The class, taught by Nelson Arboleda, M.D., M.P.H., associate professor of global health in the Department of Public Health Sciences at the University of Miami Miller School of Medicine, provided public health students with a unique opportunity to engage with Dr. Borrero Vega and gain valuable insights into his current efforts to establish a Global Surgery and Social Change Initiative, offering a comprehensive view of Ecuador’s healthcare initiatives.

Dr. Borrero Vega outlined Ecuador's strategic vision in government functions, emphasizing universal healthcare coverage, sectorial alignment, a shift from curative to preventive healthcare models, and strengthening basic healthcare. The initiative is designed to address excessive waiting times, restricted access in remote areas, and the challenge of out-of-pocket spending on healthcare.

The implementation strategy focuses on raising the necessary budget, integrating international cooperation, and leveraging diplomatic efforts for financing.

The National Surgical, Obstetrics & Anesthetics Plan (NSOAP) involves a comprehensive situational analysis spanning four studies across 202 healthcare facilities. It entails stakeholder meetings aimed at actively integrating all key actors in the construction of public policy. The plan includes the drafting and validation process with territorial representativeness, marking the first complete subsystem articulation in policy design. 

Strategies for Delivery

The plan contains measures including expanding cost-effective surgical procedures, monitoring surgical capacity, bringing services closer to the entire population, and integrating innovative medical technologies and practices to assure high-quality, safe, timely, and inexpensive healthcare. 

Recognizing the importance of collaboration, Dr. Borrero Vega emphasized diplomatic efforts to promote surgical care in the Latin American region. “Ecuador's proactive steps include developing political commitments, knowledge transfer, resource sharing, advocating for funding, and fostering mutual achievements.”

NSOAP also focuses on implementing strategies for delivering quality, safe, timely, and affordable care for rural and indigenous communities. This involves reinforcing gynecological-obstetric, fetal, neonatal, and pediatric care in the Amazonia region. It also incorporates strengthening the trauma system in the Galapagos Islands, advancing cervical cancer health service delivery in rural areas, and implementing health digitalization initiatives.

Advances and Investments

Dr. Borrero Vega highlighted notable accomplishments, including the inauguration of 42 new operating rooms across the country bolstering diagnostic support services.

Significant financial investments were made towards enhancing infrastructure, acquiring state-of-the-art equipment, and strengthening the workforce. Other investments included ambulances and the overall improvement of healthcare facilities. The detailed breakdown of investments for the years 2022-2023 is as follows:

Infrastructure: $26.7 million

Equipment: $98.8 million

Workforce: A total of 6,785 individuals are associated with this investment, amounting to $79.5 million, with 4,281 allocated specifically for surgical areas.

The former vice president of Ecuador envisions a future where every country in the region has assessed its national surgical systems, developed clear roadmaps for improvement, and achieved standardized protocols for equal access by 2050. Dr. Borrero Vega issued a call to action for a joint effort to realize this vision.

“United, we can overcome the barriers that prevent access to safe and affordable care systems,” said Dr. Borrero Vega.

In addition to broadening the students’ awareness of global health challenges, Dr. Borrero Vega's visit to the Department of Public Health Sciences exemplified the value of collaborative efforts in shaping equitable healthcare systems.

“The exchange of knowledge and experiences serves as an inspiration for future public health leaders, encouraging them to actively contribute to the betterment of healthcare worldwide,” said Dr. Arboleda.

Written by Deycha Torres Hernández, published on January 23, 2024.