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Universal Health Coverage in Marginalized Populations: A Qualitative Evaluation of a Health Reform Implementation in Rural Ecuador
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Akutkliniken i Linköping.ORCID-id: 0000-0002-3606-1329
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Primärvården i centrala länsdelen.ORCID-id: 0000-0001-9116-8156
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.ORCID-id: 0000-0003-4224-1032
Museo Nacl Med Eduardo Estrella, Ecuador.
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2019 (engelsk)Inngår i: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 56, artikkel-id 0046958019880699Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

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.

sted, utgiver, år, opplag, sider
Sage Publications, 2019. Vol. 56, artikkel-id 0046958019880699
Emneord [en]
health care reform; health services accessibility; qualitative research; rural health services; universal coverage
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Identifikatorer
URN: urn:nbn:se:liu:diva-161129DOI: 10.1177/0046958019880699ISI: 000488970600001PubMedID: 31578919Scopus ID: 2-s2.0-85072919721OAI: oai:DiVA.org:liu-161129DiVA, id: diva2:1366123
Merknad

Funding Agencies|Centre for General Practice and Primary Health Care, County Council of Ostergotland, Sweden; County Council of Ostergotland, Sweden

Tilgjengelig fra: 2019-10-28 Laget: 2019-10-28 Sist oppdatert: 2019-12-11bibliografisk kontrollert

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