title: [Equity-based considerations for transforming the Ecuadorian health system].
abstract: OBJECTIVE
  The present study was aimed at analysing socioeconomic inequity regarding the use of health services in Ecuador, inequity regarding the geographic distribution of healthcare-related human resources and reflecting on the challenges concerning equity which the Ecuadorian health system is currently facing.
  
  
  METHODS
  The Ecuadorian Demographic, Maternal and Infant Health Survey (2004) was used as the main data source, as its sample was representative of the Ecuadorian population. Multilevel multivariate analysis (MLWiN 2.02 statistical software) and spatial data analysis regarding health resources (GeoDa 1.0.1) were used for estimating the effects of using health services.
  
  
  RESULTS
  It was found that social, economic and geographic inequity limited access to health services in Ecuador. People living in low economic resource households or indigenous housing and people living in rural areas (many of them having all three characteristics at the same time) had less possibility of using health services. In spite of a marked concentration of health-service providers in urban areas, it was found that the presence of healthcare personnel (excluding doctors) in rural public entities increased the possibility of using preventative and curative services.
  
  
  CONCLUSIONS
  Efforts at transforming the Ecuadorian health system must be aimed at reducing social, cultural and financial barriers and inequality regarding the distribution de healthcare-related human resources, particularly in rural areas. Community and family orientation of the services and increasing spaces for citizen participation are necessary for reducing such inequity.
authors.affiliation: Escuela de Salud Pública, Universidad San Francisco de Quito, , dlopez@usfq.edu.ec.
authors.forename: Daniel
authors.initials: D
authors.lastname: López-Cevallos
authors.affiliation: Centro de Estudios Latinos y Acción Participativa, Oregon State University, , daniel.lopez-cevallos@oregonstate.edu.
authors.forename: Chunhuei
authors.initials: C
authors.lastname: Chi
authors.affiliation: Escuela de Medicina, Departamento de Desarrollo Comunitario Integral, Universidad San Francisco de Quito, Ecuador, fortega@usfq.edu.ec.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ortega
mesh_terms: D003430:Cross-Sectional Studies; D004484:Ecuador; D005260:Female; D018166:Health Care Reform; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019035:Rural Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution; D012959:Socioeconomic Factors; D062206:Spatial Analysis