Health Promotion in Ecuador: A Solution for a Failing System


In 2008, the newly written Ecuadorian Constitution guaranteed access to healthcare for all citizens. Consequently, a vast amount of resources have been directed toward rebuilding the public healthcare system, which was in shambles due to the effects of neoliberalism. Although national healthcare studies show positive outcomes, community-based research studies from an impoverished rural barrio in southern Ecuador indicate that the public healthcare system has been unable to address a health epidemic. Based on several years of fieldwork, we argue that the failure originates from the continued functioning of the biomedical model of healthcare as the dominant health discourse in Ecuador. The ensuing result has been the construction of health system governed by an “administrative state” that enforces health policies from the top-down and delivers “episodic” emergency-style care. Accordingly, we maintain that the Ministry of Health (MOH) should create a nationwide community-based health promoter program guided by the principles of health promotion.

Share and Cite:

Rasch, D. and Bywater, K. (2014) Health Promotion in Ecuador: A Solution for a Failing System. Health, 6, 916-925. doi: 10.4236/health.2014.610115.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Becker, M. (2011) Correa, Indigenous Movements, and the Writing of a New Constitution in Ecuador. Latin American Perspectives, 38, 47-62.
[2] Lind, A. (2012) “Revolution with a Woman’s Face”? Family Norms, Constitutional Reform, and the Politics of Redistribution in Post-Neoliberal Ecuador. Rethinking Marxism: A Journal of Economics, Culture, & Society, 24, 536-555.
[3] Conaghan, C.M. (2008) Ecuador: Correa’s Plebiscitary Presidency. Journal of Democracy, 19, 46-60.
[4] Goldman, M. (2009) La descentralización del sistema de salud del Ecuador: Un estudio comparativo de “Espacio de Decisión” y capacidad entre los sistemas municipales de salud de Quito, Guayaquil y Cuenca.
[5] De Paepe, P., Echeverría Tapia, R., Santacruz, E., et al. (2012) Ecuador’s Silent Health Reform. International Journal of Health Services, 2, 219-233.
[6] (2013) Programa Acción Nutrición.
[7] (2013) Más de 350 mil niños ecuatorianos reciben micronutrientes contra la anemia desde hoy.
[8] (2013) Sistema de Salud de Ecuador se ubica entre los 20 mejores del mundo.
[9] Republic of Ecuador (2013) Constitution of 2008.
[10] Beckerman, P. (2002) Crisis and Dollarization in Ecuador: Stability, Growth and Social Equity. World Bank, Washington DC.
[11] Sottoli, S. and Núñez, J.F. (2006) Social Investment Initiatives in Latin America: Linking Budgets, Poverty Reduction and Children’s Rights. Revista Panameña de Política, 1, 151-172.
[12] Waters, W.F. (2006) Globalization and Local Response to Epidemiological Overlap in 21st Century Ecuador. Globalization and Health, 2.
[13] Cooley, S. (2008) Bringing Body to Bear in the Andes: Ethnicity, Gender, and Health in Highland Ecuador. New Directions in Medical Anthropology, 17, 132-160.
[14] Baum, F., Bégin, M., Houweling, T. and Taylor, S. (2009) Changes Not for the Fainthearted: Reorienting Health Systems toward Health Equity through Action on the Social Determinants of Health. American Journal of Public Health, 99, 1967-1974.
[15] Wade, D.T. and Halligan, P.W. (2004) Do Biomedical Models of Illness Make for Good Healthcare Systems? British Medical Journal, 329, 1398-1401.
[16] Navarro, V. (2008) Neoliberalism and Its Consequences: The World Health Situation since Alma Ata. Global Social Policy, 8, 152-155.
[17] Tejerina, H., Soors, W., De Paepe, P., Aguilar Santacruz, E., Closon, C.M. and Unger, J.P. (2009) Socialist Government Health Policy Reforms in Bolivia and Ecuador: The Underrated Potential of Integrated Care to Tackle the Social Determinants of Health. Social Medicine in Practice, 4, 226-234.
[18] World Health Organization (WHO) (2013) Country Cooperation Strategy: At a Glance. Switzerland.
[19] Alvaro, M. (2011) Ecuador Bolsters Strained Health Care System.
[20] Ministerio de Desarrollo Urbano y Vivienda (2013) Programa de intervención territorial e integral.
[21] (2013) Most Efficient Health Care: Countries.
[22] Baum, F., MacDougall, C. and Smith, D. (2006) Participatory Action Research. Journal of Epidemiology and Community Health, 60, 854-857.
[23] Mundel, E. and Chapman, G.E. (2010) A Decolonizing Approach to Health Promotion in Canada: The Case of the Urban Aboriginal Community Kitchen Garden Project. Health Promotion International, 25, 166-173.
[24] Robertson, A. (1998) Shifting Discourses on Health in Canada: From Health Promotion to Population Health. Health Promotion International, 13, 155-166.
[25] Nylen, W.R. and Dodd, L.C. (2003) Participatory Democracy versus Elitist Democracy: Lessons from Brazil. Palgrave Macmillan, New York.
[26] Rubin, E. (2009) The Citizen Lawyer and the Administrative State. William and Mary Law Review, 50, 1335-1379.
[27] World Health Organization (WHO) (1986) Ottawa Charter for Health Promotion.
[28] Brown III, H.S., Stigler, M., Perry, C., Dhavan, P., Arora, M. and Reddy, K.S. (2013) The Cost-Effectiveness of a School-Based Smoking Prevention Program in India. Health Promotion International, 28, 178-186.
[29] Kumar, S. and Preetha, G.S. (2012) Health Promotion: An Effective Tool for Global Health. Indian Journal of Community Medicine, 37, 5-12.
[30] Roberts, G. (1997) The Kadavu Health Promotion Model, Fiji. Health Promotion International, 12, 283-290.
[31] Jiang, Z., Wang, D., Yang, S., Duan, M., Bu, P., Green, A. and Zhang, X. (2011) Integrated Response toward HIV: A Health Promotion Case Study from China. Health Promotion International, 26, 196-211.
[32] Laverack, G. and Mohammadi, N.K. (2011) What Remains for the Future: Strengthening Community Actions to Become an Integral Part of Health Promotion Practice. Health Promotion International, 26, 258-262.
[33] Ndiaye, S.M., Quick, L., Sanda, O. and Niandou, S. (2003) The Value of Community Participation in Disease Surveillance: A Case Study from Niger. Health Promotion International, 18, 89-98.
[34] Baum, F., Newman, L., Biedrzycki, K. and Patterson, J. (2010) Can a Regional Government’s Social Inclusion Initiative Contribute to the Quest for Health Equity? Health Promotion International, 25, 474-482.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.