A/HRC/44/48/Add.1 limited private investment, have remained. 5 In 2014, there was a financial slowdown, caused primarily by a sharp decline in the price of oil, challenges in accessing new sources of funding and the appreciation of the US dollar. 6 Between 2015 and 2018, GDP growth averaged 0.6 per cent and poverty and the Gini coefficient (a measure of income inequality) have remained relatively stable at around 22.7 per cent and 0.47, respectively, since 2014.7 With regard to employment, the latest official data from December 2019 puts the economically active population at 65.3 per cent, while the unemployment rate is 3.8 per cent and the percentage of adequate employment was 38.8 per cent of the economically active population.8 9. To finance growing fiscal imbalances, public debt has doubled in recent years and international reserves have plunged to low levels.9 The Special Rapporteur was informed that the Government had announced in early 2019 a process of rationalizing public investment and optimizing current expenditures that foresaw a decrease in public spending. In March 2019, Ecuador reached an agreement with the International Monetary Fund (IMF), which would provide support for the country’s economic policies over the following three years. 10 The Special Rapporteur was informed that, in accordance with the structural adjustments demanded by the IMF, health workers were being dismissed from the administrative and substantive areas of care, in line with Ministerial Agreement No. 195, without a clear figure to date as to the number and category of health personnel affected. Although it is not clear exactly how the budget cuts announced in 2019 will affect the health sector, the Special Rapporteur is concerned that much-needed medical and technical expertise in the health-care system risks being suppressed. That could create an additional strain on a system that is already overburdened and with limited human and financial resources. The dismissal of health-care workers at the central and operational levels risks having an impact on the institutional capacity to ensure access and health coverage for the overall population. 10. The Special Rapporteur followed developments that took place in the country after his visit, including the protests triggered by the austerity measures announced by the Government. Austerity measures are of special concern as they often directly affect the minimum core content of economic, social and cultural rights, and impact directly or indirectly and disproportionately on those individuals already discriminated against or living in the most vulnerable situations. In compliance with article 2.2 of the International Covenant on Economic, Social and Cultural Rights, ratified by Ecuador in March 1969, and the provision on progressive realization of those rights, States should not adopt impermissible retrogressive measures, unless strictly justifiable. While the Special Rapporteur is mindful of the challenges that may arise in times of financial constraint, he reminds the Government that austerity measures should not be to the detriment of achievements made and the fulfilment of international human rights obligations. He strongly recommends ensuring that the necessary financial and human resources are in place to secure adequate access to health services, reaching at least 4 per cent of GDP, as provided under the Constitution (transitory provision 22). 11. The Special Rapporteur wishes to endorse the recommendations of the Committee on Economic, Social and Cultural Rights, adopted in November 2019, in which the Committee recommended that Ecuador “review the economic measures taken and under consideration and ensure transparency and dialogue in order to guarantee the enjoyment of economic, social and cultural rights”. In particular … the Committee recommended that Ecuador: “Not reduce social spending in the areas of health and education from the levels achieved in 2018” and “Maintain budget lines related to social investment in respect of the most disadvantaged groups and facilitate the effective and sustainable implementation of public policies” (E/C.12/ECU/CO/4, para. 6). 5 6 7 8 9 10 4 See www.worldbank.org/en/country/ecuador/overview#1. See www.paho.org/salud-en-las-americas-2017/?p=4272. Ibid. See www.ecuadorencifras.gob.ec/empleo-diciembre-2019/. See International Monetary Fund (IMF), “Ecuador’s new economic plan explained”, 21 March 2019. See IMF, “IMF Executive Board approves US$4.2 billion extended fund facility for Ecuador”, press release 11 March 2019.