Part 1: Access to curative care in first-line health services: an experience in Ecuador

Introduction

In LMICs it is generally acknowledged that access to curative care could be improved if primary care health services were strengthened and new health centres opened when required, if in addition skilled teams are organized in these services and if resource allocation does not discriminate against primary care as has historically been the case in many LMICs. Some publications also focus on the importance of good doctor-patient communication, as highlighted in Chapter 17 of this section, to improve access and to ensure effective integration of health services (Haddad & Fournier, Litvack & Bodart, 1993). There are also important technical dimensions of supporting primary care health services, including sustainable drug supplies in public services (Hanson & Gilson, 1993) (see Part 2 of this chapter).

However, while many publications analyze the determinants of service utilization and the impact of services on health status, little has been published on how to actually improve access to health care because the discussion to date has been part of a larger neoliberal policy framework, that views comprehensive care as rhetoric as well as in isolation from publicly oriented health services.

The following Part 1 describes a study based on empirical research and interventions in several sites which was implemented by an international team to improve access to curative health care in a network of MoH health centres (primary care health services) in Ecuador between 1993 and 1998.