On February 19, 2026, the Ecuadorian Ministry of Public Health (MSP) announced a significant restructuring of its institutional territorial organization. This change replaces the existing zonal coordinations and district directions with decentralized units and provincial directions. The reform is based on a comprehensive analysis of the Ministry's institutional presence across territories, aiming to enhance the efficiency and effectiveness of public health service delivery.

The 152-page document detailing this reorganization highlights the compliance with Executive Decrees 70 and 108, issued in August 2025. These decrees mandate a shift towards territorial decentralization, promoting the establishment of provincial directions and technical offices. The MSP aims to ensure that these new structures will facilitate better governance, improved health services accessibility, and a closer alignment of health initiatives with local needs.

Furthermore, the agreement's provisions are mandatory for all central-level organs of the Ministry of Health as well as all decentralized units. This institutional shift is poised to have significant implications for public health management in Ecuador, potentially leading to more responsive health policies and a greater focus on community health outcomes, as local offices may better address specific regional health challenges.