The AHD Model

AHD is the only rural health provider in Latin America that delivers quality care based on a proven model of self-sufficiency and capacity building. AHD offers the only residency program that trains rural family physicians — where local faculty train Ecuadorian physicians to work in their own communities.

AHD has been operating Pedro Vicente Maldonado (PVM) hospital and clinics for 17 years and has served more than 150,000 people. PVM has been financially self-sustaining since 2007. In 2014, AHD constructed a new health complex with a 60-bed hospital, outpatient facilities, and a training center at Hesburgh Hospital in a different part of the country, Santo Domingo.

In addition to adding critically needed hospital care to an area where 400,000 mostly poor people live, this new complex allowed AHD to expand its family medicine residency program from 6 doctors a year to 60, and to conduct meaningful public health research in the community. Both PVM and Hesburgh facilities are operated 100% by Ecuadorians.

Andean Health trains local doctors in Family Medicine through a 3-year residency program in partnership with the Catholic University of Ecuador. Graduates of the program train 50 doctors in a special program with Ecuador’s Ministry of Health. Those doctors learn AHD’s best medical and administrative practices and bring them out to their public places of employment.

Residents train in AHD’s state-of-the-art simulation lab located on Hesburgh Hospital’s campus, which was designed with Northwestern’s Feinberg School of Medicine and Jump Simulation in Peoria, Illinois.

AHD’s facilities utilize a unique combination of local financing mechanisms and public-private partnerships in order to be financially self-sustaining: fees for service, payments from Ecuador’s Social Security Institute, contracts with local companies, and contributions from local municipalities.

This means that donations from the U.S. are used to expand the model and training programs, as opposed to paying for day-to-day operations at AHD’s facilities.

  • Hospital Pedro Vicente Maldonado – 100% Sustainable
  • Hesburgh Hospital – 65% Sustainable
  • Residency Programs – 85% Sustainable
  • Research Initiatives – 100% Sustainable

Andean Health & Development’s facilities are staffed with 100% local Ecuadorians. We work with and for the communities we serve. We do not operate a parallel system to the public one; instead we believe that working within the existing system is the only way to transform it.

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Hesburgh Hospital


The hospital’s campus includes:

  • a residency program that trains 60 doctors a year
  • a simulation lab contextualized for rural Ecuador
  • two operating rooms
  • a full ER
  • a pharmacy
  • a laboratory
  • isolation wards
  • a neonatal unit
  • dental services
  • an ultrasound machine
  • a CT scanner
  • an MRI
  • a dorm for physician residents
  • inpatient wing
  • outpatient wing

The hospital serves every patient who comes through the door and each day, moves closer to financial break-even.

Hesburgh Hospital opened in June 2014, but we still are raising funds to realize the dream of a full service, financially self-sustaining teaching hospital.

Hospital Pedro Vicente Maldonado (PVM)

AHD’s pilot project was a hospital in the underserved community of Pedro Vicente Maldonado (PVM). The hospital opened in 2000, and by 2007, was financially self-sustaining. Hospital PVM provides high quality care to an extended community of 80,000 and is a training ground for physicians and other leaders in the local community. Today the hospital continues to be 100% financially self-sustaining.

Andean Health Institute

AHD has created the Andean Health Institute (AHI) to support the AHD mission by systematically measuring the impact of its work, better understanding the determinants of health and disease in rural Latin America, and sharing the lessons learned with the larger public health community. AHI engages strategic operational and academic partners, and influences policies to provide quality, accessible, and sustainable health care in rural Latin America.

Strategic Areas of Focus for AHI

  1. Monitor and Measure. Evaluate AHD/Saludesa’s health and education outcomes and impact.
  2. Research. Research the principal public health threats to our communities, including perceptions of health and illness. Visit Salud Rural, AHD’s online medical journal in Spanish to learn about recent research efforts. 
  3. Policy Leadership. Influence local, regional and global health practice and policy.

Current initiatives of the AHI

  • Research study on mosquito-borne illnesses in partnership with the University of Wisconsin-Madison
  • Research study on antibiotic resistance patterns in Ecuador in partnership with Notre Dame’s Eck Institute for Global Health
  • Publication of a Spanish language online medical journal utilized by health care workers across Latin America:
  • Maternal-child health program utilizing telemedicine and community health workers in partnership with Ronald McDonald House Charities.


Fall 2018 News

Many considered financial self-sustainability for a poor rural hospital an impossibility, but our first hospital in Pedro Vicente Maldonado (PVM) achieved that goal in 2007. It certainly wasn’t easy. We experimented with all sorts of revenue generating ideas to keep the hospital running, and most failed. One combination of financing mechanisms finally did work: a public-private partnership with Ecuador’s national social security system. Social security pays us for the patients in their system, and we charge other patients who are able to pay very reasonable prices. Although that public relationship has many challenges, it catalyzed our successful journey to 100% financial self-sustainability. To this day...

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