Observation (CEACR) - adopted 2010, published 100th ILC session (2011)

Medical Care and Sickness Benefits Convention, 1969 (No. 130) - Ecuador (Ratification: 1978)

The Committee regrets to note that the report supplied by the Government in 2008 reproduced the text of its report of 1998 and is therefore entirely unresponsive to the Committee’s observation of 2007. Both reports did not contain any information concerning the application of Articles 21–32 of the Convention. The Committee would like to believe that the Government of Ecuador takes its reporting obligation under article 22 of the ILO Constitution seriously and endeavours to apply international Conventions in good faith. It therefore expects the Government to supply a new detailed report containing reliable information on the application of all Articles of the Convention according to the report form adopted by the Governing Body, covering the developments in medical care and sickness insurance for the whole period since 1993. Meanwhile, the Committee has examined the Law on Social Security of 2001, the statistics of the Ecuadorian Social Security Institute (IESS) annexed to the report and the Government’s brief reply to the questions raised in the Committee’s previous observation. It has also examined the recent ILO study – Assessment of the social security system of Ecuador (June 2008) (Diagnóstico del sistema de seguridad social del Ecuador) (hereinafter the Assessment).

Part I (General provisions). Article 2, in conjunction with Articles 11(a) and 20(a). Scope of coverage. The Committee observes that the statistics of the IESS for the year 2003 do not permit it to ascertain whether the scope of coverage required by these provisions of the Convention (at least 25 per cent of all employees in the country) is attained in Ecuador, as the statistics do not specify the number of employees protected in the prescribed classes in relation to the total number of employees in Ecuador. The Committee hopes that these numbers will be specified by the Government in its next report.

Article 3. Coverage of agricultural employees. Upon ratifying the Convention, Ecuador has availed itself of the temporary exclusion from its provisions of the employees in the sector comprising agricultural occupations on condition that it shall gradually increase the number of agricultural employees protected and regularly report the progress achieved in the application of the Convention to such employees. Such exclusion is permitted by the Convention in case agricultural employees were not protected by the legislation of the country at the time of the ratification and may be maintained until the legislation applying the provisions of the Convention is extended to cover also agricultural employees. The Committee recalls that, after the ratification of the Convention in 1978, agricultural workers were incorporated into the social security system under a special scheme for the protection of agricultural workers by virtue of Decree No. 21 of 1986. The statistics of the IESS are structured by the regime of affiliation to the Compulsory General Social Security (Seguro General Obligatorio – SGO) and include, besides such categories as employees in the banking, domestic and construction sector, the category of agricultural affiliates (agrícolas), whose number in 2003 amounted to 18,664 persons out of the total number of 1,184,484 persons covered by the SGO. With respect to those categories, the Law on Social Security of 2001 establishes a special scheme only for workers in the construction sector and does not refer to any special scheme for agricultural workers. Moreover, according to sections 2a and 9a of this Law, workers in a relation of dependency, irrespective of the nature of their occupation or place of work, are subject to the SGO, which includes the General Health Insurance Scheme providing medical care and sickness benefits required by the Convention. The Committee understands therefore that agricultural employees are now fully covered by the Ecuadorian legislation applying the Convention in the same manner as employees in industrial undertakings and that the initial reason for excluding agricultural employees from the application of the Convention subsists no more. It would like the Government to furnish in its next report all the appropriate explanations and statistics requested in Article 3(2) and (3) of the Convention. If agricultural employees are indeed covered, the Committee invites the Government to consider renouncing its right to avail itself of the exclusion authorized by this Article as from a stated date.

Part II (Medical care). Articles 11(a) and 12, in conjunction with Article 14 (Coverage of the wives and children of insured persons). In reply to the Committee’s previous observation concerning the need to extend coverage by health insurance of the family members of the insured person, the Government states that medical care is given to children of the insured person during the first year of their life. The Government’s report repeats however under Articles 5 and 12 of the Convention the statement made in 1998 that medical care for the family members of the insured person was not developed in Ecuador. The description of the health insurance provided by the IESS and attached to the Government’s report (Annex 2) begins by stating that coverage is extended to affiliated persons and children of affiliated women (los afiliados y los hijos de las afiliadas), which means that children of male affiliates are not covered. In contrast, section 102 of the Law on Social Security extends comprehensive medical care to the affiliated person, his or her spouse or partner, and children under 6 years of age. However, the 2008 ILO Assessment (pages 52–53) determined that in practice this provision has not been implemented, medical coverage has not been extended to the wives of insured persons, and their children remain covered by medical care only for the first year of their life.

Notwithstanding the contradictory character of some of the above information, which the Government is invited to clarify, the Committee understands that, with regard to medical coverage of the wives and children of insured persons in Ecuador, there exists a huge gap between what is prescribed in law and what is achieved in practice. Besides undermining the effectiveness of law, such situations point to the lack of a resolute and consistent public policy in the area of health care of the population. The Committee notes that there has been no apparent progress in the extension of coverage over the last ten years. Failure to provide basic medical care to children of small age results subsequently in an adult population becoming less healthy and requiring more medical care during their productive life, thus increasing the social and economic costs for the society as a whole. The Committee considers that recalling the country’s legal obligation under the Convention to raise the level of medical care to the internationally agreed minimum could be, together with the related international technical assistance, an important factor inducing the Government to elaborate effective policies and measures for improving the state of health of the nation and its labour resources. Fulfilling its obligations under the Convention would require of the Government, inter alia, to put in place a clearly defined national programme for the development of medical coverage of the wives and children of the insured persons. Such programme should be time-bound and result-oriented, setting out benchmarks to monitor progress particularly with respect to children of defined age, which should be progressively raised. For additional guidance in the elaboration of such a programme the Government may wish to turn to the Medical Care Recommendation, 1944 (No. 69), as well as to the advice from the technical departments of the Office.

The Committee is raising other points in a request addressed directly to the Government.