Ecuador case study

in 1977 asked the Association of University Programs in Health Administration (AUPHA) to provide a methodology, subsequently codified into a series of management problem-solving (MAPS) modules, for assessing the management of indigenous health systems. These modules were then used in several in-country consultations, one of which, summarized in this report, sought to design the primary care component of the Government of Ecuador"s Integrated Rural Health Delivery System (IRHDS). AUPHA analyzed the interrelationship of IRHDS with the socioeconomic strategies incorporated in Ecuador"s 5-year (1980-84) development plan and the constraints (e.g., lack of institutional capacity, the use of inappropriate technologies etc.) which limited delivery of Ministry of Health (MOH) services to 18.6% of the population in 1977. Through site visits; interviews at the national, provincial, and microregional levels; and document analyses, AUPHA identified a number of priority concerns for the IRHDS: the role of rural health promoters; the supply of basic drugs and of other medical material; the flow and use of statistics in the MOH; and management of provincial MOH offices (in terms of finance and budget, facilities and equipment maintenance, personnel, and technical assistance). On the basis of these summary assessments, AUPHA developed proposals to address IRHDS management needs in the following areas: (1) developing management at the microregional level to effectively acquire and use resources; (2) building provincial management capacity through technical assistance and training programs; (3) improving health service management and national policymaking; and (4) coordinating the MOH and the Rural Development Secretariat to ensure accountability and resource and information flows. Other recommendations for long-term problems include building interagency coordination; making projects accountable to local communities; specifying the functions of rural health promoters; attracting qualified physicians into rural areas; and providing technical assistance to develop self-assessment and project implementation skills.