The Rural Hospital In Ecuador Improving rural secondary care is an essential expansion of the primary care strategy in many lower- and middle-income countries.

David Gaus


Over a period of twelve years, the author’s vision of improving the health of ru- ral Ecuadorians has evolved from an initial emphasis on primary health care to secondary care. The local community convinced him of the critical need for an efficiently managed, high-quality, and affordable rural secondary care hospital. Exploring a variety of funding op- tions, the hospital ultimately achieved financial sustainability, principally through Ecuador- ian public sources. Now, in partnership with the Ministry of Public Health (MOH), the rural hospital model that evolved in Pedro Vicente Maldonado is being adapted as a pilot project in an existing MOH rural hospital. [Health Affairs 28, no. 4 (2009): 1003–1010; 10.1377/ hlthaff.28.4.1003]

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World Health Organization, “Declaration of Alma-Ata, International Conference on Primary Health Care, Alma-Ata, USSR [now Khazakhstan], 6–12 September 1978,” Systems_declaration_almaata.pdf (accessed 14 April 2009).

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