Health workforce and sanitary capacity in Ecuador: Challenges in professional absorption and infrastructure

Abstract

Objective: To analyze the structural imbalance between the healthcare workforce and physical infrastructure in Ecuador through graduation trends and physical capacity (2015–2024) and active personnel density (2015–2021). Methods: An ecological study based on provincial administrative data. The Professional Sufficiency Index (PSI) and the Professional Absorption Index (PAI) were calculated. Fixed-effects regression models and Incidence Rate Ratios (IRR) were employed to evaluate the association between professional density (physicians and professional nurses) and installed capacity (beds and healthcare facilities). Results: Regarding active personnel (2015–2021), physician density increased from 18 to 23 per 10,000 inhabitants, identifying values above the structural alignment threshold (PSI: 1.14–1.35). Professional nurses showed a progressive increase in their sufficiency index, escalating from a PSI of 0.63 to 0.92 (β = 0.28, p = 0.001). The PAI evidenced a downward trend in labor absorption; the integration of physicians fell from 23.55% to 10.22%, and for professional nurses from 21.70% to 15.82%. Multivariate analysis confirmed a negative relationship between personnel density and the availability of healthcare facilities (2021 IRR: 0.93; p < 0.001). No statistically significant association was found with the expansion of hospital beds (p > 0.05). Conclusions: The Ecuadorian healthcare system experiences a structural mismatch due to the decoupling between academic training and physical absorption capacity. The absolute increase in professionals is not associated with an expansion of the service network but rather with greater pressure on pre-existing infrastructure. The strategic expansion of physical capital must be planned based on provincial population density rates, prioritizing decentralization to correct territorial disparities and the shortage of professionals in peripheral rural areas and the Amazon region.