by Lesley O’Connell.  

Inca trail

Achupallas, a village perched 4000 meters above sea level in the Ecuadorian Andes offers sweeping mountain views, and marks the beginning of the Inca Trail to Ingapirca, the best preserved pre-Colonial Inca ruin in Ecuador that linked Quito with Cuzco. True to its heritage, more than 90% of the village’s population is Kichwa speaking.  Not surprisingly, geographic accessibility in Achupallas is a challenge, its 30 or so communities are distributed at altitudes ranging from 2300 to 4000 meters above sea level, many located along precipitous mountain sides. How do they get basic services like health?

When I first visited Achupallas in 2012, the medical rural doctor assigned there for his year’s stay, was overly frustrated, given the health center’s limited capacity to meet the population’s demands. Likewise, in an open ended dialogue, community leaders emphatically expressed concern for better access and quality of health services, as well as respectful treatment and recognition of their traditional system of healing.

A few years later, it is encouraging to visit the village and see those concerns being addressed.  The Ministry of Health is finalizing the construction of a new health center financed with Inter-American Development Bank resources. More importantly, with the new health center a full set of medical and nursing staff will arrive to better attend patient demand, complementing the medical rural doctors who continue to rotate out yearly.

These investments support a holistic view of health and well-being, strengthening primary care through the creation of new types of health centers with new architectural designs and service portfolios that are part of the new health care model developed by the Ministry, as mandated by the 2008 Constitution. The model emphasizes health promotion through the organization and deployment of comprehensive health teams, made up of family medical doctors, nurses, dentists and primary care technicians that should systematically conduct community and home visits.

But, because of Achupallas’ topography and rocky dirt roads, many of its communities are more than three hours from town, with outliers ranging from six, seven, and ten hours. To get to the health clinic, families travel on foot, by horseback, truck, or a combination thereof.  These communities do not have effective access to health services (which should be within 2 hours using common modes of travel according to the Ministry’s norms,). This makes regular visits by the health teams a key service to assuring effective access to health for these communities.  The teams do their best – getting rides when possible, carrying their medical supplies or using the Ministry’s truck assigned to them weekly, though it is sometimes not available. It is important that the Ministry maps out the accessibility challenges of each of its new health centers to define appropriate strategies to help mobilize the health teams.

Combined with various incentives offered by the Ministry, the new health centers will hopefully attract the medical professionals needed to run them. However, the health teams’ work will also be more effective through training in the soft skills they need, such as friendliness, respect and understanding of the local culture, which includes training in the Kichwa language,  traditional health practices, and cosmovision, and better connection to the traditional health providers (yachaks, who provide traditional healing and spiritual advice in the community, and parteras, who provide health services during pregnancy and  delivery,  among others).

In the last few years while working in Ecuador, I have carried in my mind the soaring views of Achupallas countered with the frustration of that rural medical doctor, who probably rotated out a long time ago.  I am glad that the IDB and the Ministry of Health are making headway on the promise to improve health in this village.

What is your government doing to reach communities that are similar to Achupallas? Share with us in the comments section below or on Twitter.

Lesley D. O’Connell is a Social Protection Senior Specialist, currently based at the IDB’s office in Ecuador.

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