# Medicines availability in Ecuador's public system (2015–2024): a policy design analysis of financing, public procurement, and governance

## TL;DR

This paper analyzes how policy design issues in Ecuador's public system have led to medicines shortages from 2015 to 2024.

## Contribution

The study provides a policy design analysis linking financial, procurement, and governance challenges to medicines availability.

## Key findings

- Budget contraction and volatile execution hinder sustained medicines availability.
- Procurement has become more fragmented, reducing transparency and increasing uncertainty.
- Governance issues like institutional weakness and delayed information strain decision-making.

## Abstract

Medicines shortages are a major health policy challenge in Ecuador and reflect inconsistencies in the architecture of public-sector medicines access policy. This Health Policy paper, grounded in the policy design framework, synthesises administrative records and policy documents (2015–2024) to show how budget contraction, volatile execution, and weak ex ante needs assessment hinder the translation of allocations into sustained availability. Procurement has shifted from a centralised electronic catalogue towards more fragmented purchasing modalities, while limited transparency in inventory management sustains uncertainty about needs and stock. Governance constraints, including institutional weakness, gaps in timely information, and extensive Constitutional Court oversight, further strain decision-making. Strengthening coherence across financing, procurement, information systems, and governance, alongside more stable leadership, is essential to translate formal commitments into reliable access to essential medicines.