UNIVERSAL HEALTH COVERAGE

Ecuador 2019 | HEALTH & EDUCATION | INTERVIEW

The Ministry of Public Health is steadfast in ensuring that the right to healthcare guaranteed in the country's constitution becomes a reality.

María Verónica Espinosa Serrano
BIOGRAPHY
María Verónica Espinosa Serrano’s academic and professional career has been guided by her interest and commitment to public health. She was appointed as Minister of Public Health in 2017. She studied medicine at the Universidad Internacional del Ecuador, continuing her residence at Hospital Carlos Andrade Marín del Instituto Ecuatoriano de Seguridad Social. She obtained her master’s degree in public health at the San Francisco University in Quito and a diploma in sexual and reproductive health and rights from the Isalud University in Argentina. She was previously the medical director at Laboratorios LIFE, an Ecuadorian pharmaceutical company. Prior to her appointment as minister, she was Deputy Minister of Governance and Health Surveillance.

What are the main public health challenges for Ecuador being a leading tourism destination in Latin America, and how do you ensure adequate healthcare provision to travelers?

The Ecuadorian state, by constitutional mandate, guarantees comprehensive, universal, and free healthcare to all persons in the national territory, without any discrimination and regardless of their immigration status. Thanks to this political and constitutional will, we have been recognized internationally by several agencies of the United Nations System for not only our commitment to ensuring universal access to health services, but also the country's leading role in international forums to promote universal access at the sub-regional, regional, and international levels. This represents a great challenge—not only for Ecuador but all countries in the region—in terms of the sustainability of health systems. The right to health is enshrined in the Charter of the UN as well as in constitutions and regulations of most countries. The challenge is ensuring greater sources of financing, specific to the national health system.

How do you envision improving the dynamics between public and private healthcare in Ecuador?

Ecuador received the prestigious United Nations Award for Public Service 2017 (UNPSA) in the category of Innovation and Excellence in the Provision of Health Services for the creation of the Comprehensive Public Health Network (RPIS). However, a system has to be also articulated with the private sector. Under this premise, the ministry offers healthcare services to the entire population. The municipalities have programs and health facilities in which they also provide care to the uninsured population. The social security institutions cover the salaried affiliated population. The private sector, called complementary private network (CPN), includes for-profit entities and non-profit organizations of civil society and social service. Also, there are private medical offices equipped with infrastructure and technology. We work with the Association of Clinics and Private Hospitals of Ecuador (ACHPE) in several aspects, but especially in the care process through referrals of patients, reciprocally and continuously. Between January and August 2018, 68,950 referrals were made to CPN, whose care is 100% financed by public health funders. All these actions are constantly evaluated, and we are committed to making the relationship process more efficient, always taking into consideration the principle of complementarity, namely to take advantage of the installed capacity and expertise of each actor in the system so as not to duplicate efforts but to strengthen the resolutive capacity of the national system, both public and private.

What are the main challenges and goals for your term as Minister of Health?

The right to health must be collective and based on the principles of equity, solidarity, efficiency, effectiveness, and quality. Health is a constitutional right, and we are committed to protecting it. We are also committed to building the new legal framework that allows it to be effective. Therefore we work in the debate and preparation of the new Organic Code of Health (COS), probably the most important regulatory framework for the national health system. As immediate goals, the MSP proposed the implementation of a unique clinical history of births and deaths to strengthen the health system and the monitoring of patients. Another issue that concerns us is the judicialization of access to medicines, which consists of the use of lawsuits to compel governments to provide access to medicines that have not been incorporated into public health coverage. Health cannot be guaranteed by decree, judicial provision, or sentence; health needs the establishment of technical public policies that assure the collective good. Without health, the national objective that governs our public policy is unattainable. To guarantee the right to health, we must recognize the existence of structural factors that determine the health of the population. That is why we will continue to direct our actions toward the global objective of poverty reduction and to achieve a substantial increase in the quality of life of our citizens.