The AHD Model

AHD’s Rural Hospital Model is unique because of its…

1.  Physician Residency Program for local doctors

2.  Collaborations with local and US partners

3.  Self-Sustainability

Meeting the Need in Rural Ecuador

Rural Ecuadorian populations face a plethora of health care issues rooted in social, economic and political determinants. A major issue for rural populations is the relative lack of access to high quality, hospital-based health care. The nearest hospitals are typically hours away in major cities, forcing sick villagers to overcome geographic, economic, and cultural barriers to seek care in a far-away tertiary hospital.

These barriers result in less than half of rural inhabitants utilizing the current system. Those who are willing and able to pay for health services would greatly prefer to receive quality care in their own community if such hospitals were available to them.

Primary Healthcare (PHC) as a strategy has accomplished much in Ecuador, since the 1977 Alma Ata Proclamation. Nevertheless, women continue to suffer and often die from pregnancy complications. Children continue to die at an alarming rate from infectious diseases. Diseases such as diabetes, cardiovascular disease, and arthritis, now more common because of an aging population, are not treated appropriately because most health professionals in the countryside do not have the necessary medical expertise.

PHC needs reinforcement, but it cannot stand alone. Secondary services, (hospital care) in rural areas of developing countries need to address these more complex health conditions. Unfortunately, few rural hospitals in developing countries possess the tools to accomplish this. Limitations in clinical and administrative knowledge, coupled with financial constraints and unclear policies, make for an environment inadequately prepared to confront these challenges. To learn more about secondary care’s role in Ecuador, read Dr. Gaus and Board Members’ article, Making Secondary Care a Primary Concern, in the Pan American Journal of Health.

AHD is filling this void…

Hospital Pedro Vicente Maldonado has demonstrated that first rate medical care can indeed be locally financed and sustained, making the “health for all” vision of PHC something real and tangible for remote, poor populations.

First, the AHD Model emphasizes comprehensive health care. Hospital Pedro Vicente Maldonado (PVM) utilizes family physicians, who are best equipped to undertake the broad range of secondary health challenges in the countryside.

Second, the AHD Model involves strengthening the existing health care infrastructure to address the complex health problems in secondary care.  We do this not only by recognizing tangible infrastructure, such as quality medical equipment and fully functioning electronic medical records, but also by investing in human resources.  Hospital PVM has empowered local health care professionals through the establishment of a Physician Residency Program in partnership with the Catholic University of Ecuador and a Nurse Training Program with Luis Vargas Torres University.  These students learn the best medical and administrative practices available to become tomorrow’s rural care leaders.

Finally, the AHD Model champions financial self-sustainability.  The key to financial success has been public-private partnerships with the local, regional, and national governments of Ecuador.  Hospital PVM incurs no operating deficit.  It has achieved this through an innovative combination of financing mechanisms: payments on a services – rendered basis from the Social Security Administration (SSA) (60%), small fees for service from patients (35%), and contributions from local municipalities (5%).  Fees range from $3 for an outpatient visit to $180 for a cesarean section. AHD uses the public funds more efficiently than does the public health sector, which leaves additional money to cover payments by indigent patients. Only with this model can everyone in the community, in spite of limited resources, count on quality medical services. No one is turned away, and the hospital operates with its own revenues. To learn more about the AHD Model, read Dr. Gaus’s article in the Global Health Council’s Health Affairs, The Rural Hospital in Ecuador.


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Andean Health & Development
UW Department of Family Medicine
1100 Delaplaine Ct.
Madison, WI 53715
Email:  Phone: (619) 788-6833