Health and Social Security
Both the public and the private sectors provided health
services. Most public health care came under the aegis of the
Ministry of Public Health, although the armed forces, the
Ecuadorian Social Security Institute (Instituto Ecuatoriano de
Seguridad Social--IESS), and a number of other autonomous agencies
also contributed. The Ministry of Health covered about 80 percent
of the population and IESS another 10 percent.
The Ministry of Public Health organized a four-tiered system of
health care. Auxiliary health-care personnel staffed posts that
served small rural settlements of fewer than 1,500 inhabitants.
Health centers staffed with health-care professionals serviced
communities of 1,500 to 5,000 inhabitants. Urban centers took care
of the larger provincial capitals. Provincial and national
hospitals were located in the largest cities. In the early 1980s,
there were approximately 2,100 health establishments nationwide;
the Ministry of Public Health ran more than half. Both the limited
numbers of health-care professionals and their lack of training
hampered public health care. These deficiencies were most apparent
in regard to medical specialists, technicians, and nurses.
Infant mortality-rate estimates in the early 1980s ranged from
70 to 76 per 1,000 live births, with government projections of 63
per 1,000 live births for the period 1985 to 1990. Although these
rates were a significant improvement from the death figure of 140
recorded in 1950, they remained a serious concern. Infant mortality
varied significantly by region and socioeconomic status. Surveys in
urban areas showed a range of 5 to 108 infant deaths per 1,000 live
births, whereas those in rural areas varied from 90 to 200.
Intestinal ailments and respiratory diseases (including bronchitis,
emphysema, asthma, and pneumonia) caused roughly three-fourths of
all infant deaths.
Childhood mortality (deaths among one- to four-year olds)
dropped to 9 per 1,000 in the mid-1980s following immunization
campaigns and some attempts to control diarrheal diseases. Acute
respiratory infections represented one-third of all deaths in this
age group. Further improvement in the childhood mortality rate
demanded extending the immunization program, increasing the
availability of oral rehydration therapy, improving nutrition, and
controlling respiratory ailments.
Precise, detailed evidence about children's nutritional status
remained limited and contradictory. The government conducted a
national survey in 1959 and followed this with more limited studies
in the late 1960s and 1970s. In the late 1960s, 40 percent of
preschool children showed some degree of malnutrition. Among
children under 12 years of age, 30 percent were malnourished and 15
The main causes of death among adults in the mid-1980s were
motor vehicle accidents, coronary heart disease, cerebrovascular
disease, cancer, and tuberculosis. Maternal mortality remained
high--1.8 per 100,000 live births in the mid-1980s. As with the
case of infant mortality, maternal mortality national averages
masked considerable regional variation, with the rate nearly three
times higher in some areas. These higher percentages reflected the
limited access many rural women had to health care. In the early
1980s, more than 40 percent of all pregnancies were not monitored;
the majority of births were unattended by modern medical personnel.
A number of tropical diseases concerned health officials.
Onchocerciasis (river blindness) was found in a number of small
areas; its range was expanding in the mid-1980s. Although Chagas'
disease (a parasitic infection) was not prevalent, environmental
factors favored its spread. Leishmaniasis (also a parasitic
infection) was expanding in the deforested areas of the coast and
coastal tropical forest. Malaria was found in 60 percent of the
country and became a major focus of public health efforts in the
late 1980s. A drop in mosquito control programs coupled with severe
flooding in 1981 and 1982 led to an increase in the prevalence of
malaria in the mid-1980s. Between 1980 and 1984, the number of
reported cases increased ten times. As of 1988, Ecuador also
reported forty-five cases of, and twenty-six deaths from, acquired
immune deficiency syndrome (AIDS).
The Ecuadorian Social Security Institute, an autonomous agency
operating under the Ministry of Social Welfare, offered its members
old-age, survivor, and invalidism benefits, sickness and maternity
coverage, and work injury and unemployment benefits. In 1982,
however, the system covered only approximately 23 percent of the
economically active population (21 percent of men and 33 percent of
women). Coverage varied widely according to urban or rural
residence as well as sex. Urban women had the highest rates of
coverage (42 percent), whereas rural men had the lowest (9 percent)
table 9, Appendix). Employees in banking, industry, commerce,
and government, and self-employed professionals had coverage for
most benefits. Agricultural workers were covered for work injury
and unemployment benefits and were gradually being included in
pension funds and survivors' and death benefits.
* * *
Osvaldo Hurtado's Political Power in Ecuador describes
the dynamics of Ecuadorian society from the colonial to the modern
era. Norman E. Whitten, Jr.'s numerous studies offer a wealth of
data concerning Costa blacks and Oriente Indians. Simon Commander
and Peter Peek's "Oil, Exports, Agrarian Change, and the Rural
Labor Process: The Ecuador Sierra in the 1970s" is an insightful
analysis of social change in the Sierra. Frank Salomon, Peter C.
Meier, Joseph B. Casagrande, and Wendy A. Weiss all describe the
dynamics of ethnic relations. DeWight R. Middleton and Marilyn
Silverman examine coastal society, especially the changes resulting
from migration. Axel Kroeger and Françoise Varobora-Freedman, Mario
Hiraoka, Shozo Yamamoto, and Michael J. Harner examine the
indigenous peoples of the Oriente or the impact of colonization on
that region. (For further information and complete citations,
Data as of 1989