Gestión Pública y Función Contractual en Instituciones de Salud: Evidencia Empírica desde el Distrito 02D01 Guaranda-Salud

Contract management in public health institutions is crucial for operational efficiency and service quality. This article investigates deficiencies in administrative and contractual management at the District Directorate 02D01-Guaranda-Health in Ecuador, an area with a high rural population and limited access to health services. Using a mixed methodological approach that combines quantitative and qualitative analysis, the critical factors affecting the execution of public contracts are diagnosed, such as high staff turnover, poor training, and limited use of technology. A set of differentiated short-, medium-, and long-term intervention strategies, validated by experts, is proposed to optimize processes, strengthen staff technical capacities, and improve transparency. Expected results include the development of a conceptual model of contract management for rural contexts, a comprehensive diagnosis of the current situation, and a progressive implementation plan. It is concluded that optimizing contract management is essential to improving user satisfaction and quality of care, contributing to a more equitable and efficient health system.