The public health system is available for people (and their families) without regular employment. Although access is universal, there are three different types of providers. The third level comprises specialised hospitals, situated in the major Ecuadorian cities, such as Quito and Guayaquil. The second level covers general hospitals, where care is provided by general doctors and some specialists. The first level covers health centres, some of which may include 24-hour emergency care, and are normally staffed by young HCPs. 7 These phases have been used in a systematic review to classify reported barriers and facilitators to healthcare access for any disease, 8 and could be applied also to asthma healthcare.Įcuador is an upper-middle-income country, with a health system organised at three different levels. Tanahashi designed a model of effective health service coverage that includes factors related to health services and to the population distributed into four phases: availability, accessibility, acceptability and contact ( figure 1). 6ĭifferent models have been proposed to study access to health services. 2–5 High asthma prevalence, lack of specialised doctors, poor access to asthma medications and lung function tests, lack of regular follow-up or low adherence to long-term medications are some of the factors considered to underlie the high asthma morbidity and mortality in Latin America. In general, in Latin America, control of childhood asthma tends to be poor, resulting in preventable harm such as repeated use of emergency care and hospitalisations for asthma attacks. However, inadequate asthma management is common, particularly in low-resource settings. 1 Adequate health and home care access are essential to improve the management of children with asthma. Asthma is a chronic disease that requires a long-term collaborative approach to management, to ensure control of daily symptoms and avoid asthma attacks.
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