Reaching the millennium development goal for child mortality: Improving equity and efficiency in Ecuador's health budget

Healthcare in Ecuador has improved substantially over the last 30 years but spending remains low compared to other countries in the region and there are severe inequalities in the system, particularly in access to healthcare for the indigenous population, the poor and those living in rural areas. The 1990s saw a series of health sector reforms, but many of the proposed measures remain to be implemented, hindered by institutional weaknesses and a series of economic crises. The main focus of this paper, however, is on how to reduce infant mortality rates, particularly for marginalized groups. The recommendations aim to help the country achieve the Millennium Development Goal (MDG) of reducing child mortality by two-thirds in the period 1990–2015. For many better-off sectors of the population this target is already in sight. The analysis shows that with the right health spending priorities that are almost budget-neutral, the MDG is within reach for the whole population. The related recommendations for health policies go some way in addressing the broader problems in health service delivery, including low access to services, inequalities across population groups and geographical areas, and low quality of services. The recommendations are to protect the immunization program that has suffered recent budget cuts and expand the Free Maternity Program (guaranteeing free access to free pre-natal and delivery to all women). In the long-term the government could consider a universal health insurance system as a means of improving equity and efficiency in delivering healthcare, especially to the poor. However, current financial constraints make that option impractical at present. The analysis uses an innovative combination of econometric modelling techniques aimed at finding the most cost-effective ways to achieve the desired results