Ecuador currently ranks 20, in most efficient health care countries, compared to 111 back in the year 2000.  Ecuadorians have a life expectancy of 77.1 years. The infant mortality rate is 13 per 1,000 live births, a major improvement from approximately 76 in the early 1980s and 140 in 1950. 23% of children under five are chronically malnourished. Population in some rural areas have no access to potable water, and its supply is provided by mean of water tankers. There are 686 malaria cases per 100,000 people. Basic health care, including doctor's visits, basic surgeries, and basic medications, has been provided free since 2008. However, some public hospitals are in poor condition and often lack necessary supplies to attend the high demand of patients. Private hospitals and clinics are well equipped but still expensive for the majority of the population.