Ecuador

The Health in the Americas+¹ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.

Environmental and social determinants of health

In 2000 the total population of Ecuador was 12 626 507 inhabitants; by 2023 this figure had risen to 18 190 484, representing a 44.1% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 8.1% of the total population, an increase of 3.3 percentage points compared to the year 2000. In 2023, there were 100.4 women per 100 men and 31.9 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 66.6% of the total population of the country in 2023 (12 121 663 people). When we add these figures to the potentially passive population (4 599 799 under 15 years of age and 1 469 023 over 65 years of age), the result is a dependency ratio of 50.1 potentially passive people per 100 potentially active people. This ratio was 67.4 in 2000.

Life expectancy at birth in 2023 was 78.1 years, higher than the average for the Region of the Americas and 5.2 years higher that in 2000.

Figure 1. Population pyramids of Ecuador, years 2000 and 2023

Between 2007 and 2020, the average number of years of schooling in Ecuador increased by 14.2%, reaching an average of 8.8 years in the latest year for which information is available. The unemployment rate in 2022 was 4.0%. Disaggregated by sex, the rate was 4.7% for women and 3.4% for men. The literacy rate was 99.0% in 2021. In men, this figure was 99.5%; in women, 98.6%. In addition, 33.0% of the population were below the national poverty line in 2020, a decrease from 64.4% in 2000. In 2020, 6.5% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 1.90 per day; this is below the regional average of 3%.

During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 7.7% (from a score of 0.687 to a score of 0.74); during the same period, the index rose 13.5% internationally and 9.4% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2021

In 2020, public expenditure on health accounted for 4.97% of gross domestic product (GDP) (Figure 3) and 13.91% of total public expenditure, while out-of-pocket spending on health accounted for 33.83% of total health expenditure.

Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2020

Digital coverage

In 2021, 76.2% of the population had an internet connection, representing a considerable increase from 2000, when 1.5% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2017, infant mortality in Ecuador decreased from 15.5 to 9.9 deaths per 1000 live births, a decrease of 36.1% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 3.6% to 7.7% between 2000 and 2018, while exclusive breastfeeding in the child population up to 6 months of age was 79.26% in 2004 (the latest year for which information is available).

Regarding the immunization strategy, measles vaccination coverage was 74.0% in 2022, a decrease of 10.0 percentage points from 2000.

The maternal mortality ratio for 2020 was estimated at 65.7 deaths per 100 000 live births, a reduction of 45.3% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 2.0 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 30.9% decrease, from 88.8 live births per 1000 women aged 15 to 19 years in 2000 to 61.4 in 2023. In 2020, 96.4% of births were attended by skilled birth personnel. Between 2004 and 2013 the percentage of pregnant people who had four or more consultations for antenatal care increased from 57.5% to 79%.

Figure 4. Infant mortality per 1000 live births, 1995–2020

Figure 5. Maternal mortality per 100 000 live births, 2000–2020

Communicable diseases

In 2021, there were 31 new cases of tuberculosis per 100 000 population in Ecuador. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 3.5 (1.7 in women and 5.4 in men).

In 2021, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 22.3 per 100 000 population. The age-adjusted mortality rate for HIV was 3.7 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 74.5%.

There were no reported cases of human rabies in the country in 2020.

Noncommunicable diseases and risk factors

In Ecuador in 2023, the prevalence of tobacco use among people aged 15 and older was 10.6%. In the same age group, the prevalence of overweight and obesity was 56.0% in 2016.

Also in 2016, 54.4% of the population reported insufficient physical activity. 

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 17.9%, a decrease of 2.7 percentage points compared to 2000 (20.6%). The prevalence of diabetes mellitus, which stood at 6.3% in 2000, increased to 8% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Ecuador was 194.2 deaths per 100 000 population, a decrease of 33% compared to the rate of 290 in 2000. This meant that, in 2019, the rate in the country was 14.3% lower than the average rate reported for the Region of the Americas as a whole. Among potentially preventable premature deaths, the rate for preventable causes was 102 per 100 000 population in 2019, which is 25.6% lower than the regional average rate; and the rate for treatable causes was 92.2 per 100 000 population, below the regional average of 89.6.

The overall age-adjusted mortality rate was 4.8 per 1000 population in 2019, a decrease of 22.8% compared to 2000 (6.2 deaths per 1000 population).

When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 56 per 100 000 population (64.1 per 100 000 in men and 48.5 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 365.5 per 100 000 population (411.7 per 100 000 in men and 326.6 per 100 000 in women). The rate of age-adjusted mortality from external causes was 53.8 per 100 000 population (84.2 per 100 000 in men and 24.4 per 100 000 in women), including road traffic accidents (20.6 per 100 000 population), homicides (7.1 per 100 000 population) and suicides (7.7 per 100 000 population). In 2000, the percentage distribution of causes was 62.4% for noncommunicable diseases, 23.1% for communicable diseases, and 14.5% for external causes; in 2019, the percentages were 76.2%, 12.3%, and 11.5%, respectively (Figure 6).

Figure 6. Proportional mortality in Ecuador, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 18.3 per 100 000 men; lung cancer, 6.7 per 100 000; and colorectal cancer, 6.8 per 100 000. In women, these values were 9.9 deaths per 100 000 for breast cancer; 5.6 per 100 000 for lung cancer; and 6.8 per 100 000 for colorectal cancer.

The health situation and the COVID-19 pandemic

In Ecuador in 2020, there were a total of 224 764 cases of COVID-19, representing 12 630.2 per million population. In 2021, there were 334 674 identified cases, equivalent to 18 806.4 per million population, while, in 2022, the number of reported cases was 452 319, equivalent to 25 417 cases per million. In 2020, there were 14 034 deaths directly caused by COVID-19 in people diagnosed with the disease, or 788.6 per million population; in 2021, 19 638 deaths were reported, equivalent to 1103.5 per million; in 2022, there were 2210 reported deaths, or 124 per million. In 2020, Ecuador ranked ninth in the Region of the Americas in terms of the number of deaths from COVID-19, 22nd in 2021, and 45th in 2022, with a cumulative 2016.49 deaths per million population over the three years (Figure 7). 

According to estimates by the World Health Organization,  there were a total of 46 403 excess deaths in 2020, or 263.8 per 100 000 population. A total of 34 466 deaths were estimated in 2021, for an excess mortality rate of 193.6 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 85.6% of the country's population. As of 2 July 2022 (latest available data), 78% of the population had completed the vaccination schedule. The vaccination campaign began on 20 January 2021, and four types of COVID-19 vaccine have been used to date.

Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023

Prospects

Measures to achieve universal health coverage

During 2021, the Ministry of Public Health (MSP) of Ecuador led a participatory process aimed at developing the Ten-Year Health Plan 2022–2031 (PDS 2022–2031),  with the following objectives:

• Reduce inequalities and inequities in effective, universal, and free access to health, through an intersectoral approach to the social and environmental determinants of health.
• Promote the well-being of the population at all stages of life through the formation of healthy and safe environments, communities, and lifestyles.
• Reduce the disease burden through a comprehensive approach to public health that will reduce preventable diseases and preventable deaths.
• Guarantee access to comprehensive and quality health services, with an emphasis on primary care networks that have efficient and transparent management models.
• Transform the national health system to ensure universal access to health and universal health coverage.

Challenges related to population health

Among the challenges facing Ecuador's public policy agenda are the five identified in PDS 2022–2031, with their respective impact indicators and corresponding strategies. These challenges include:

• Reducing existing gaps in the rate of malnutrition among children under 2 years of age in indigenous populations.
• Reducing the rate of adolescent pregnancies.
• Reducing the maternal mortality ratio.
• Reducing the percentage of hospitalizations for disorders treatable through outpatient care.
• Promoting the formation of health teams that include professionals from different vulnerable populations, such as indigenous populations, with special emphasis on people living in rural areas.

COVID-19 pandemic response

The response plan designed by the public authorities to tackle the pandemic, with its corresponding strategies and actions, is based on the ten pillars of Ecuador's national COVID-19 plan, also known as “Plan Fénix.”  

After considering the nationwide impact of the pandemic, the health authorities established pillar 10 of Plan Fénix (vaccination) as a priority. This resulted in national vaccination coverage of 79% for the primary series, and 35% for the first booster. 

The response plan also included strengthening epidemiological and laboratory surveillance capacities, including virological and genomic surveillance; surveillance of adverse events following immunization (AEFI); self-assessment of vaccine effectiveness; infection control; and reorganization of health services to expand the capacities for intensive care and hospitalization. This will make it possible to meet the high demand resulting from the concurrent and recurring waves of COVID-19 in 2021, including the one that occurred toward the end of 2021 and early 2022, with the highest number of cases to date.

Measures to reduce inequalities in health

The policies designed and implemented by the Ministry of Public Health (MSP) reflect unqualified respect for constitutional principles aimed at reducing social inequalities and health inequities. These principles include, as priority care groups, older people, children and adolescents, pregnant women, people with disabilities, people deprived of their liberty, and people suffering from catastrophic or highly complex diseases. In addition, the Constitution of the Republic of Ecuador  guarantees the right to health of people in situations of migration and assigns special importance to the rights of indigenous peoples, whose rights have historically been violated. 

The Intersectoral Strategic Plan for the Prevention and Reduction of Chronic Child Malnutrition  promotes an approach based on interventions to reduce chronic child malnutrition, with special emphasis on children from indigenous communities, which register the highest reported rates of malnutrition. 

Public authorities have developed a series of instruments based on a human rights approach and respect for the principles of equality—particularly gender equality—inclusion, and equity. This list of instruments includes the development of manuals for the health care of LGBTI (lesbian, gay, bisexual, transgender, and intersex) people; implementation of first reception rooms for victims of gender violence; and interculturally relevant quality health care for people belonging to indigenous groups, Afro-Ecuadorians, and Montubios, among other groups living in situations of vulnerability.

National strategy to address inequalities in health

The main purpose of Ecuador's PDS 2022–2031  is to reduce inequalities and inequities in effective, universal and free access to the right to health, through an intersectoral and comprehensive approach to the social and environmental determinants of health. To this end, strategies have been designed that coordinate various initiatives, primarily addressing the social determinants of health, for the priority care groups most exposed to these inequalities and inequities––a segment of the population with high demand for comprehensive services.

Lastly, there has also been a proposal to establish a specific monitoring system for these priority care groups in order reduce inequities and inequalities in access to health and health care. 

The sources of the interagency indicators used in this profile can be found in this table.

For the latest data on health indicators for the Region of the Americas, be sure to visit the PAHO Core Indicators portal.