Universal Health Coverage in Marginalized Populations

A Qualitative Evaluation of a Health Reform Implementation in Rural Ecuador

Bibliographic Data

ID13775118
AuthorsMartin Eckhardt (0000-0002-3606-1329, Linköping University), Siw Carlfjord (0000-0001-9116-8156, Linköping University), Tomas Faresjö (0000-0003-4224-1032, Linköping University), Antonio Crespo-Burgos (Museo Nacional de Medicina “Eduardo Estrella,” Quito, Ecuador), BIRGER C FORSBERG (0000-0001-6179-3970, Karolinska Institute, Stockholm, Sweden), Magnus Falk (0000-0001-6688-3860, Linköping University, corresponding author)
Year2019
Volume56
Publication date2019-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueINQUIRY The Journal of Health Care Organization Provision and Financing (JOURNAL)
Journal identifiersISSN: 0046-9580 • E-ISSN: 1945-7243
PublisherSAGE Publishing (PUBLISHER • US)
DOI10.1177/0046958019880699
OpenAlexW2977479545
LanguageEN
Citations received5
References cited29

In 2008, Ecuador underwent a major health reform with the aim of universal coverage. Little is known about the implementation of the reform and its perceived effects in rural parts of the country. The aim of this study was to explore the perceived effects of the 2008 health reform implementation, on rural primary health care services and financial access of the rural poor. A qualitative study using focus group discussions was conducted in a rural region in Ecuador, involving health staff, local health committee members, village leaders, and community health workers. Qualitative content analysis focusing on the manifest content was applied. Three categories emerged from the texts: (1) the prereform situation, which was described as difficult in terms of financial access and quality of care; (2) the reform process, which was perceived as top-down and lacking in communication by the involved actors; lack of interest among the population was reported; (3) the effects of the reform, which were mainly perceived as positive. However, testimonies about understaffing, drug shortages, and access problems for those living furthest away from the health units show that the reform has not fully achieved its intended effects. New problems are a challenging health information system and people without genuine care needs overusing the health services. The results indicate that the Ecuadorean reform has improved rural primary health care services. Still, the reform faces challenges that need continued attention to secure its current achievements and advance the health system further

Business · Economic growth · Economic shortage · Economics · Environmental health · Focus group · Government (linguistics · Health care · Health care reform · Political science · Population · Public relations · Qualitative research · Quality (philosophy · Rural area · Rural health · Sociology · Global Maternal and Child Health · Healthcare Systems and Reforms · Marketing · Medicine · Nursing · Primary Care and Health Outcomes · Health Policy

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