Abstract
BackgroundLatin America (LA) has experienced constant economic and political crises that coincide with periods of greater inequality. Between 1996 and 2007 Ecuador went through one of the greatest political and socio-economic crises in Latin America, a product of neo-liberal economic growth strategies. Between 2007 and 2012 it regained political stability, promoted redistributive policies, and initiated greater social spending. To understand the possible influence on the political and economic context, we analyzed the coverage and inequalities in five Reproductive, Maternal, and Child Health (RMNCH) and two water and sanitation interventions using survey data from a broad time window (1994–2012), at a national and subnational level.MethodsThe series cross-sectional study used data from four representative national health surveys (1994, 1999, 2004 and 2012). Coverage of RMNCH and sanitary interventions were stratified by wealth quintiles (as a measure of the socio-economic level), urban-rural residence and the coverage for each province was mapped. Mean difference, Theil index and Variance-weighted least squares regression were calculated to indicate subnational and temporal changes.ResultsFrom 1994 to 2004, Ecuador evidenced large inequalities whose reduction becomes more evident in 2012. Coverage in RMNCH health service-related interventions showed a rather unequal distribution among the socioeconomic status and across provinces in 1994 and 2004, compared to 2012. Sanitary interventions on the contrary, showed the most unequal interventions, and failed to improve or even worsened in several provinces. While there is a temporary improvement also at the subnational level, in 2012 several provinces maintain low levels of coverage.ConclusionsThe remarkable reduction of inequalities in coverage of RMNCH interventions in 2012 clearly coincides with periods of regained political stability, promoted redistributive policies, and greater social spending, different from the former neo-liberal reforms which is consistent with observations made in other Latin American countries. Territorial heterogeneity and great inequalities specially related with sanitation interventions persists. It is necessary to obtain high quality information with sharper geographic desegregation that allows to identify and understand local changes over time. This would help to prioritize intervention strategies, introduce multisectoral policies and investments that support local governments.
Highlights
Latin America (LA) has experienced constant economic and political crises that coincide with periods of greater inequality
The remarkable reduction of inequalities in coverage of RMNCH interventions in 2012 clearly coincides with periods of regained political stability, promoted redistributive policies, and greater social spending, different from the former neo-liberal reforms which is consistent with observations made in other Latin American countries
We further identified interventions related to access to safe water and improved sanitation (WAS), which are established in the existing literature as being highly complementary to RMNCH, and are associated with great gains in mother and child survival [32]
Summary
Latin America (LA) has experienced constant economic and political crises that coincide with periods of greater inequality. Inequality is a major global challenge, including in Latin America, which has experienced periods of dramatic decline in levels of social spending accompanied by economic crises and political instability [1]. The widespread adoption of neo-liberal economic growth strategies has increased poverty and widened income inequalities in the provision of health services [2, 3]. In countries such as Ecuador, Bolivia, Argentina and Brazil, periods of greatest economic and political crisis coincide with marked increases in inequality, as measured by the Gini Index [4, 5]. Based on how interventions are faring across population groups, they may need to be integrated, reducing costs, duplication, and inefficiencies [12]
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