Assessing critical gaps in COVID-19 testing capacity: the case of delayed results in Ecuador.

BACKGROUND: Testing is crucial for COVID-19 response and management, however, WHO's preparedness index omits estimations of actual testing capabilities, which influence the ability to contain, mitigate and clinically manage infectious diseases. With one of the highest excess death rates globally, Ecuador had a comparatively low number of confirmed COVID-19 cases, which may have been influenced by limited availability of data for decision-making due to low laboratory capacity. METHODS: We examine de-identified data on 55,063 individuals with suspected COVID-19 between February 27 and April 30, 2020 included in the RT-PCR testing database collected by the Ministry of Health. Processing times and rates per province, and the number of pending tests, were tallied cumulatively. We assessed the relationship between sample shipping, laboratory capacity and case completion using a negative binomial generalized linear model. RESULTS: The national average time for case completion was 3 days; 12.1% of samples took ≥10 days to complete; the national average daily backlog was 29.1 tests per 100,000 people. Only 8 out of 24 provinces had authorized COVID-19 processing laboratories but not all processed samples. There was an association between samples coming from outside the processing laboratory province, the number of other samples present at the laboratory during processing, and the amount of time needed to process a sample. Samples from another province took 1.29 times as long to process, on average. The percentage of pending results on April 30 was 67.1%. CONCLUSION: A centralized RT-PCR testing system contributes to critical delays in processing, which may mask a case burden higher than reported, impeding timely awareness, and adequate clinical care and vaccination strategies and subsequent monitoring. Although Ecuador adapted or authorized existing facilities to address limitations in laboratory capacity for COVID-19, this study highlights the need to estimate and augment laboratory capabilities for improved decision making and policies on diagnostic guidelines and availability. Support is needed to procure the necessary human and physical resources at all phases of diagnostic testing, including transportation of samples and supplies, and information management. Strengthening emergency preparedness enables a clear understanding of COVID-19 disparities within and across the country.

Sustainability in chronic disease prevention: lessons from the Salud al Paso program in Ecuador.

This study analyzes the conditions and possibilities of sustainability of the Salud al Paso program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of the implementation of this initiative, focused on the prevention of noncommunicable diseases (NCDs), was based on the program's user database, the information gathered on the perspectives of operational staff, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the on-demand activities included in the program and limit activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elder care programs, and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived as a project with an insufficient vision of its sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of NCDs requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral coordination articulation, especially with the Ministry of Public Health and other service networks.

El presente estudio analiza las condiciones y posibilidades de permanencia del programa Salud al Paso de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.

Sustainability in chronic disease prevention: lessons from the Salud al Paso program in Ecuador

[ABSTRACT]. This study analyzes the conditions and possibilities of sustainability of the Salud al Paso program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of the implementation of this initiative, focused on the prevention of noncommunicable diseases (NCDs), was based on the program’s user database, the information gathered on the perspectives of operational staff, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the on-demand activities included in the program and limit activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elder care programs, and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived as a project with an insufficient vision of its sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of NCDs requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral coordination articulation, especially with the Ministry of Public Health and other service networks.

[RESUMEN]. El presente estudio analiza las condiciones y posibilidades de permanencia del programa Salud al Paso de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.

Sustainability in chronic disease prevention: lessons from the Salud al Paso program in Ecuador / Sostenibilidad en la prevención de enfermedades crónicas: lecciones del programa Salud al Paso en Ecuador

ABSTRACT This study analyzes the conditions and possibilities of sustainability of the Salud al Paso program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of the implementation of this initiative, focused on the prevention of noncommunicable diseases (NCDs), was based on the program's user database, the information gathered on the perspectives of operational staff, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the on-demand activities included in the program and limit activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elder care programs, and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived as a project with an insufficient vision of its sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of NCDs requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral coordination articulation, especially with the Ministry of Public Health and other service networks.

RESUMEN El presente estudio analiza las condiciones y posibilidades de permanencia del programa Salud al Paso de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.

[Sustainability in chronic disease prevention: lessons from the Salud al Paso program in Ecuador]. / Sostenibilidad en la prevención de enfermedades crónicas: lecciones del programa Salud al Paso en Ecuador.

This study analyzes the conditions and possibilities of sustainability of the "Salud al Paso" program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of this implementation, focused on the prevention of noncommunicable diseases, was based on the program's user database, the information gathered on the perspectives of operational personnel, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the free demand activities included in the program and limit the activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elderly care programs and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived more as a project with an also insufficient vision of sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of noncommunicable diseases requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral articulation, especially with the Ministry of Public Health and other service networks.

Sostenibilidad en la prevención de enfermedades crónicas: lecciones del programa Salud al Paso en Ecuador

[RESUMEN]. El presente estudio analiza las condiciones y posibilidades de permanencia del programa “Salud al Paso” de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.

[ABSTRACT]. This study analyzes the conditions and possibilities of sustainability of the “Salud al Paso” program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of this implementation, focused on the prevention of noncommunicable diseases, was based on the program’s user database, the information gathered on the perspectives of operational personnel, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the free demand activities included in the program and limit the activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elderly care programs and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived more as a project with an also insufficient vision of sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of noncommunicable diseases requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral articulation, especially with the Ministry of Public Health and other service networks.

Developing local health policy: Profiling needs and opportunities in the Municipality of Quito, Ecuador.

We describe the steps taken and analysis applied in developing a local health policy agenda for the city of Quito, in Ecuador. In 2014, the Health Commissioner's Office of the Municipality of Quito analyzed the city's epidemiological health profiles, social determinants of health, the legal authority of the Municipality, and relevant literature to understand the city's health burden and develop a Ten-Year Health Plan (2015-2025). Results revealed that Quito's population suffered from noncommunicable chronic diseases (diabetes and hypertension) and identified the primary risk factors (poor nutrition, physical inactivity, and resulting overweight or obesity). Other common conditions included respiratory diseases, mental health conditions, deaths and injuries from motor vehicles, violence, and physical insecurity. The plan emphasized health promotion and disease prevention with the aim of transforming citizens' health perceptions with their active participation by fostering public and private intersectoral commitment to improve the quality of life of the population .