In the name of COVID-19: legitimizing the exclusion of community participation in Ecuador’s health policy

Abstract

Summary Global shifts toward a disease-oriented, vertical approach to health has involved limiting the right for communities to participate in decision-making. Ecuador’s authoritarian legacy has forced civil society and social organizations to adopt ‘coping strategies’, while large protests recently derived into violent struggles. The country has been severely hit by the COVID-19 pandemic amid corruption scandals involving hospital and food purchases by government during the response. This study critically examines how Ecuador’s government took into consideration ‘community participation’ as a value and tenet of health promotion. Our systematic textual analysis focuses on 53 consecutive resolutions by the National Emergency Operations Committee (EOC) leading the decision-making processes, which, explicitly requires community participation. Results show that the ‘lifecycle’ of the central government’s evolving policy framing centered on law enforcement and the private sector, followed by the social sector. Further, there is no evidence of stakeholders from civil society or organizations taking part in decision-making. Having legitimized the exclusion of community participation in Ecuador’s response to the COVID-19 pandemic, it is possible that the government will fail to consider the wider social implications of its impact. In particular, the limits to local governments becoming informed and making decisions without mediation by the National EOC will further impede community participation in health decision-making in the future. This implies that local knowledge and experiences will also not inform health policy.

Determinants of self-reported health status during COVID-19 lockdown among surveyed Ecuadorian population: a cross sectional study

“…Our main findings were that the determinants of regular or poor self-reported health status among Ecuadorian-surveyed adult persons were: (i) being female, (ii) perceiving housing conditions as inadequate for coping with the lockdown, (iii) living with people who require care, (v) perceiving extreme difficulties in coping with both work exigencies or managing household chores, (vi) a history of COVID-19 infection, (vii) presence of chronic diseases, and (viii) depressive symptoms. Similar to other studies, the complex Ecuadorian context during lockdown [10,13–16,18] helps explain the accentuated impact of such factors on the self-reported health status of the Ecuadorian population.…”

“…A little worried, n (%) (13) Moderately worried, n (%) (33) Quite worried, n (%) (28) Very worried, n (%) (23) Very high difficulties to cope with the job or take care of household chores, n (%) 109 ( 5)…”

“…In this context, a few studies conducted in Ecuador reported an increased prevalence of psychological distress symptoms [25]. Some studies and anecdotal data point to an increase in many factors that are determinants of poor mental health during a health emergency, such as the burden of unpaid domestic labor for women, gender-based violence [13,19], child abuse [26], lack of access to medicine for prior chronic diseases, poor housing conditions, and overcrowding [27].…”

Between two pandemics: Older, gay men's experiences across HIV/AIDS and COVID-19

“…With a growing appreciation in the literature of the influence of social factors and inequities on health outcomes (i.e., social determinants of health) and an extensive body of social research specific to HIV/AIDS ( El-Sadr, 2020 ; Forstein, 2013 ; Halkitis, 2021 ) the social aspects of pandemics are receiving more attention ( Gregersen, 2020 ; Halkitis, 2021 ; Jones, 2020 ). Socioeconomic status, for example, is identified as a powerful predictor of health; consequently, those living in poverty are much more likely to fall ill and experience further disadvantage amidst a pandemic than those who are not ( Hatzenbuehler, Phelan, & Link, 2013 ; Thomas, 2019 ; Torres & López-Cevallos, 2021 ). To add to the growing body of literature that highlights that pandemics are socially and culturally embedded, and the consequent social implications, we conducted a study informed by the research question: how did the HIV/AIDS pandemic shape older gay men's perspectives of COVID-19?…”

Exceptional Prices of Medical and Other Supplies during the COVID-19 Pandemic in Ecuador

“…13 Even though the law requires civil society organizations' participation in Emergency Operations Committee meetings, they have not been present during the sessions convened for the pandemic response, which has limited transparency in decision-making. 14 In addition, as Ecuador was seeing a steady rise in the number of confirmed cases early in the pandemic, its diagnostic capacity did not increase to meet demands. 15 Ecuador mandated face masks on April 7, 2020, for the general population, 16 but these were not freely distributed by the government nor was a price cap established.…”