By Mauricio Torres-Tovar & Pol De Vos
Mauricio Torres-Tovar, MD, MPH. Emerging Voice 2010.
President of the International Association of Health Policy (IAHP)
Ecuador, a country of the Andean region of South America, has been characterized by the combativeness of its people in recent decades. A highly dynamic social mobilization, led mainly by the indigenous movement, generated a wave of riots since the early ’90s that led to the resignation of eight presidents, three of them directly because of social protests. Since 2007, when President Rafael Correa was elected, the country returned to stability.
The re-election of Correa (with 57%) for a third presidential term in February this year, shows the support for this president among large sections of the middle class and the poor. Correa’s government is part of a Latin American anti-neoliberal wave, which started with Hugo Chavez in Venezuela in 1999, and includes Bolivia, Nicaragua, Uruguay, Paraguay, Brazil, El Salvador and Argentina.
One of the initial decisions of Correa was the convening of a Constituent National Assembly. The new constitution was officially launched in July 2008 and ratified through a popular referendum in September of that year.
The new Constitution defines Ecuador as a sovereign, independent, intercultural, multi-national and secular country, committed to a development model based on the (indigenous people) idea of “buen vivir”. In ancient Quechua, the term “Sumak Kawsay” means “good living” in harmony with our communities, ourselves, and most importantly, our living, breathing environment. According to Ariruma Kowii, an Ecuadorian (indigenous) writer and poet and also a leader of the indigenous movement, Sumak Kawsay is “an ancient Andean conception of life that has remained in force in many indigenous communities until now. Sumak means the ideal, the beautiful, the good, the realization, while Kawsay represents the life, in reference to a decent life, in harmony and balance with the universe and human beings. In sum, Sumak Kawsay means to live the fullness of life”.
Based on this constitution, Correa took a number of social and economic measures that benefited the poor and middle class (under the label ‘socialismo del Buen Vivir’). He also developed a foreign policy committed to Latin American integration, challenging the United States by forcing them to withdraw their military basis in the country (in Manta) and conducting a critical audit of Ecuador’s external debt. This led to a significant reduction of the debt as Correa only accepted the “fair” part of it. He argued that a big part of the debt was immoral and illegitimate (“odious”) because it had been contracted during the military regimes.
Increasing the budget for social policies
The Correa government has increased social investments in health and education, with real estate lending at low interest rates and a housing allowance of $ 6,000, and a $ 50 per month subsidy to 2 million people through the Human Development Grant, funded through taxes on the financial sector.
According to the National Institute of Statistics of Ecuador, as a result of these social measures, the poverty rate (2,54 dollar /day) decreased (from 37% of the population in 2007 to 27% in 2012), real unemployment now hovers around 5 % and the minimum wage increased (from $ 292 to $ 318). These investments largely explain Correa’s strong popular support.
More money for health
The government increased health investments from $ 371 million in 2004 to 1.6 billion in 2012. The money was mainly invested in the production and distribution of generic medicines, the set up of public health programs and prevention campaigns, immunization campaigns, the establishment of mobile hospitals and mobile medical teams to distant regions. Main achievements are the renovation of 469 health facilities, the construction of 52 new facilities, the investment of $ 119 million in medical equipment, the acquisition of 152 new ambulances, the allocation of $ 182 million to free medicines, the contracting of 14,977 health professionals and the purchase of 1,753 basic health kits.
However, strong criticism exists. According to the Ecuadorian Medical Federation the increase of the health budget led to “a moderate expansion of coverage and a lot of propaganda”, and implied large purchases without the necessary control. Also, from 2011 onwards the government strengthened 3 pillars of neoliberal politics (health labour flexibility, privatization and outsourcing of services), leading to “unmotivated dismissal of public health workers” and using “public resources to purchase private services”.
While the constitution established the creation of a national public health system to overcome the current segmentation and fragmentation, until today no steps have been taken. Neither has the promise been kept to tackle the more structural causes of health inequity, and to better take into account the traditional culture of the indigenous majorities.
Important people’s organizations consider that Correa’s health policy has failed to confront the main social determinants of health so far. His government refrains from tackling the structural causes of health inequities and does not incorporate the knowledge and practices of traditional medicine, in a country where a large part of the population is indigenous.
The opposition of social movements
Correa’s government first generated widespread sympathy among the poor, social movements and organizations. However, in recent years there has been a process of radicalization on issues of mining, oil exploitation and the (ab)use of water sources. Correa’s government reacted to the demands and increasing mobilization of the communities against mineral and oil extraction with the criminalization of social protest and the persecution of indigenous leaders and students.
Although President Correa has been able to break the logic of neoliberal policies of his predecessors, a broad and radical popular movement, advocating sustainable development, opposes his extractive projects, because they remain within the actual capitalist development matrix, of which the global social and ecological logic are considered to be unsustainable. The movement advocates a radical shift towards a more ecological approach of development, and more structural changes in the distribution of wealth and power in the Ecuadorian society, arguing that 5% of the land owners still possess 52% of agricultural land, while 60% of smallholders access only 6.4%. This contradiction is aggravated by the presidential decision to use large territories for the development of biofuels, while planning to amend the Constitution in order to facilitate the cultivation of genetically modified seeds.
Ecuador’s challenges in a new context
Hugo Chavez’s death changed the political context in the Latin American region, as the process of structural change might slow down and the level of people’s participation might decrease. Sadly, against this backdrop, the Ecuadorean government might be tempted even more to go for the Brazilian neo-developmental route with economic growth, based on extractive mining and bio-energy projects.
Anti-neoliberal policies enjoy strong support among the majority of the population. A growing part of the indigenous population mobilizes for a paradigm shift, changing the matrix of consumption and exploitation. The movement wants to end extractivism and the pillage of the planet by the capitalist development model and advocates for a more ecological equilibrium model.
This contradiction is a global one, and involves each of us: while we might consider these ideas as utopian, at the same time we understand that such a dramatic paradigm shift is needed if we want mankind to survive…