National and subnational coverage and inequalities in reproductive, maternal, newborn, child, and sanitary health interventions in Ecuador: a comparative study between 1994 and 2012

Abstract

Background Latin America (LA) has experienced constant economic and political crises that coincide with periods of greater inequality. Between 1996 and 2007 Ecuador went through one of the greatest political and socio-economic crises in Latin America, a product of neo-liberal economic growth strategies. Between 2007 and 2012 it regained political stability, promoted redistributive policies, and initiated greater social spending. To understand the possible influence on the political and economic context, we analyzed the coverage and inequalities in five Reproductive, Maternal, and Child Health (RMNCH) and two water and sanitation interventions using survey data from a broad time window (1994–2012), at a national and subnational level. Methods The series cross-sectional study used data from four representative national health surveys (1994, 1999, 2004 and 2012). Coverage of RMNCH and sanitary interventions were stratified by wealth quintiles (as a measure of the socio-economic level), urban-rural residence and the coverage for each province was mapped. Mean difference, Theil index and Variance-weighted least squares regression were calculated to indicate subnational and temporal changes. Results From 1994 to 2004, Ecuador evidenced large inequalities whose reduction becomes more evident in 2012. Coverage in RMNCH health service-related interventions showed a rather unequal distribution among the socioeconomic status and across provinces in 1994 and 2004, compared to 2012. Sanitary interventions on the contrary, showed the most unequal interventions, and failed to improve or even worsened in several provinces. While there is a temporary improvement also at the subnational level, in 2012 several provinces maintain low levels of coverage. Conclusions The remarkable reduction of inequalities in coverage of RMNCH interventions in 2012 clearly coincides with periods of regained political stability, promoted redistributive policies, and greater social spending, different from the former neo-liberal reforms which is consistent with observations made in other Latin American countries. Territorial heterogeneity and great inequalities specially related with sanitation interventions persists. It is necessary to obtain high quality information with sharper geographic desegregation that allows to identify and understand local changes over time. This would help to prioritize intervention strategies, introduce multisectoral policies and investments that support local governments.

Ethnic inequalities in reproductive, maternal, newborn and child health interventions in Ecuador: A study of the 2004 and 2012 national surveys

“…Ecuador is among a number of Latin American countries that have made significant progress in improving health care access and reducing inequalities in the past decade and a half. 16 , 17 Between 2006 and 2012, as the GDP increased from 4.2 to 12.6%, public investment in the social sector increased, 18 the Gini index fell about 6.1% (from 52.2 to 46.1), and the proportion of the population living in poverty decreased from 37.6 to 27.3%. Between 2006 and 2014, total health expenditure as a percentage of GDP (Gross Domestic Product) increased from 5.9 to 9.2, and a significant reduction in out-of-pocket spending was observed.…”

Measurement and Mapping of Maternal Health Service Coverage Through a Novel Composite Index: A Sub-National Level Analysis in India

“…Prior research mainly focussed on the theme of Reproductive, Maternal, New born and Child Health (RMNCH) service coverage and their inequities at national and sub-national level in India. Majority of them used Coverage Gap Index (CGI) as an outcome measure of the RMNCH service coverage, which is primarily constituted by the domains of reproductive services, maternal and new born care, immunization and management of illness [19][20][21]. However, there were only two indicators namely 'skilled birth attendant' and 'antenatal care coverage' under the domain of maternal and new born care, which makes the measurement of maternal health service coverage narrow and incomplete.…”

Social inequalities in healthcare utilization during Ecuadorian healthcare reform (2007–2017): a before-and-after cross-sectional study

“…Thus, from 2007 to 2014, the poverty headcount ratio and the income inequality (Gini index) were reduced, from 36.7% to 21.5%, and from 53.4 to 44.7, respectively [ 3 ]. Besides these, a new healthcare reform aiming to increase access to and quality of healthcare services with a solid base on Alma Ata's primary healthcare principles was introduced [ 4 ].…”