High healthcare spending has underlined the current administration's agenda, with efforts now being made to retain talent and expand service access.

The government invested $7 billion in public health projects between 2007 and 2012, the bulk of which was allocated to the “construction and rehabilitation of hospital infrastructure across the country," said Carina Vance Mafla, Minister of Public Health. With the Ministry not having invested in the creation of hospital beds in Guayaquil for 30 years, the country had begun to face a shortfall. In 2013, the Ministry of Public Health plans to invest $930 million in ongoing and new projects, which “represents the largest and most significant investment in public health carried out in Ecuador for the last two decades," added the Minister. Under a 10-year plan, 100 health centers are currently being built under the purview of the Ministry, while another 900 are planned for the next four years. The system is certainly busy, providing 40 million services in 2012, or 110,000 a day. This is compared to the 16 million services carried out in 2006. In terms of sophistication, Ecuador is also becoming a center for transplants, with the first liver transplant in the country carried out in 2009 at Hospital Metropolitano. In 2012, the overall number of transplants carried out by the public and private sectors rose by 25%.

Ecuador's private health sector is focused mainly on public sector agreements, in addition to partnerships with institutions around the country and overseas. The public sector, as laid out in the 2008 constitution, provides “permanent and timely access, without exception, to all comprehensive health care programs and services." Despite the desire to expand access, however, the current public healthcare system covers only 51% of the Ecuadorean population according to a June 2011 paper published by the Ministry of Social Development in Quito, hence the urgency to extend access through the construction of new health centers. Overall, the government funds 47% of outpatient and hospital services. The challenge is now to boost the number of beds per 1,000 people, with the figure currently languishing at 1.7, compared to the WHO's recommended figure of between eight and 10.

Part of the government's efforts to promote equality in access to services has been the growing umbrella of the Ecuadorean Social Security Institute (IESS). Those benefitting from social security now number 5 million, whereas five years ago the figure was a much lower 1 million. This makes IESS the country's largest insurer, with private companies reporting around 200,000 affiliates. “Overall, I think in the next few years we will need to focus on reaching the rural population and communities where the main source of illness is the lack of drinking water and sewage system," commented Dr. Rafael Arcos R., President of the Directory at Hospital Metropolitano, a private medical establishment with 156 beds and 650 physicians.

While Ecuador's education sector has not failed to produce medical graduates, the problem lies in the country's historical failure to keep up with demand, as well as retain talent. “The country clearly lacks specialists and medical staff," said Arcos, adding that he believed “it would be good to attract foreign doctors and specialists to the country." Among other steps he suggested need to be taken to boost the number of medical professionals in Ecuador, he highlighted the need “to improve the availability of economic resources for health institutions, as well as raise the salaries of medical staff." With many industry insiders sharing Arcos' views, the calls have not fallen on deaf ears at the Ministry. “We have increased the salaries of many specialists and health professionals, and we have strengthened the quality control processes for our employees," said Minister Vance, adding that it is “important to recognize their work and role in society." According to the Minster, efforts have already begun to pay off; “In only the first three months of 2013, over 300 health professionals have come back to Ecuador," she concluded. She also told TBY that the Ministry has experienced “increasing interest from foreign professionals in coming to work in Ecuador." Teófilo Lama Pico, President of Grupo Hospitalario Kennedy, also stresses the need to boost the level of education in order to keep medical personnel in Ecuador. “We need to strengthen educational programs to offer future doctors and specialists all the tools needed to become excellent professionals in Ecuador without leaving the country," he told TBY.

In terms of pharmaceuticals, the sector was worth $1.27 billion in 2012, with the figure set to grow 10% in 2013. It mainly produces for domestic use, and accounts for between 15% and 20% of total market consumption overall. With the pharmaceuticals sector on a strong upward growth curve in Latin America—sales totaled $74.5 billion in 2012 across the continent, and are set to grow at a compound annual rate of 8% until 206—firms have begun eyeing Ecuador as a place to base their operations. One such firm is Takeda Pharmaceuticals International GmbH, which launched a wholly owned subsidiary in Ecuador in 2013. In total, there are 200 pharmaceutical firms operating in Ecuador, and generic drugs represent between 8% and 10% of products on the market.

Moving into 2013, increased spending will boost rural access to healthcare. The planned expansion will only be successful, however, if Ecuador can boost medical personnel retention rates and either encourage Ecuadoreans working abroad to come home, or else entice foreign staff into medical institutions in the country.