The precariousness of public health is by no means recent but rather constitutes a chronic

problem in the region. But the conjunctural factor that surely exacerbated the impact of the
pandemic in Ecuador has been the political situation that the country has gone through during
the last year.

This situation has conditioned the response of the Ecuadorian State, since all kinds of social or
economic measures to contain the pandemic necessarily arises from the fragile situation of the
pact that relations between the government and civil society are currently going through. In
this sense, the situation of the covid-19 pandemic in Ecuador has shown that the development
and impact of science and medicine in Ecuadorian society are inextricably linked to the
processes of political, social, and economic fragility that this South American nation has been
experimenting for the last few years.

In Ecuador, the health emergency found a system of health with structural conditions of
fragmentation and segmentation, fewer public resources allocated unfavorable health and
economic conditions that conditioned the response to the social, health and economic crisis.

Table 2: Estimated losses in the health sector. March-May 2020

Component Total (USD millions)

Production and distribution of goods and 724.69
health services
Resources, infrastructure, and physical assets 83.37
from the health sector
Access of the population to goods and services 59.8
health
Governance of the health sector 1.6
Increased vulnerability and risks 0.53
from the health sector
Total losses in the health sector 869.99
Source: Technical Secretariat Planifica Ecuador

According to the socioeconomic evaluation of the COVID-19 in Ecuador, carried out for the first
months of the effects of the pandemic in the country (March-May 2020), the accumulated
losses in the sector health (both public and private) totaled USD 870 million (Technical
Secretariat Plans Ecuador, 2020).

The needs for the acquisition of diagnostic tests, drugs, medical devices, increased personnel
and other supplies required for the care of patients with COVID-19 demanded greater
resources. patients with COVID-19 demanded greater financial resources from the health
financial resources from the health systems. In response, most Latin American countries took
measures to strengthen public health budgets to strengthen public health budgets (Casalí et
al., 2021).

In Ecuador, the state budget for health did not reflect the greater needs generated by the
health emergency. In 2020, the accrued budget of the Ministry of Public Health was USD 2,557
million, with an annual decrease of 8.1%, that is, USD 227 million less than in 2019. In 2021,
the codified budget of the Ministry of Health Public is USD 2,681 million which, if executed in
its entirety, would reflect a annual increase close to 5%
other problems are the lack or shortage of medicines, medical supplies and equipment, the
deplorable infrastructure of public hospitals and the transfer of patients to other hospitals or
payment of bills that insurance companies do not cover due to the economic crisis that
completely affects public health care.

doctors of the calderon teaching hospital and other hospitals declared that:

In this health house there are around 300 surgeries repressed. It also has several problems: it
has no equipment, no supplies and medicines, the Laparoscopy towers do not work, nor do the
Endoscopy and Colonoscopy towers. "We are in a very serious situation, and we can no longer
work," said Carolina Del Salto, president of the Association of Physicians of the Calderón
General Teaching Hospital.

Actually "there are two hospitals that are falling down", one of them is the Pablo Arturo
Suárez. However, this situation is replicated in hospitals nationwide, the CMP has reported.

Juan Barriga, representative of the Associations of Doctors of Hospitals of Quito of the Ministry
of Public Health, has maintained that doctors "cannot work" due to the lack of supplies and
materials for patients.

"We have hospitalized patients to be transferred to other hospitals, but they do not receive us
either because they do not have what is necessary, and the agreement houses do not receive
them either because they are not paid," he denounced.