Palliative care in Ecuador: unequal access to alleviate serious health-related suffering

The Global Observatory on Palliative Care ATLANTES, from the Institute for Culture and Society (ICS) of the University of Navarra and the Ecuadorianassociation of Palliative Care have presented at the Iberoamerican University of Ecuador the report on the status of palliative care in Ecuador, developed according to the indicators of the World Health Organization (WHO). The study, carried out by the ATLANTES team thanks to the support of the Colibrí Fund, has served to show the status of palliative care in the country and to analyze the challenges and opportunities to reduce the gaps identified. In addition, a commitment was signed for the implementation of the report 's suggestions in the different care settings.

According to the Lancet Commission on Global Access to Palliative Care and Pain Relief,each year more than 78,000 people in Ecuador experience severe health-related suffering requiring palliative care. To address this status, the country has 144 specialized palliative care services, equivalent to 0.8 services per 100,000 population, below the WHO recommendation of 2 services per 100,000 population. However, the distribution of services is uneven: the supply is greater in the highlands and very limited in the Amazon. Likewise, there is only one specialized pediatric service, which provides palliative care to children with cancer, which reflects a significant gap in the care of children and adolescents with serious illnesses.

The report also sample that there is limited availability of essential medications for pain and symptom management. For example, oral morphine is not available at all levels of care and national opioid consumption is 16 mg/capita/year (318 S-DDD per million inhabitants/day), well below international standards of adequate access.

Education and policies

One of the most important challenges is the training of professionals. According to the report, of the 22 medical Schools in Ecuador, only 5 include a mandatory module on palliative care. In the case of Nursing Schools , only 4 of the 26 existing ones offer a mandatory module in this area for basic training . Scientific research remains limited: 19 peer-reviewed publications were identified in the last five years and a ratio of 0.1 articles per 100,000 inhabitants, although the annual palliative congresses have strengthened the national academic community.

Regarding palliative care policies, the researchers regret that the proposed measures do not achieve the expected results. The country has had a National Palliative Care Plan since 2013, updated in 2022-2026, and formally integrated into the basic portfolio of health services. However, implementation remains incomplete and without a specific budget . In addition, The Organic Law on Palliative Care, approved in March 2025, recognizes palliative care as an integral part of the health system and guarantees the right to dignified and continuous care, although it still lacks clear implementation mechanisms and guidelines on advance directives. The Ministry of Public Health formally recognizes palliative care within its structure, but lacks an operational coordination entity and stable budget allocation, which prevents, according to experts, an effective and sustained implementation of the national plan.

Despite the challenges faced by the country, Ecuador ranks 85th worldwide in palliative care development , according to the Global Map of Palliative Care 2025 also developed by the ATLANTES team. This research sample a level of development "in progress" according to WHO indicators, where it is exposed that Ecuador combines regulatory and training advances with challenges in equity and access.