Compulsory medical service in Ecuador: The physician's perspective

Compulsory medical service programs for physicians and other health care pr ofessionals have been installed in developing countries around the world. T he underlying assumption for the creation of these programs is that the inc reased presence of physicians will improve the health status of rural popul ations which exhibit higher rates of morbidity and mortality compared to ur ban populations. This assumption, however, has been challenged by recent ev aluative studies of compulsory service programs in Latin America. This pape r reports on the physician's perspective of Ecuador's compulsory service pr ogram, known as medicatura rural. Based on responses to a self-administered questionnaire completed by 127 physicians who hart fulfilled or were curre ntly fulfilling their medicatura rural requirement, in-depth interviews wit h physicians and other officials, and visits to several rural placement sit es, the paper examines some of the fundamental programmatic and logistical problems that have impeded the successful implementation of the program sin ce its inception in 1970. While the majority of the physicians reported tha t the medicatura rural experience was both professionally and personally re warding, many view the program as conceptually flawed with respect to its g oal of improving the health status of rural communities. The physicians' su ggestions for improving the medicatura rural, which elucidate some of the p rogram's basic conceptual flaws and reflect the criticisms of compulsory me dical programs in other Latin American countries, are discussed. Finally, U galde's (1988) recommendation for replacing compulsory medical service prog rams with a "rural health corps" is considered. (C) 1998 Elsevier Science L td. All rights reserved.