E-Government as a Tool for Territorial Cohesion in the Health Sector: Evidence from the Ecuadorian Territory

Within the current framework of digital transformation in the public sector, this study provides an in-depth examination of the impact of e-government strategies implemented by Ecuador’s Ministry of Public Health (MSP) to optimize healthcare services. Employing a mixed-methods approach, the research combined structured surveys, semi-structured interviews, and documentary analysis of administrative data from two representative districts: an urban area (Pueblo Viejo) and a rural area (Urdaneta). The findings reveal substantial improvements in operational efficiency, service accessibility, and perceived quality in the urban context, where technological infrastructure, staff training, and institutional leadership have facilitated the adoption of digital tools such as online appointment scheduling, electronic medical records, and telemedicine. Conversely, rural areas continue to face significant gaps linked to limited connectivity, low levels of digital literacy, and minimal institutional promotion, hindering effective access to and use of these platforms. The qualitative analysis identified critical factors such as user trust, administrative overload, and unequal infrastructure, all of which condition the sustainability of digitalization. The study concludes that the success of these strategies relies not solely on technological availability but on the balanced integration of human capacities, infrastructure, and territorially sensitive public policies. It is recommended to foster investment in connectivity, continuous training programs, and technologies adapted to rural contexts, in order to ensure equitable, efficient, and high-quality healthcare, thereby strengthening territorial cohesion and contributing to the achievement of the Sustainable Development Goals (SDGs) in health.