Abstract submitted for AAAs

The Reemergence of Primary Health Care: Evaluating the Impacts of Medical Pluralism in Rural Ecuador

The Alma Ata Declaration of 1978 emphasized Primary Health Care (PHC) as the optimal approach to decrease global health inequities. Following decades of neoliberal reform and growing participation of non-governmental organizations [NGOs] in health care delivery, PHC is reemerging in Latin America as national governments reassert control over health care. Today, PHC programs seek a balance between traditional and biomedical practices to enhance health and extend access to all citizens. The health transition, marked by rapid changes in family size, fertility and patterns of mortality and morbidity, provides a theoretical foundation for a rapid assessment of health care in Mondaña, Ecuador in December 2009-January 2010 conducted by a team of faculty and student researchers through the annual field school of the University of Colorado Denver.  Mondaña is a valuable case study because of its close articulation with the Yachana Foundation, an NGO promoting sustainable development through eco-tourism, educational programs and health initiatives. This paper discusses the current state of maternal health care in Mondaña, for example, how traditional and biomedical modalities interact. It also is a focal point to assess changes in health-seeking behavior created by construction of a government-funded, Yachana-supported maternity hospital. The new hospital incorporates Traditional Birth Attendants into their biomedical model of care as a response to Kichwa women’s current preference to birth at home. We will examine rapidly changing health care approaches in which local people are actively working with governments and NGOs to construct a system that reflects their needs and cultural realities.