Socialist government health policy reforms in Bolivia and Ecuador: The underrated potential of integrated care to tackle the social determinants of health


  • Herland Tejerina Institute of Tropical Medicine Antwerp
  • Werner Soors Institute of Tropical Medicine Antwerp
  • Pierre De Paepe Institute of Tropical Medicine Antwerp
  • Edison Aguilar Santacruz Instituto de Salud Pública, Pontificia Universidad Católica del Ecuador
  • Marie-Christine Closon Université catholique de Louvain / École de Santé Publique, Unité de socio-économie de la santé
  • Jean-Pierre Unger Institute of Tropical Medicine Antwerp


primary health care, social determinant of health, health systems


Background Selective vertical programs prevailed over comprehensive primary health care in Latin America. In Bolivia and Ecuador, socialist governments intend to redirect health policy. We outline both countries’ health system’s features after reform, explore their efforts to rebuild primary health care, identify and explain policy gaps, and offer considerations for improvement. Methods Qualitative document analysis. Findings Earlier reform left Bolivia’s and Ecuador’s population in bad health, with limited access to a fragmented health system. Today, both countries focus their policy on household and community-based promotion and prevention. The negative effects on access to care of decentralization, dual employment, vertical programming and targeting are largely left unattended. Neglecting care is understandable in the light of particular interpretations of social medicine and social determinants, international policy pressures, reliance on external funding and institutional inertia. Current policy choices preserve key elements of selective care and consolidate commodification. It might not improve health and worsen poverty. Interpretation Care can be considered as a social determinant on its own. Key to the accomplishment of primary care is an integrated application of family medicine, taking advantage of individual care as one of the ways to act on social determinants. It deserves a central place on the policy-makers’ priority list, in Bolivia and Ecuador as elsewhere.

Author Biography

Herland Tejerina, Institute of Tropical Medicine Antwerp

MD, MPH, estudiante de PhD, investigador en salud pública






Themes and Debates