Governance of Preventive Health in Rural Ecuador: A New Paradigm from Social Neuroscience and Community Leadership

Abstract

Introduction: Preventive healthcare in rural Ecuador faces a disconnect between the management of Decentralized Autonomous Governments (GADs) and the socio-health realities of rural women, highlighting the need for a new interdisciplinary paradigm. Materials and methods: A qualitative systematic review was conducted following the PRISMA guidelines, searching Scopus, PubMed, Web of Science, SciELO, and Google Scholar (2021–2026). After applying inclusion and exclusion criteria, 16 studies were selected (10 for the main synthesis). The findings were compared with the practices of the Motiva Movement (2019–2026) through document analysis, interviews, and participant observation. Results: The synthesis shows that episodic, care-based interventions are insufficient. Preventive programs gain sustainability when they integrate three factors: neurosocial literacy (understanding the impact of chronic stress on the prefrontal cortex and decision-making), symbolic revaluation of the environment, and empowerment of local women leaders as affective regulators in the face of elevated cortisol levels. Evidence confirms that prolonged exposure to rural stressors alters executive functions, affecting self-care. Discussion: The effectiveness of the current decentralization model (COOTAD) is questioned, demonstrating that the transfer of powers without local technical capacities exacerbates territorial disparities. The experience of the Motiva Movement (seven years) demonstrates that collaboration between local governments and civil society organizations constitutes an effective alternative. Conclusions: A shift towards "well-being ecosystems" is required, focused on transforming human capital and neurocognitive autonomy, where local governments transcend their logistical role to become agents of public neuro-education.