The Business Year

Carina Vance Mafla

ECUADOR - Health & Education

A Meaningful Contribution

Minister of Public Health, Ecuador


Carina Vance Mafla was born in Oakland, California, and attended Williams College after completing high school in Ecuador. She went on to earn a Master’s in Public Health, returning then to Ecuador in 2004. She has worked extensively as a lesbian, gay, bisexual, transgender (LGBT) rights activist, and was the Executive Director of Fundacion Causana. She was appointed to the cabinet by President Rafael Correa in January 2012.

"Our work and projects help to increase the productive working life of our inhabitants and the quality of life."

The country has tripled its investment in the public health field since 2007. What have been the key projects implemented by your Ministry?

The current government of Ecuador has invested around $7 billion in public health projects from 2007 to 2012. The project that represents the largest investment is the construction and rehabilitation of hospital infrastructure across the country. For example, in Guayaquil, the largest city in our country, the Ministry of Public Health did not invest in the creation of more hospital beds for the last 30 years, and that needed to be addressed. Overall, the demand for public health services and infrastructure has grown in the country; however, the supply of health services has not followed along. Up until now, we mostly focused on rehabilitating existing infrastructure, whereas from now on we will put an emphasis on the development of new projects. In 2013, we have a geographical strategy that provides the framework and guide to what and where needs to be built in Ecuador in terms of hospital infrastructure. At the same time, we have revised bureaucratic processes in order to facilitate and speed up the above-mentioned processes and dynamics. In 2013 alone, we will 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. We have a strategic development plan for the next 10 years, we are constructing 100 health centers now, and we plan to build over 900 new health centers over the next four years. In this context, and since we are the most important health service provider in the country, we always aim to raise quality standards to international levels. In 2012, we provided over 40 million services, which represented around 110,000 services per day. In parallel, we put great efforts into continuing to facilitate the access of Ecuadorean citizens to the public health system. The main idea and mission of our Ministry, based on the 2008 Constitution, is to provide universal health care to the citizens of Ecuador regardless of their background, and that requires high levels of investment if we want to achieve positive and productive results in the short term. Another cornerstone of our work has to do with human capital; a field that the current government has always prioritized. We have doubled the number of professionals working in the Ministry of Public Health, we have increased the salaries of many specialists and health professionals, and we have strengthened the quality control processes for our employees. It is important to recognize their work and role in society, especially in terms of wages. In this context, such changes have attracted back many Ecuadorean specialists and doctors working abroad. In only the first three months of 2013, over 300 health professionals have come back to Ecuador. In addition to that trend, we have experienced an increasing interest from foreign professionals in coming to work in Ecuador.

What are the current human capital needs for Ecuador in the health field?

We need a qualified work force for the health industry, both nationally and internationally. We welcome all those who want to come back to Ecuador and those who want to come here for the first time, because foreign expertise clearly contributes to the improvement of our professionals and system. However, we do not actively recruit from abroad. We also have strengthened the education programs and financial tools for students to get the best education at the international level, because for many years we lacked the level of graduate students the industry requires. It is all about providing vision and a clear medium-term vision for the development of the public health system.

“Our work and projects help to increase the productive working life of our inhabitants and the quality of life.”

How is the work implemented by your Ministry contributing to the development of Ecuador?

Our work and projects help to increase the productive working life of our inhabitants and the quality of life. We provide society with all the health tools and services required at any time during their lives. In addition, we contribute to reduce poverty levels and the living expenses of Ecuadorean citizens, thereby increasing their purchasing power. Finally, we facilitated the coverage and access to treatments and services for all spheres of society when it comes to catastrophic illnesses. We also contributed to higher levels of specialization in both the public and private sectors. For example, in 2012 we increased the number of transplants carried out in Ecuador by 25%, and at the same time we have taken important steps in the prevention and emergency segments of the sector. In fact, Ecuador joined international efforts to help reduce, among other things, smoking levels and implement new vaccinations in order to reduce mortality rates in several segments of society.

What is the Ministry’s strategy to build closer ties between the public and the private sectors?

We think it is very important to build bridges between both sectors, and for example, since 2012, the public sector externalizes some services through the private sector. Therefore, the Ministry also encourages and stimulates the development of the private sector in Ecuador, because that will also drive the development and improvement of the both sectors in terms of quality and service.

What kind of relationship does the Ministry have with the Ecuadorean Social Security Institute (IESS)?

The IESS is one of the largest providers of public health services. From the Ministry side, we set up policies and strategies for the development of the sector, and we do so working very closely with the IESS, which has played a key role in drawing the future geographical and hospital infrastructure strategy. The main idea behind these collaborative terms is to join efforts to strengthen the public health system in Ecuador. The IESS also purchases some services through us, which at the end of the day increases the availability of financial resources for the public health system. Overall, we can talk about a strong relationship that becomes even stronger and efficient over time, because by uniting forces and efforts we can achieve higher goals.

What are some of your main priorities for the public health system over the medium term?

We have already achieved important goals in terms of access; we have gone from 16 million health services provided in 2006 to over 40 million in 2012 by restoring the public health system. Starting from 2013, we will implement an accreditation process for our hospitals, which will bring a qualitative change to the system that will complement the quantitative one mentioned above. We need to further increase transparency, efficiency, and quality standards in the public health system.

© The Business Year – April 2013



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