FREE MATERNITY AND CHILD CARE LAW (LMGAI)

1. FREE MATERNITY AND CHILD CARE LAW(LMGAI) PRINCIPLE: Recognition of the right to health and of the sexual and reproductive rights of women and female and male children under 5 years of age.

2. FREE MATERNITY AND CHILD CARE LAW (1998) OBJECTIVE: Eliminate the economic barriers that women and children under five years old face when accessing health services through the “financing of medicines, inputs, micronutrients, supplies, laboratory tests and complementary tests” (Art. 2 LMGAI)

3. FREE MATERNITY AND CHILD CARE LAW (1998): SERVICES Targeted at women Maternity: Prenatal check-ups; care for normal and at-risk births, cesarean sections, post-partum care; obstetric emergencies, intra-family violence, toxemia, sepsis, donation of blood and hemoderivatives. Sexual and reproductive health programs: DOC, STIs, family planning methods, HIV testing.

4. FREE MATERNITY AND CHILD CARE LAW (1998): SERVICES Newborns: Care for healthy newborns and for newborns with pathologies of different levels of complexity according to their needs, including blood and hemoderivatives. Children under five years of age: Illnesses addressed in the AIEPI strategy and related complications.

5. FREE MATERNITY AND CHILD CARE LAW: FINANCING • 3% from the Tax on Special Consumption (ICE) • $15,100,000 from the Solidarity Fund • National Fund for Infant Nutrition (FONNIN) allocated to the Ministry of Public Health (MSP) • Resources from the National Institute for Women and Children (INNFA) for the reduction of maternal and child mortality and for reproductive health

6. LMGAI: RESOURCE MANAGEMENT MODEL Ministry of Economy and Finance (MEF) 3% of the ICE SOLIDARITY FUND 15,100,000 Automatic each month Agreement (May, Oct) LMGAIEXECUTIVE UNIT Health Solidarity Fund (BCE) By production FSLS MANAGEMENT COMMITTEE Local Health Solidarity Fund LOCAL EXECUTIVE UNITS Health Areas and hospitals

7. FREE MATERNITY AND CHILD CARE LAW: MODEL OF CONTROL SUPPORT AND FOLLOW-UP COMMITTEE LMGAI EXECUTIVE UNIT USER COMMITTEES FSLS MANAGEMENT COMMITTEES HEALTH AREAS AND HOSPITALS

8. FREE MATERNITY AND CHILD CARE LAW: RESPONSIBILITIES OF THE MSP • Apply the decrees of the Law “in a compulsory manner in all (of its) establishments,” and “at the different levels of management.” • Define the national norms that guarantee the application of the Law (guarantee the quality of the services and the performance of the national disease control programs).

9. FREE MATERNITY AND CHILD CARE LAW: RESPONSIBILITIES OF THE MSP • Accredit other “not-for-profit entities that provide health services, including Traditional Medicine providers” so that they are able to participate as providers. • Establish technical guidelines so that Municipalities are able to implement programs for the promotion of sexual and reproductive rights and child health, and put in place transportation systems that can respond timely to obstetric, neonatal and pediatric emergencies.

10. FREE MATERNITY AND CHILD CARE LAW: RESULTS

11. LMGAI: Production and required budgetEcuador 2002-2006 * Projections based on the average production from January to August, 2006

12. FREE MATERNITY AND CHILD CARE LAW: RESULTS NUMBER OF WOMEN COVERED BY THE UEMGAI (Executive Unit of LMGAI) Num. of WOMEN # 907,187 1,003,028 1,122,208 1,294,002 YEARS

13. FREE MATERNITY AND CHILD CARE LAW: RESULTS

14. FREE MATERNITY AND CHILD CARE LAW: RESULTS NUMBER OF CHILDREN COVERED BY THE UEMGAI Num. of CHILDREN # 953,828 718,481 1,557,232 YEARS

15. Free maternity and child care law: The Impact of the Law 1994-2005 Percentage Prenatal Control Institutional Birth Home Birth Post-partum Control

16. FREE MATERNITY AND CHILD CARE LAW: IMPACTS • Maternal mortality has not declined (1995-2004) • Child mortality has declined slightly (1994-2004) • The LMGAI, together with the Child Nutrition Program (PAI), is a program that contributes to the progressivity of expenditures by the MSP (Angeles et al, 2006). • The MSP, through the LMGAI, finances approximately 30.7% of the national consumption of contraceptive methods, particularly among the population that resides in rural areas, and the Sierra, Amazon and Insular regions (Demographic and Maternal-Child Health Survey -ENDEMAIN,2004).

17. FREE MATERNITY AND CHILD CARE LAW: LESSONS LEARNED • It is necessary to guarantee sources of financing that increase in accordance with the expansion of coverage. • The impact of the LMGAI depends on the quality and strength of the MSP health services. • Citizen surveillance through User Committees (CUS) has allowed for improvements in the application of the LMGAI at all levels, including the development of public management based on citizen rights and the promotion of female empowerment. • The inter-sectoral nature of the CUS has been an important contribution to the sustainability of the application of the LMGAI.

18. FREE MATERNITY AND CHILD CARE LAW: LESSONS LEARNED 5. The participation of Municipalities in the FSLS Management Committees (CGFSLS) has provided them with the opportunity to work in a coordinated manner with the MSP units. 6. The separation of financing and service provision within the MSP has allowed for the strengthening of its stewardship, in the spheres related to the implementation of the LMGAI. 7. The application of the LMGAI has contributed to expansion of the insurance function of the MSP.

19. “Let us be part of the group of women that over the course of history has contributed to building happiness, justice and equity.” Monitoring the application of this Law gives us that opportunity