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

Direct Request (CEACR) - adopted 2022, published 111st ILC session (2023)

Previous comments: C.118 direct request; C.121 direct request; C.128 direct request.

In order to provide a comprehensive view of the issues relating to the application of ratified Conventions on social security, the Committee considers it appropriate to examine Conventions Nos 102, 118, 121, 128 and 130 together.

The Committee notes the Government’s report and the observations of the Trade Union Association of Agricultural, Banana and Rural Workers (ASTAC), in respect of which the Committee requests the Government to provide its comments in its next reports.

Articles 1, 71(3) and 72(2) of Convention No. 102. Article 4 of Convention No. 121. Articles 7, 14 and 20 of Convention No. 128. Article 7 of Convention No. 130. Coverage of the social security system and general responsibility of the State for the proper administration of social security institutions and services and for the sustainable financing of social security benefits. The Committee notes the indication by the ASTAC in its observations that the number of insured workers is under 50 per cent of the economically active population and that this rate is approximately 13 per cent in the agricultural sector. It adds that in many cases employers do not register their workers, deduct the amount of the contributions from their wages and do not transfer them to the social security system. It reports that, due to the low registration rates, the Ecuadorian Social Security Institute (IESS) is experiencing a financial crisis, resulting in inefficiency in the provision of benefits. The Committee also notes the statistical data contained in the National Employment, Underemployment and Unemployment Survey (ENEMDU), according to which the occupied population consists of 8,008,824 persons, while the population in formal employment, and therefore who are subject to compulsory registration with the social security system, is 2,773,750. In the rural sector, the data shows that persons engaged in “underemployment” or “other than formal employment” are more numerous than workers in formal employment. During the first quarter of 2022, the informal sector accounted for 73.2 per cent in rural areas. While hoping that the Government will provide its comments concerning the observations of the ASTAC, and taking into account the statistics of the National Employment, Underemployment and Unemployment Survey, the Committee requests the Government to provide full statistical data including the current coverage of the social security system in terms of numbers of beneficiaries, disaggregated by branch and the various economic sectors, including the informal economy, in relation to the total number of workers, as indicated in the report forms for Conventions Nos 102, 121, 128 and 130.

Article 5 of Convention No. 118. Payment of benefits abroad.The Committee notes that the Government’s report does not provide information in reply to its previous comments on the manner in which benefits in the branches (a) to (d), (f) and (g), which have been accepted by Ecuador, are paid to beneficiaries living outside Ecuador. It therefore once again requests the Government to provide: (i) information on the national laws and regulations that give effect to the Convention and on the existence of bilateral agreements on this subject, with an indication of the manner in which the payment of benefits is ensured for beneficiaries abroad; and (ii) statistics on the benefits paid in this regard, disaggregated by the type and number of beneficiaries, type of benefit, amount paid and country of residence of the beneficiaries.

Articles 13, 14 and 18 (in conjunction with Articles 19 and 20) of Convention No. 121. Amount of periodical payments. The Committee notes the information provided by the Government in relation to its previous comments, clarifying that the average of previous earnings is used for the calculation of all benefits. The Committee observes that Articles 19(1) and (6) and 20(1) and (4) provide guidance on the basis that can be used or with which calculations must be compared in relation to average earnings. Taking into account the information provided by the Government indicating that benefits are calculated on the basis of average of previous earnings, the Committee requests the Government to: (i) indicate whether a ceiling is applied to contributions or the payment of benefits; (ii) demonstrate the manner in which the calculation of the average earnings as a basis for determining the amounts of contributions meets the requirements set out in Articles 19 and 20 of the Convention.

Article 21 of Convention No. 121. Review of rates of cash benefits. The Committee notes the statistical data provided by the Government in relation to its previous comments, indicating the number of beneficiaries and the total amount of benefits of each type paid over the past ten years. The Committee recalls that, in accordance with Article 21 of the Convention, the rates of cash benefits shall be reviewed following substantial changes in the general level of earnings or cost of living. The Committee therefore considers it necessary to provide further statistical data required in the report form as a basis for assessing the real impact of the adjustments of pensions and other long-term cash benefits, taking into account changes in the general level of earnings and in the cost of living in the country. The Committee once again requests the Government to provide specific statistical data required to assess the application of Article 21 of Convention No. 121 in relation to the rates of adjustment of benefits.

Part VII (Miscellaneous provisions), Article 38 of Convention No. 128. Coverage of agricultural workers. The Committee notes with interest the information provided by the Government in reply to its previous comment that Decision No. 636/2021 of the Executive Board envisages the provision of health, invalidity, old-age and survivors’ benefits to agricultural workers covered by the rural social security scheme. The Committee therefore encourages the Government to provide further information on the manner in which the new provisions give effect to the Convention in relation to the provision of invalidity, old-age and survivors’ benefits to agricultural workers, with a view to bringing to an end the temporary exclusion authorized by Article 38(2) of the Convention.

Observation (CEACR) - adopted 2013, published 103rd ILC session (2014)

With reference to its direct request on the application of the Invalidity, Old Age and Survivors’ Benefits Convention, 1967 (No. 128), the Committee notes the information provided by the Government in relation to the scope of application of the Convention (Part I – Article 2, in conjunction with Articles 11(a) and 20(a) of the Convention), the coverage of small-scale farmers and of agricultural workers (Article 3).

Part II (Medical care). Articles 11(a) and 12, in conjunction with Article 14 (Coverage of the spouses and children of insured persons). Further to its previous comment, the Committee notes the adoption of Resolution No. C.D.332 of the Ecuadorian Social Security Institute (IESS) issuing the regulations for the granting of benefits under the general individual and family health insurance scheme. The Committee notes with satisfaction the amendment of sections 102, 105 and 117 of the Social Security Act which has the effect of extending coverage of social protection for health and sickness to dependent spouses and partners and children up to 18 years of age.

Direct Request (CEACR) - adopted 2012, published 102nd ILC session (2013)

The Committee notes with regret that the Government’s report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Repetition

With reference to its 2007 observation, the Committee asks the Government to supply a detailed report on the application of the Convention according to the report form adopted by the Governing Body and to include in it full information on the point mentioned below.

Part I (General provisions). Article 2 of the Convention, in conjunction with Articles 11(a) and 20(a). Coverage of small farmers. The Committee notes that the Law on Social Security of 2001 incorporates the special scheme of Social Security of Farmers (Seguro Social Campesino – SSC), which covers self employed fishermen and small farmers who work for their own account or for their communes and do not receive wages from a public or private employer (section 2 of the Law). The strategic plan for the development of SSC in 2008 supplied by the Government under Convention No. 128 aimed at increasing its coverage to 40 per cent of the rural population. According to the supplementary statistics provided in 2008, in addition to the Government’s report on Convention No. 130, in June 2008 SSC counted 1,012,578 affiliated members, which is only slightly less than the number of affiliates to the Compulsory General Social Security scheme (Seguro General Obligatorio – SGO). The Committee further notes that section 131 of the Law on Social Security of 2001 stipulates that persons covered by the SSC have the right to the same medical care and sickness benefits that are provided by the General Individual and Family Health Insurance of the SGO. This means that the SSC could be fully taken into account for the purpose of the application of the Convention by Ecuador, including determination of the scope of coverage of the persons protected. At present, by having recourse to Articles 11(a) and 20(a), Ecuador has chosen to limit the personal scope of application of the Convention to “prescribed classes of employees”, which by definition do not include farmers and self-employed fishermen. On the other hand, extending coverage to these categories may enable the country to consider the broader option of applying the Convention to prescribed classes of the economically active population, which is offered by Articles 10 and 19 of the Convention. The Committee would like the Government to study this option in the light of the country’s obligation under Article 2(3) to increase the number of persons protected as circumstances permit. Please supply updated information and statistical data on the development of the special scheme of Social Security of Farmers and the extension of its coverage of the rural population of Ecuador.

Observation (CEACR) - adopted 2012, published 102nd ILC session (2013)

The Committee notes with regret that the Government’s detailed report due in 2012 has not been received. Considering that the previous report supplied by the Government in 2008 reproduced the text of its report of 1998 and was therefore entirely unresponsive to the Committee’s observation of 2007 and did not contain any information concerning the application of Articles 21–32 of the Convention, the Committee trusts that the Government of Ecuador will take 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.

The Committee hopes that the Government will make every effort to take the necessary action in the near future.

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

With reference to its 2007 observation, the Committee asks the Government to supply a detailed report on the application of the Convention according to the report form adopted by the Governing Body and to include in it full information on the point mentioned below.

Part I (General provisions). Article 2 of the Convention, in conjunction with Articles 11(a) and 20(a). Coverage of small farmers. The Committee notes that the Law on Social Security of 2001 incorporates the special scheme of Social Security of Farmers (Seguro Social Campesino – SSC), which covers self‑employed fishermen and small farmers who work for their own account or for their communes and do not receive wages from a public or private employer (section 2 of the Law). The strategic plan for the development of SSC in 2008 supplied by the Government under Convention No. 128 aimed at increasing its coverage to 40 per cent of the rural population. According to the supplementary statistics provided in 2008, in addition to the Government’s report on Convention No. 130, in June 2008 SSC counted 1,012,578 affiliated members, which is only slightly less than the number of affiliates to the Compulsory General Social Security scheme (Seguro General Obligatorio – SGO). The Committee further notes that section 131 of the Law on Social Security of 2001 stipulates that persons covered by the SSC have the right to the same medical care and sickness benefits that are provided by the General Individual and Family Health Insurance of the SGO. This means that the SSC could be fully taken into account for the purpose of the application of the Convention by Ecuador, including determination of the scope of coverage of the persons protected. At present, by having recourse to Articles 11(a) and 20(a), Ecuador has chosen to limit the personal scope of application of the Convention to “prescribed classes of employees”, which by definition do not include farmers and self-employed fishermen. On the other hand, extending coverage to these categories may enable the country to consider the broader option of applying the Convention to prescribed classes of the economically active population, which is offered by Articles 10 and 19 of the Convention. The Committee would like the Government to study this option in the light of the country’s obligation under Article 2(3) to increase the number of persons protected as circumstances permit. Please supply updated information and statistical data on the development of the special scheme of Social Security of Farmers and the extension of its coverage of the rural population of Ecuador.

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

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.

Observation (CEACR) - adopted 2007, published 97th ILC session (2008)

The Committee notes that the Government’s report has not been received. It must therefore repeat its previous observation, which read as follows:

The Committee notes the adoption on 30 November 2001 of the new Social Security Act. It asks the Government to indicate whether the new Act has come into force and, if so, to please provide detailed information on the extent to which the new legislation gives effect to each of the provisions of the Convention, as well as the information requested in the report form, including statistics. The Committee also requests the Government to supply any regulations that have been adopted to apply the new Act. The Committee hopes that the next report will also contain information on the measures adopted to give effect to the following provisions, on which the Committee has been commenting for a number of years.

Articles 11 and 12 of the Convention. In its previous report, the Government expressed the intention of ensuring free medical coverage for the spouses and children of insured persons, in accordance with these provisions of the Convention, either through the Ecuadorean Social Security Institute or other social security systems. The Committee requests the Government to indicate whether the new legislation ensures such coverage and, if so, to please indicate whether medical insurance has been extended in practice to the members of the insured person’s family and, if so, please provide the information requested by the report form under Article 12.

The Committee hopes that the Government will make every effort to take the necessary action in the very near future.

Observation (CEACR) - adopted 2005, published 95th ILC session (2006)

The Committee notes the adoption on 30 November 2001 of the new Social Security Act. It asks the Government to indicate whether the new Act has come into force and, if so, to please provide detailed information on the extent to which the new legislation gives effect to each of the provisions of the Convention, as well as the information requested in the report form, including statistics. The Committee also requests the Government to supply any regulations that have been adopted to apply the new Act.

The Committee hopes that the next report will also contain information on the measures adopted to give effect to the following provisions, on which the Committee has been commenting for a number of years.

Articles 11 and 12 of the Convention. In its previous report, the Government expressed the intention of ensuring free medical coverage for the spouses and children of insured persons, in accordance with these provisions of the Convention, either through the Ecuadorean Social Security Institute or other social security systems. The Committee requests the Government to indicate whether the new legislation ensures such coverage and, if so, to please indicate whether medical insurance has been extended in practice to the members of the insured person’s family and, if so, please provide the information requested by the report form under Article 12.

Direct Request (CEACR) - adopted 1999, published 88th ILC session (2000)

Articles 11 and 12 of the Convention. In its previous report, the Government expressed the intention of ensuring free medical coverage for the wives and children of insured persons, in accordance with these provisions of the Convention, either through the Ecuadorian Social Security Institute or other social insurance systems. According to the Government's latest report, medical insurance coverage has not been extended to the members of the family of insured persons. In these conditions, the Committee once again trusts that the Government will make every effort to ensure that the wives and children of both insured persons and beneficiaries of social security benefits, referred to in Article 12 of the Convention, including the beneficiaries of survivors' benefits, are provided with free medical care, and that the Government's next report will indicate the measures taken for this purpose.

Direct Request (CEACR) - adopted 1995, published 83rd ILC session (1996)

With reference to its observation, the Committee notes the information supplied by the Government in reply to its previous comments.

Articles 11 and 12 of the Convention. The Government reaffirms its intention to ensure the provision of free medical care for the spouse and children of an insured person, provided through the Social Security Institute of Ecuador (IESS) or other systems of social insurance. The Committee expresses anew its hope that the Government will be able to indicate in its next report the measures taken in this regard concerning the spouse and children of insured persons, as well as of recipients of the social security benefits mentioned in Article 12 of the Convention, including survivors' benefits.

The Committee asks the Government to indicate if the regulations concerning medical treatment mentioned in section 105 of the codified statute of the IESS has been adopted and, if so, to provide a copy of the text.

Observation (CEACR) - adopted 1995, published 83rd ILC session (1996)

Referring to its previous comments, the Committee notes with satisfaction that pursuant to resolution No. 750 of 5 February 1991, the Superior Council of the Ecuador Institute of Social Security (IESS) has abrogated sections 91 and 92 and modified section 90 of the codified statutes of the IESS, thereby extending full medical and dental care and pharmaceutical assistance to the recipients of old-age and invalidity benefits, in conformity with Article 12 of the Convention.

Direct Request (CEACR) - adopted 1993, published 80th ILC session (1993)

1. Article 11 of the Convention. In reply to the Committee's previous comments, the Government indicates that the problems caused by the inadequacy of the medical infrastructure have not yet been solved and that they continue to prevent the extension of the benefits of the Sickness Insurance to the families of insured persons. The Committee notes this information and the attention paid by the Government to the extension of medical insurance. It also notes with interest that in social security in the rural sector rapid progress is being made towards family health care. The Committee again expresses the hope that the Government will pursue its efforts to ensure that free medical care is extended in the near future to the wives and children of insured persons, as envisaged by this provision of the Convention, and requests it to continue providing information on progress made in this respect.

2. Article 12. In its previous comments, the Committee drew the Government's attention to the need to amend sections 16 to 18 of the Statutes of the former Social Security Medical Department to bring them into conformity with this Article of the Convention which provides that persons who receive social security benefit for invalidity, old age, death of the breadwinner or unemployment, and, where appropriate, the wives and children of such persons, shall continue to receive medical care.

The Government refers to a series of provisions in the Labour Code, concerning occupational hazards, and indicates that certain invalidity and old-age benefits provide coverage for life. The Committee takes note of this information. However, it notes with regret that, in addition to the fact that the provisions of the Labour Code which have been referred to do not cover benefits in the event of common illnesses, section 91 of the new consolidated Statutes of the Ecuadorian Social Security Institute (IESS) of 7 May 1990 confirms that, in principle, medical care is provided to retired persons in respect of one and the same illness, for a maximum of six months. The Committee therefore hopes that the Government will take the necessary steps to amend sections 90, 91 and 92 of the consolidated Statutes of the IESS of 1990 in order to ensure the application of this provision of the Convention under which persons receiving social security benefits - and where appropriate, their wives and children - continue to be entitled to medical care.

Lastly, the Committee asks the Government to provide the text of the medical care regulations referred to in section 105 of the codified Statutes of the IESS of 1990, as soon as it has been adopted.

Direct Request (CEACR) - adopted 1987, published 74th ILC session (1987)

1. Article 11 of the Convention. The Government again indicates that it is continuing to give priority to the extension of medical insurance to the families of insured persons but that, unfortunately, the medical infrastructure is insufficiently developed to carry out this programme at the present time. The Committee takes note of this information and hopes that the Government will continue its efforts to extend free medical care to the wives and children of insured persons in the near future as required by this provision of the Convention. The Committee requests the Government to provide information on any progress made in this connection.

2. Article 12. In reply to various comments of the Committee, the Government has indicated that sickness benefits in cash and kind are accorded as from the first day of the contingency, as long as the insured person had contributed for a period of six months. The Committee wishes to draw the attention of the Government to the fact that its earlier comments did not relate to the existence of a qualifying period but rather to the need to amend sections 16 and 18 of the By-laws of the former medical department of social insurance so as to provide the right to medical benefits without time-limits to persons in receipt of a social security benefit for invalidity, old age, death of the breadwinner or unemployment, as well as where appropriate, the wives and children of such persons. As a result of articles 16 to 18 of the By-laws mentioned above, the recipients of invalidity and old-age benefits are only entitled to such assistance, in principle, for six months whereas, under Article 12 of the Convention, medical care to a recipient of social security benefits must be assured throughout the contingency. The Committee therefore hopes that in accordance with the assurances given by the Government in its last report, the above-mentioned provisions of the By-laws of the former medical department of social insurance can be amended shortly so as to ensure the application of the provision of the Convention (see also under Article 11 above as regards the wives and children of the persons covered by Article 12).

Finally, the Committee would be grateful if the Government would communicate the text of the medical assistance regulations referred to in section 26 of the By-laws of the former medical department and section 78 of the By-laws of the Ecuadorian Social Security Institute as soon as they are adopted.