health services networks based on PHC, the MPH must tackle the fragmentation and segmentation that characterize its health system.

As a first step in that direction, and based on the Integrated Health Delivery Networks Initiative developed by PAHO with the support of USAID, an evaluation of the primary care network in five provinces of the northern border - Esmeraldas, Carchi, Ibarra, Coca y Sucumbíos - was conducted from February 9 - March 5, 2009. The Initiative defines 12 attributes of integrated networks for which specific components were identified, whose presence or absence shows the degree of integration/fragmentation of the network at a given time. As part of this operational research, a General Integration Index was developed. The index allows a fast, precise and objective overview of the key network components in need of strengthening and helps in the prioritization of interventions areas, the design of strategies, and evaluation.

The methodology as a whole and the Integration Index in particular are powerful tools that can be used not only for comparative analyses but also as a platform of instruments and processes that can support health systems decision making at the time of designing and implementing necessary interventions for the strengthening of networks linked to a specific health model or strategy.

Last Updated on Tuesday, 11 January 2011 10:52

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