Introduction. Ecuador has undertaken important reforms in search of universality and equity however; the system continues fragmented and does not guarantee universal access. This study aims to address the evolution of the health system of the Ecuador in order to contribute with the process the country and the Region reform from the perspective of social representations Objective. Describe the governance, financing and provision of services related to political, social and economic factors, identify good practices, lessons learned and challenges in construction of the system. Methodology. Qualitative descriptive-interpretative study based on the Theory of Social Representations, through systematic review of documents and in-depth interviews with 14 actors involved in the reform process, which were codified, analyzed and interpreted, highlighting the majority perceptions, convergences and ...