Health facilities are largely concentrated in the towns and are both too expensive and too distant to be used by most of the highland Amerindian population. Hospitals are operated by agencies of the national government, the municipalities, and private organizations or persons. As of 1999, there were an estimated 1.7 physicians and 1.6 hospital beds per 1,000 people. In the same year, total health care expenditure was estimated at3.6% of GDP. In 2002, the birthrate was an estimated 25.5 per 1,000 people. As of 2000, 66% of married women (ages 15 to 49) used contraception. The infant mortality rate in 2000 was 28 per 1,000 live births. Life expectancy at birth was 70 years. In 1997, Ecuador immunized large numbers of children up to one year old as follows: tuberculosis, 99%; diphtheria, pertussis, and tetanus, 76%; polio, 77%; and measles, 75%. The overall death rate in 2002 was an estimated 5.4 per 1,000 people.
Malnutrition and infant mortality are the country's two basic health problems. In 1996, children under five years old had a 48% mortality rate. As of 1994, major causes of death were cited as follows: communicable diseases (116 per 100,000); neoplasms (78 per 100,000); injuries (83 per 100,000), and circulatory system diseases (142). Malaria, which as recently as 1942 caused about one-fourth of the deaths in Ecuador, is still a problem; 12,011 cases were reported in 1996. In 1999, there were 172 cases of tuberculosis per 100,000 people. In 1996, 40 cases of measles were reported. Cholera still persists; however, less than 1% of the 1,060 cases accounted for died of cholera in 1996. Other health problems are largely being controlled. Yellow fever was eliminated by the efforts of the Rockefeller Foundation. Two antituberculosis organizations have helped reduce the mortality from that disease, which earlier was responsible for one-fifth of the nation's deaths. In 2000, 71% of the population had access to safe drinking water and 59% had adequate sanitation.
Some 186 new cases of AIDS were reported in 1996, when the cumulative total since 1984 was 1,279. As of 1999, the number of people living with HIV/AIDS was estimated at 20,000; deaths from AIDS in 2001 were estimated at 232. HIV prevalence was0.29 per 100 adults.