Central University of Ecuador, Faculty of Medicine, Quito, Ecuador.
Riberao Preto Medical School, University of Sao Paulo. FMRP-USP, São Paulo, Brazil.
Int J Equity Health. 2021 Jan 28;20(1):48. doi: 10.1186/s12939-020-01359-1.
Latin 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.
The 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.
From 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.
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. 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.
拉丁美洲（LA）经历了持续的经济和政治危机，这些危机与不平等加剧的时期相吻合。1996 年至 2007 年期间，厄瓜多尔经历了拉丁美洲最大的政治和社会经济危机之一，这是新自由主义经济增长战略的产物。2007 年至 2012 年期间，厄瓜多尔恢复了政治稳定，推行了再分配政策，并增加了社会支出。为了了解政治和经济背景的可能影响，我们利用全国和次国家层面广泛时间窗口（1994-2012 年）的调查数据，分析了五项生殖、孕产妇和儿童健康（RMNCH）以及两项水和卫生干预措施的覆盖范围和不平等情况。
这项系列横断面研究使用了四次具有代表性的全国健康调查（1994 年、1999 年、2004 年和 2012 年）的数据。根据财富五分位数（衡量社会经济水平的指标）、城乡居住情况对 RMNCH 和卫生干预措施的覆盖范围进行分层，并绘制了每个省的覆盖范围图。计算了均值差异、泰尔指数和方差加权最小二乘回归，以表明次国家和时间变化。
1994 年至 2004 年期间，厄瓜多尔的不平等现象很大，2012 年的不平等现象有所减少。1994 年和 2004 年，RMNCH 卫生服务相关干预措施的覆盖范围在社会经济地位和各省之间的分布不均，与 2012 年相比。相比之下，卫生干预措施的分布最为不均，而且在多个省份的情况并没有改善，甚至恶化。虽然在次国家一级也出现了暂时的改善，但 2012 年，一些省份的覆盖率仍然较低。
2012 年 RMNCH 干预措施覆盖率不平等的显著减少，与政治稳定的恢复、再分配政策的推行和社会支出的增加时期明显吻合，这与以前的新自由主义改革不同，这与在其他拉丁美洲国家的观察结果一致。特别是与卫生干预措施有关的地区异质性和巨大不平等仍然存在。有必要获得具有更精确地理细分的高质量信息，以便识别和了解随时间的当地变化。这将有助于确定干预策略的优先顺序，引入支持地方政府的多部门政策和投资。
