Click amount to donate direct to CounterPunch
  • $25
  • $50
  • $100
  • $500
  • $other
  • use PayPal
Spring Fund Drive: Keep CounterPunch Afloat
CounterPunch is a lifeboat of sanity in today’s turbulent political seas. Please make a tax-deductible donation and help us continue to fight Trump and his enablers on both sides of the aisle. Every dollar counts!
FacebookTwitterGoogle+RedditEmail

The Right to Health in Ecuador

fter two decades of social and political upheavals that nearly bankrupted the government on several occasions, Ecuador is now enjoying the most stable period in its history. This new calmer context has enabled the country to break with the priorities of previous governments. Rafael Correa’s government has rehabilitated public services, placing fundamental issues such as education and health, previously the preserve of the technocrats, back at the core of politics and citizenship.

Ecuador’s new constitution, approved by referendum in 2008, gives an important place to public health. It recognises the need for a far-reaching structural reform of the sector, not only the government’s management of it, but more broadly its many social, economic and cultural ramifications through a radical review of the country’s health policy based on a new social contract.

Article 32 of the new constitution states: “Health is a right guaranteed by the state and whose fulfilment is linked to the exercise of other rights, including the right to water, food, education, sport, work, social security, a healthy environment and everything that promotes well-being. The state shall guarantee this right by implementing economic social, cultural, educational and environmental policies. It shall guarantee permanent, timely and non-exclusive access to programmes, actions and services promoting and providing comprehensive healthcare and reproductive health. The provision of healthcare services shall be governed by the principles of equity, universality, solidarity, interculturalism, quality, efficiency, effectiveness, prevention, and bioethics with a fair gender and generational approach.”

Article 32 highlights the government’s multi-disciplinary approach. In addition to direct action, the goal is to combine healthcare policy with various related social issues — such as access to potable water — and lay down some fundamental principles to guide the state in the management of its services.

The true novelty of the constitution is the role allocated to well-being (sumak kawsay in Quechua), of which public health is one of the pillars. It is not just a development tool, a way of ensuring that the economy operates smoothly because a healthy workforce is able to produce more; it is also a prerequisite for the common good, since healthy citizens are better able to exercise their democratic rights.

The constitution also stipulates the requirements for the effective implementation of universal access to healthcare. Article 362 states: “Healthcare as a public service shall be provided through state, private, autonomous and community institutions, as well as those that practice alternative and complementary ancestral medicine. … Public state health services shall be universal and free of charge at all levels of care, and shall include necessary procedures of diagnosis, treatment, medicines and rehabilitation.”

By placing health back in the realm of public service, the constitution has freed it from the market forces that governed it over the past decades. The exercise of human rights is the departure point in this historic process. Now it is up to the state to ensure that universal access to healthcare becomes a reality by setting up an integrated public network of medical services and consolidating the national health system.

Such an ambitious objective clearly requires significant financing. Since Rafael Correa became president six years ago, public investment in healthcare has totalled more than $9bn (the four previous governments only spent a combined total of $2.6bn).

Health coverage has grown proportionately. In 2006, 16m medical treatments were provided. In 2012 the figure was more than 40m. The increase was due to the building of new infrastructure (14 hospitals and 956 health centres by 2017), greater flexibility of consulting hours, and a determination to improve coordination between the central health administration and the many services depending on it at grass roots level, as well as clear rules on complementarity with private health service providers.

Ecuadorians are benefitting from an unprecedented redistribution of wealth. This historic effort has allowed public health to become a key factor in social justice. The increase in the number of hospitals and healthcare centres throughout the country has given millions of patients access to services from which they had been excluded, because of distance, poverty, discrimination or lack of information. Even taking demographic growth and an increasing demand for checkups into account, the increase in consultations suggests that the new public health service has successfully passed its field trials. Public health policy has mobilised all the public sectors, as reflected in the objectives for the National Plan for Good Living for 2013-17.

The remaining questions are how health services and preventative actions will be taken on board by society, and how the people themselves, as the driving force of citizenship, will take charge of their own part in the process. The task now facing the government is to show that real democracy remains the most important social determinant. The right to health in Ecuador today may be perceived both as a victory and a challenge.

Carina Vance is Ecuador’s health minister.

Translated by Krystyna Horko.

This article appears in the excellent Le Monde Diplomatique, whose English language edition can be found at mondediplo.com. This full text appears by agreement with Le Monde Diplomatique. CounterPunch features two or three articles from LMD every month.

More articles by:
May 24, 2018
Gary Leupp
Art of the Dealbreaker: Trump’s Cancellation of the Summit with Kim
Jeff Warner – Victor Rothman
Why the Emerging Apartheid State in Israel-Palestine is Not Sustainable
Kenn Orphan
Life, the Sea and Big Oil
James Luchte
Europe Stares Into the Abyss, Confronting the American Occupant in the Room
Richard Hardigan
Palestinians’ Great March of Return: What You Need to Know
Howard Lisnoff
So Far: Fascism Lite
Matthew Vernon Whalan
Norman Finkelstein on Bernie Sanders, Gaza, and the Mainstream Treatment
Daniel Warner
J’accuse All Baby Boomers
Alfred W. McCoy
Beyond Golden Shower Diplomacy
Jonah Raskin
Rachel Kushner, Foe of Prisons, and Her New Novel, “The Mars Room”
George Wuerthner
Myths About Wildfires, Logging and Forests
Binoy Kampmark
Tom Wolfe the Parajournalist
Dean Baker
The Marx Ratio: Not Clear Karl Would be Happy
May 23, 2018
Nick Pemberton
Maduro’s Win: A Bright Spot in Dark Times
Ben Debney
A Faustian Bargain with the Climate Crisis
Deepak Tripathi
A Bloody Hot Summer in Gaza: Parallels With Sharpeville, Soweto and Jallianwala Bagh
Josh White
Strange Recollections of Old Labour
Farhang Jahanpour
Pompeo’s Outrageous Speech on Iran
CJ Hopkins
The Simulation of Democracy
Lawrence Davidson
In Our Age of State Crimes
Dave Lindorff
The Trump White House is a Chaotic Clown Car Filled with Bozos Who Think They’re Brilliant
Russell Mokhiber
The Corporate Domination of West Virginia
Ty Salandy
The British Royal Wedding, Empire and Colonialism
Laura Flanders
Life or Death to the FCC?
Gary Leupp
Dawn of an Era of Mutual Indignation?
Katalina Khoury
The Notion of Patriarchal White Supremacy Vs. Womanhood
Nicole Rosmarino
The Grassroots Environmental Activist of the Year: Christine Canaly
Caoimhghin Ó Croidheáin
“Michael Inside:” The Prison System in Ireland 
May 22, 2018
Stanley L. Cohen
Broken Dreams and Lost Lives: Israel, Gaza and the Hamas Card
Kathy Kelly
Scourging Yemen
Andrew Levine
November’s “Revolution” Will Not Be Televised
Ted Rall
#MeToo is a Cultural Workaround to a Legal Failure
Gary Leupp
Question for Discussion: Is Russia an Adversary Nation?
Binoy Kampmark
Unsettling the Summits: John Bolton’s Libya Solution
Doug Johnson
As Andrea Horwath Surges, Undecided Voters Threaten to Upend Doug Ford’s Hopes in Canada’s Most Populated Province
Kenneth Surin
Malaysia’s Surprising Election Results
Dana Cook
Canada’s ‘Superwoman’: Margot Kidder
Dean Baker
The Trade Deficit With China: Up Sharply, for Those Who Care
John Feffer
Playing Trump for Peace How the Korean Peninsula Could Become a Bright Spot in a World Gone Mad
Peter Gelderloos
Decades in Prison for Protesting Trump?
Thomas Knapp
Yes, Virginia, There is a Deep State
Andrew Stewart
What the Providence Teachers’ Union Needs for a Win
Jimmy Centeno
Mexico’s First Presidential Debate: All against One
May 21, 2018
Ron Jacobs
Gina Haspell: She’s Certainly Qualified for the Job
Uri Avnery
The Day of Shame
FacebookTwitterGoogle+RedditEmail