[Sustainability in chronic disease prevention: lessons from the Salud al Paso program in Ecuador]

This study analyzes the conditions and possibilities of sustainability of the "Salud al Paso" program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of this implementation, focused on the prevention of noncommunicable diseases, was based on the program's user database, the information gathered on the perspectives of operational personnel, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the free demand activities included in the program and limit the activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elderly care programs and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived more as a project with an also insufficient vision of sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of noncommunicable diseases requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral articulation, especially with the Ministry of Public Health and other service networks.