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Universal Health Coverage in Marginalized Populations: A Qualitative Evaluation of a Health Reform Implementation in Rural Ecuador
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine in Linköping.ORCID iD: 0000-0002-3606-1329
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.ORCID iD: 0000-0001-9116-8156
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0003-4224-1032
Museo Nacl Med Eduardo Estrella, Ecuador.
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2019 (English)In: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 56, article id 0046958019880699Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Sage Publications, 2019. Vol. 56, article id 0046958019880699
Keywords [en]
health care reform; health services accessibility; qualitative research; rural health services; universal coverage
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
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
Note

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

Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2019-11-04Bibliographically approved

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Eckhardt, Martin

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Eckhardt, MartinCarlfjord, SiwFaresjö, TomasFalk, Magnus
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Division of Community MedicineFaculty of Medicine and Health SciencesDepartment of Emergency Medicine in LinköpingPrimary Health Care in Central CountyPrimary Health Care Center Kärna, Linköping
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Inquiry
Health Care Service and Management, Health Policy and Services and Health Economy

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