| An outbreak of war with neighboring
Peru over ownership of some of the now valuable Amazon territories
initiated a further budgetary strain. Governments borrowed further
large sums to finance illegal shipments of often defective weapons
from neighboring countries Argentina and Chile, in what turned
into a protracted and unwinable war with Peru.
Servicing a huge debt to foreign governments and banks, the country
was
ill-prepared in terms of financial reserves to meet the collapse
of the Asian, and then most Latin American, financial markets,
in 1998. This was closely followed by a drop in world oil prices,
sinking an economy that had been taking on water. The country’s
currency, the Sucre, lost so much value that many large national
and private banks refused to accept it as payment for debt. In
order to stave off complete economic collapse, the country abolished
its own currency in favor of using only the U.S. dollar for all
transactions. Millions of people who had their money in banks
lost most their savings overnight through devaluation.
This period of economic instability heralded political volatility,
as different political parties, and national institutions including
the military, began to struggle over who was to blame for the
state of the country; and who would control its rich resources.
Seven presidents in eight years followed, emblematic of the instability
of the political process in Ecuador. The effect of this on government
run programs, including healthcare, has been direct and destabilizing.
One especially insidious effect has been that with each change
of Presidents, through presidential patronage, all appointed health
ministry positions are filled with the new president’s supporters.
This has included changing thousands of officials from every level
of the healthcare system, from top to bottom, seven times in eight
years! Most officials have hardly had a chance to learn their
jobs, before being replaced.
Instability in Ecuador’s government sector has also affected
healthcare delivery by promoting corruption. Transparency
International, the Berlin based non profit, compiles an annual
Corruptions Perceptions Index devoted to ranking countries
by their level of corruption from 10 to zero. The cleanest countries
get the highest score and place first on the list. Ecuador scored
a 2.5, ranking it 117th in the world, tied with Afghanistan. Both
were edged out by the Palestinian Authority which scored a 2.6.
That means, that despite whatever money is budgeted for national
healthcare, and however favorably that may compare with some of
Ecuador’s neighbors, that without effective management and
oversight of that money, a huge percentage of it “disappears”
before it reaches those it was intended to help.
“Corruption is a major cause
of poverty as well as a barrier to overcoming it. The two scourges
feed off each other, locking their populations in a cycle of
misery. Corruption must be vigorously addressed if aid is to
make a real difference in freeing people from poverty.”
Transparency
International
Unfortunately, the very nature of healthcare systems makes them
especially vulnerable to corruption in all countries. Specifically,
healthcare involves uncertainty, as people cannot predict when
they will need it. Information is asymmetric meaning not all information
is shared between patients, providers, and healthcare systems.
Finally, there are a large number of players involved in the healthcare
system, including providers, administrators, pharmaceutical companies,
equipment suppliers, regulators, payers, et. al.; opening up the
system for corruption on many different levels by many different
parties, each with differing agendas.
Transparency International reports in its special
report on healthcare corruption “that three factors,
uncertainty, asymmetric sharing of information, and a large number
of players, all create systematic opportunities for corruption.
These three factors combine to divide information among different
actors – regulators, payers, providers, patients and suppliers
– in ways that make the system vulnerable to corruption
and that hinder transparency and accountability.”
Specifically, “in the case of direct public provision of
health care services [such as Ecuador] the most common forms of
abuse involve kickbacks and graft in procurement, theft, illegally
charging patients, diverting patients to private practice, reducing
or compromising the quality of care, and absenteeism.” Read
about the Causes
of Corruption in Health Sector here.
Read the Parroquia of Cotogchoa’s official 10
year development plan for the years 2002 – 2012.
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