Introduction
As a country falling under the category of states with a high mortality rate, Ecuador is selected. Based on further analysis, the Ecuador health system is not sufficiently advanced. One of the indicators that reflect the alarming situation in the state is the high infant mortality rate. Also, despite the average parameter of life expectancy at a mature age, the degree of child mortality is relatively high.
The purpose of this work is to consider the factors that affect the quality of healthcare in Ecuador and allow assessing the effectiveness of measures taken concerning the protection of the population. As a justification, academic works will be reviewed, as well as information from official websites on medical subjects. The evaluation of the governing, economic, and medical aspects of life in the country may allow identifying the basic problems and the development of the Ecuadorian healthcare system.
Location/Geography
Ecuador is located in the northwest of the South American continent on the Pacific coast. The neighboring countries are Colombia and Peru, and most of the borders are land. The nature and climate of the country are favorable for the development of a recreational area, and many tourists come here regularly. In the center of the country, there is the Andes mountain range and many active volcanoes.
The diversity of the state’s flora makes Ecuador the region with uniquely preserved evergreen forests. The country is located in two climatic zones – equatorial and subequatorial. Steadily warm weather forms immunity to heat among residents, and occasional high temperatures are not a serious health hazard as it often happens in countries with a temperate climate. The proximity to the ocean is beneficial and allows people to receive important minerals and vitamins due to healthy eating habits and nutrition.
Population
Due to the relatively small area of ​​the country, Ecuador has a not too high population density. According to the official data provided by the World Health Organization (WHO, 2018), according to the latest census in 2016, the total population was 16 million. At the same time, children under the age of 15 made up 30% of the population, which indicates a large number of young people in the country (International Medical Aid, 2018). According to International Medical Aid (2018), most of the residents are concentrated in two large cities – Quito, the capital of Ecuador, and Guayaquil.
The population density in other parts of the country is insignificant since large areas are occupied by wild forests and mountain ranges. The average life expectancy for men is 74, and for women, this indicator is equal to 79 (WHO, 2018). By ethnic and racial composition, Ecuador is a multinational country, and most of the population are mestizos, while Indians, whites, and African Americans are in the minority (International Medical Aid, 2018).
Government
By the type of government, Ecuador is a republic, and the president is the head of the state. The legislative power is upheld by the Parliament, and the judiciary system is represented by the National Court. Also, in the state, there are many political parties, and each of them adheres to certain courses. The Government of Ecuador is an executive body whose structure includes various ministries, including the Ministry of Health. In general, the governing system in the country is not distinguished by a unique approach to controlling different spheres, and standard republican principles are supported by official boards.
Economy
Oil production and the export of fuel are the key industries that generate maximum revenue. In addition, much exotic fruit grows in the country, which is also sold in the foreign market. According to International Medical Aid (2018), the monetary reform of 2000, which determined the transition from the local currency to the US dollar, allowed stabilizing the economy of Ecuador, since before, the state’s external debts had been significant.
In terms of healthcare costs, the government allocates money for the development of this area. According to WHO (2018), based on 2014 statistics, the “total expenditure on health as % of GDP” was 9.2. Also, in the same year, the “total expenditure on health per capita” was $ 1.040 (WHO, 2018). The purchasing power parity (PPP) is an essential parameter measured in dollars and often referred to as the gross national income per capita. According to official data of 2014, in Ecuador, this indicator was equal to 10 (WHO, 2018). In general, the country’s economy is not stable, and periodic problems arise related to tax legislation, reduction in oil production, and other nuances.
State of Health (Diseases/Violence/Accidents)
Although the Government of Ecuador invests in medicine, some healthcare indicators deserve attention. In particular, even though the infant mortality rate has dropped significantly over the past decades, its indicators are still alarming. For instance, since 1990, infant mortality of under-1 age has decreased from 29.8 per 1000 live births to 13.5 per 1000 live births (Institute for Health Metrics and Evaluation [IHME], 2018).
Concerning illnesses in adults, Ischemic heart disease is the leading cause of death. Chronic heart disease, stroke, and lower respiratory infections occupy the following rating lines (IHME, 2018). Interpersonal violence takes the twelfth line of this rating, and over the past decades, the number of deaths, for this reason, has decreased by 31.8% (IHME, 2018). Accidents are not included in this gradation; therefore, their number is not significant to take into account.
Culture/Traditional Medicine
Ecuador’s health care system provides access to various medical services; nevertheless, in the country, the principles of traditional treatment are developed, and the experience of ancestors is significant. According to International Medical Aid (2018), “in rural areas and among indigenous populations, access to routine medical care is even less common” (para. 2). This factor explains the tendency of adhering to traditional healing practices and self-care methods.
Healthcare System and Delivery
Governmental health-related agencies and health regulatory organizations
The main governing board regulating the system of medicine in the country is the Ministry of Health, which is one of the divisions of the Ecuadorian Parliament. In addition to this board, other organizations monitor the work of medical personnel, including both senior and junior staff. However, all of them are managed by the Ministry, and any issues related to the resources expenditure, the reforms implementation, and the introduction of innovations in personnel activities are considered by the representatives of this administrative apparatus.
Healthcare personnel and hospitals
Work in the healthcare sector is not sufficiently in demand in Ecuador since the state does not spend much money on the modernization of this sphere. According to International Medical Aid (2018), more than 60,000 employees work in various healthcare facilities, and there are fewer than 150 hospital beds and physicians per 100,000 population (para. 2). The number of nurses is even smaller (approximately 100 per 100,000 population), which indicates the lack of assistants and problems with care. It, in turn, harms the level of public health and, in particular, the infant mortality rate.
The nursing education system and accrediting organizations
The development of nursing in Ecuador does not meet the required standards, judging by the results of the analysis of the situation in the country. As Holtz (2008) argues, the work of nurses is to meet the norms of modern principles of care and should be aimed at maintaining public health through various methods. However, the training of nurses in Ecuador, as practice shows, is not a priority.
Compared to many other countries in South America, in, the state in question, there are 22 nursing education schools in the country, which is a high indicator (Cassiani et al., 2017, p. E2913). One of the country’s main higher educational establishments, Augusto University, offers graduates to participate in the Global Health Nursing Clinical experience training program. Nevertheless, in other schools, there is no such opportunity to provide graduates with ample possibilities of training professional skills comprehensively.
Nursing associations
The main association of medical assistants in the country is the Ecuadorian Federation of Nurses (FederaciĂłn Ecuatoriana de Enfermeras/os) (Sigma, 2018). Also, there is an official program called the Nursing Volunteer Program where participants share experiences and make efforts to ensure public safety and promote health. Since the scope of nursing practice is not sufficiently developed in the country, there are not many organizations where the members of the healthcare system can cooperate and develop special programs. Voluntary alliances are not prohibited, but in general, the whole system is weak.
Health Priorities
Based on the aforementioned information from official global health organizations of non-governmental associations, it can be concluded that the state should pay much more attention to the country’s medical system. One of the priority areas of work is to reduce infant mortality, and the lack of qualified personnel is among the causes of this serious problem. According to Blais and Hayes (2015), professional nursing practice can bring positive results in case all stakeholders demonstrate an interest in the development of this sphere and its promotion.
However, judging by the costs of healthcare, the Ecuadorian government does not take sufficient initiative and does not intend to take measures to ensure activities aimed at involving employees in this area. As Holtz (2008) remarks, the proper allocation of resources and the active participation of the supreme authorities are indispensable conditions for the development of a reliable state program to support public health. Therefore, work on improving the quality of nursing education, sponsoring healthcare, and paying increased attention to mortality should be prioritized.
Conclusion: Nursing Implications
In the course of work, nursing personnel can influence positive changes and help in achieving the aforementioned priorities. The role of nurses is significant since the quality of care is inherently related to such an essential parameter of public health as mortality rate. Certainly, in Ecuador, nurses do not have high enough motivation, for instance, in the form of high cash bonuses. However, junior employees can ensure that the medical services provided in the country meet international standards. Initiation and cooperation with colleagues maybe those measures that will improve the quality of nursing care and, as a result, improve health outcomes.
References
Blais. K.K., & Hayes, J.S. (2015). Professional nursing practice: Concepts and perspectives (7th ed.). Upper Saddle River, NJ: Prentice Hall.
Cassiani, S. H. D. B., Wilson, L. L., Mikael, S. D. S. E., Peña, L. M., Grajales, R. A. Z., McCreary, L. L.,… Gutierrez, N. R. (2017). The situation of nursing education in Latin America and the Caribbean towards universal health. Revista Latino-Americana de Enfermagem, 25, e2913. Web.
Holtz, C. (2008). Global health care: Issues and policies. Sudbury, MA: Bartlett and Jones Publishers.
Institute for Health Metrics and Evaluation. (2018). Ecuador. Web.
International Medical Aid. (2018). Ecuador. Web.
Sigma. (2018). Nursing organizations: South America. Web.
World Health Organization. (2018). Ecuador. Web.