Countries of the World/COUNTRYS.BIN/dp/0118/01189.txt

Text File | 1991-06-25 | 20KB | 343 lines

$Unique_ID{COW01189}
$Pretitle{252}
$Title{Ecuador
Chapter 7B.   Health}
$Subtitle{}
$Author{Thomas E. Weil}
$Affiliation{HQ, Department of the Army}
$Subject{health
medical
percent
public
rural
guayaquil
service
water
population
program}
$Date{1973}
$Log{Table 4.*0118901.tab
Table 5.*0118902.tab
}
Country:     Ecuador
Book:        Ecuador, A Country Study
Author:      Thomas E. Weil
Affiliation: HQ, Department of the Army
Date:        1973

Chapter 7B.   Health

Administration and Finance

     The public health program as established in 1928 operated from
headquarters in Guayaquil rather than Quito because of the severity of the
health problems then existing in the port city and in the Costa in general.
The program functioned nominally under what was then the Ministry of Social
Welfare but was actually decentralized among a variety of agencies, the most
important of which were social assistance boards (juntas de asistencia social)
that operated autonomously in each province under their own budget
allocations.

     A separate Ministry of Public Health was created in 1967, but the
provincial boards and other decentralized agencies continued to carry on the
bulk of the public health work until early 1972. The new government then
decreed the transfer of the National Directorate of Health from Guayaquil to
Quito and the dissolution of the social assistance boards, whose functions
were to come directly under the ministry. The most important of the other
entities to be terminated under the centralization of health functions was the
Welfare Board of Guayaquil (Junta de Beneficiencia de Guayaquil), a
state-financed but privately structured entity that had been responsible for
most of the public health and welfare functions in Guayas Province.

     Under the Ministry of Public Health the revised program was to be
administered locally in four regions, with headquarters in Quito, Guayaquil,
Cuenca, and Portoviejo. A medical program for participants in the social
security program was to continue to operate independently, with its own staff
of medical personnel, major hospitals in Quito and Guayaquil, and dispensaries
in the larger provincial towns.

Health Hazards and Preventive Medicine

     The National Planning Board stated that reporting on the causes of
illness and death was deficient, particularly for the rural parts of the
country. In the late 1960s, for example, less than half of the reported deaths
were medically certified, and the causes were accordingly in some doubt.

     During the 1960s the principal reported causes of death were the
respiratory ailments that were particularly prevalent in the Sierra. They were
closely followed by infectious and parasitic diseases and diseases of the
digestive tract. Communicable diseases, except among young children, were less
significant causes of mortality.

     The reported causes of death differ sharply between urban and rural
localities. In 1970 nearly three-fourths of the deaths resulting from
cardiovascular diseases and nearly two-thirds of those resulting from cancers
occurred in cities and towns. In contrast, in the countryside respiratory
ailments, anemias, parasitic diseases, whooping cough, and measles caused
three-fourths or more of the fatalities. The higher reported rate of urban
mortality resulting from heart ailments and malignancies suggested a failure
to diagnose and report many rural deaths resulting from these causes. The
ailments reported to have resulted in relatively higher rates of death in
rural localities were for the most part those that need not necessarily have
been fatal and may have resulted from lack of medical care or ignorance of
proper preventive or curative measures.

     Mortality was remarkably high among infants and young children,
particularly in the Sierra. Although infant mortality declined from about 100
per 1,000 live births in 1960 to eighty-six in 1968, it remained among the
highest in Latin America. A high incidence of malnutrition among infants and
young children led to a low level of resistance to the diseases of infancy and
early childhood. In general, mortality was high at all ages up to five years,
but about one-third of all infant deaths occurred in the first month of life,
at least in part because less than 20 percent of the births were medically
attended. Most of the births took place without assistance or with the aid of
untrained midwives.

     The several national campaigns aimed at eradicating or controlling the
most serious health hazards are based on tripartite conventions signed by the
government of Ecuador with the United Nations Children's Fund (UNICEF) and the
World Health Organization (WHO), and assistance has been received from several
other foreign sources. The 1970 budget allocations for preventive inoculations
provided for 1,270,000 against polio; 555,000 against smallpox; 95,000 against
diphtheria, whooping cough, and typhoid (DPT); and smaller numbers against
typhus and rabies. Ecuador manufactures its own supplies of DPT and rabies
vaccines.

     Among the country's most notable medical achievements has been
eradication of the jungle yellow fever that was formerly a scourge in the
Costa. A campaign inaugurated in 1946 directed at eradication of the mosquito
vector of the disease was declared completed in 1967. Corresponding success
had attended a campaign against smallpox that was in progress between 1958 and
1964. During that period some 85 percent of the total population received
vaccinations, and between 1964 and 1969 no new cases were reported. In the
early 1970s, however, a preventive vaccination program was being continued.

     The most extensive and active of the campaigns in progress during the
early 1970s was conducted by the Ecuadorian Antituberculosis League (Liga
Ecuatoriana Antituberculosa-LEA), an autonomous public agency founded in 1940
in Guayaquil. Previously decentralized with provincial units operating under
loose direction of a Guayaquil national headquarters, it was among the
entities scheduled for centralization under the Ministry of Public Health in
1972. The LEA maintains a network of sanitariums, several of which were closed
during the late 1960s and early 1970s as the program moved toward
consolidation and improvement of services coupled with increased emphasis on
outpatient care.

     Another important preventive campaign is led by the National Service for
Eradication of Malaria (Servicio Nacional de Eradicacion de Malaria-SNEM).
Inaugurated in 1948 to combat the disease in the malarial portions of the
country, in which well over half of the population resided, by 1969 it was in
the consolidation stage in most of the originally malarial areas and in the
attack stage in the remainder. This WHO terminology could be translated
roughly as meaning that nowhere had the disease been eliminated, but that in
most of the areas a campaign against it was reducing incidence of the disease,
and in all other originally malaria areas a campaign was in progress.

     The campaign against polio consisted principally of inoculations of young
children. The number of new cases reported was irregularly upward from 217 in
1965 to 503 cases in 1969, but the Pan American Health Organization (PAHO)
reported that conditions for diagnosis, including virus typing, were
satisfactory according to its standards. In 1969 more than 90 percent of the
new cases reported were in children under the age of four.

     About 85 percent of the 1,585 cases of leprosy on the active register
during 1969 were ambulatory, and increased stress was being placed on
prevention through surveillance of patients and contacts and on reduction of
disability from the disease. From 1965 through 1969 some 1,600 cases  of
bubonic plague were reported, a majority occurring in the Sierra. Deratting of
houses by fumigation was the principal preventive mechanism used. An
anti-venereal program was active, principally in Quito and Guayaquil where
most of the clinics were located. Measures included serologi