Ecuador

The health system of Ecuador is fragmented throughout various institutions, making the implementation of national policies for diseases such as HIV/AIDS, malaria and tuberculosis very difficult. Up to 40 per cent of the population has no access to healthcare, in part, because of financial shortfalls in the public health sector.

MSF is working to improve healthcare for people with HIV/AIDS in the Floór de Bastión slum of Guayaquil, Ecuador’s largest city. Here MSF provides care to 540 persons with HIV, 281 of them receiving antiretroviral treatment. In 2005/2006, MSF has been decentralising care from the referral hospital to maternity clinics and health centers, promoting better patient access to diagnosis, care and follow-up.

The disease carries a strong stigma and in 2005/2006, MSF worked on breaking down myths and stigmas attached to HIV — particularly amongst health staff — through educational workshops and sensitivity training and contributed to forums on HIV in different areas of the country.

Advocating for drugs to expand treatment

Generic medicines, the cheaper alternative to branded drugs, are key to expanding treatment for HIV/AIDS. Registering drugs in Ecuador is a complicated process, and the use of qualified generic medicines is being introduced slowly given strong pressure from pharmaceutical companies to use branded drugs. MSF has been defending registration of generics with the goal of including them in the national HIV/AIDS protocol, and the National AIDS Plan is now giving greater consideration to generics because of their lower cost.

MSF has also been lobbying for fixed-dose treatment (whereby different drugs are combined into single pills) to become part of the national protocol. Fixed doses make it simpler and easier for patients to take their medicines and helps improve treatment adherence.

MSF is working on a progressive handover of the Guayaquil HIV/AIDS project to the Ministry of Health, which should be completed in 2008.

MSF has worked in Ecuador since 1996.

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