By Jahve Mescco
Servindi, July 13, 2011 – Access to quality health services is one of the fundamental rights of every human being, but, in this country, most people are excluded from the health system. As usual, indigenous populations are most affected, given their extreme vulnerability and limited inclusion in government policies.
In the last decade, the government promoted various measures to ensure access to health services for these populations. However, the provisions are the result of isolated initiatives, as well as the pressure from international bodies and native communities, rather than the state itself.
The lack of political will is made evident by the lack of a budget and human resources to promote intercultural health, in addition to the absence of a transversal approach that considers the particular needs of indigenous peoples.
Slow Progress
The National Strategy for the Health of Indigenous Peoples (2004) led to a slight improvement in the attempt to implement culturally relevant health services. It establishes the “adaptation” of health services for vertical delivery care.
The strategy sets up “waiting houses” in order to facilitate access to institutional and professional delivery care and establishes the Standard to Mainstream the Gender, Intercultural and Rights Approach in Health or the Reproductive Health Guideline with an Intercultural Approach.
As for the diagnosis of health conditions, the Department of Epidemiology of the Ministry of Health (MINSA) compiled evidence on the gaps in the health care of indigenous peoples through the Health Situation Analysis (ASIS).
One of the main promoters is, without a doubt, the National Center for Intercultural Health (CENSI) (1) that entered into agreements with indigenous organizations from 12 regions (2). This implies awareness-raising about health professionals and their training in intercultural health, as well as the development of indigenous health research (3).
CENSI was also able to obtain approval of the Technical Health Regulation and two Technical Guidelines in order to protect, establish and maintain contact with and provide health care for indigenous peoples in isolation, in recent contact or in initial contact with a high risk of morbidity and mortality.
While the work of the mobile heath care teams is noteworthy [i.e. the Comprehensive Health Care for Excluded and Remote Populations – AISPED (4) in providing health care to native communities (as of 2006, it had provided medical care to 706 communities], their service is limited due to the geographical difficulties and the limited budget.
Permanent Exclusion
Four years after the aforementioned Health Strategy was passed, official sources (5) acknowledged that “they had not achieved an important position in the various decisions of the sector that would allow it to institutionalize interculturality as the basis on which health interventions in indigenous communities would be supported.”
They also observe that the concept and implementation of interculturality in health care has been limited to the area of maternal health (6). In this regard, the Ombudsman’s Office published Ombudsman’s Report 134: “Health in Native Communities: A Challenge for the State (7)” (2008) with discouraging results.
“The intercultural health policy in the health sector has laid the groundwork for a gradual paradigm shift in medicine. Nonetheless, its implementation takes place with limited support from CENSI.”
It mentions that the medical personnel of health facilities in the native communities are not familiar with this strategy and that the state has not been able to fulfill its obligation to guarantee the availability, accessibility and cultural adaptation of the service for the population of the native communities.”
Furthermore, the Concerted National Health Plan (2007) and the new 2009 universal health insurance policy have not provided specific strategies to improve access to health services for indigenous populations scattered in the jungle.
Although the indigenous population has been added to the Comprehensive Health Insurance (SIS), only 41% of such population would use this system in some capacity, as per CENSI. The problem with providing health care to the indigenous communities is exacerbated by the difficulties they face in accessing quality health service in a timely fashion.
In addition, there are also few health facilities (poorly implemented and with insufficient medicines) and a shortage of medical personnel due to the lack of government policies and incentives, as well as the respective training that is now minimal.
Another aspect of the problem is the lack of recordkeeping systems that specifically show the health situation and challenges of the different ethnic groups with the objective of developing and prioritizing more efficient strategies to improve their health. In addition to breaking down the data by ethnic groups, it is important to change the conditions and criteria for recordkeeping (8).
Indigenous Contribution
In order to really promote intercultural health, the government must urgently start to acknowledge and revalue traditional medicine and the traditional elements of health (such as midwives and medicine men) and encourage the participation of native communities and their organization in the issue.
In this regard, we must take into consideration the health recommendations included in the “Action Plan for the Priority Issues of the Indigenous Communities (9) (2001), as well as those specified in the National Proposal of Amazon Development (10) (2009).
These contributions become relevant given the vulnerability of these populations. According to the “Socio-Demographic Characteristics of the Ethnic Groups of the Peruvian Amazon and the Geographic Space in which they Reside (11)”, the infant mortality rate in the native Amazon communities was 49.2 for every 1,000 live birthday in 2007.
At a national level, this indicator was 18.5 for every 1,000 live births. That same year, the child mortality rate in native Amazon communities was 64 for every 1,000 live births, while nationally that same indicator was 27 for every 1,000 live births.
The high rates are mainly due to the lack of health facilities located near the native communities, since, in many cases, the indigenous people must walk several hours to reach a health facility and receive medical treatment.
Notes
(1) CENSI was created in 2002 as part of the National Institute of Health (INS).
(2) See http://www.minsa.gob.pe/portal/03Estrategias-Nacionales/08ESN-Indigena/esn-indacuerdos.asp#
(3) In the context of decentralization, local and regional authorities play a key role in making decisions and implementing actions that benefit the native communities of the Amazon and the Andes, thus generating mechanisms of participatory inclusion.
(4) The Health Department prepared the AISPED Technical Regulation. This provision establishes a series of mechanisms aimed at guaranteeing and improving the health care of the populations with geographical inaccessibility living in poverty or extreme poverty.
(5) The 2009-2012 General Plan of the Health Strategy prepared by the technical team of the National Center for Intercultural Health (national coordinating body of the Health Strategy) and the members of its Permanent Technical Committee
(6) Waiting houses and vertical delivery care
(7) http://www.defensoria.gob.pe/inform-defensoriales.php
8) See the Office of Epidemiology (OGE): Analysis of the Health Situation of the Shipibo-Konibo People. 2002, Lima, Available at http://www.oge.sld.pe/publicaciones/pub_asis/asis07.pdf
(9) The plan was the result of the collaboration between indigenous organizations and other organizations that support them together with representatives of the state, thus creating the Roundtable for the Native Communities in 2001, during the transitional government of Valentín Paniagua. In spite of the agreements and commitment reached with the change of government, these were dissolved.
(10) / (11) This document was drafted by the National Coordination Group for the Development of the Amazon Peoples that was created after the unfortunate events in Bagua in June 2009. It comprised the group of representatives from the Executive Branch and accredited Amazon indigenous organizations that had the technical support of the Research Institute of the Peruvian Amazon (IIAP).
(12) The research was carried out by the National Institute of Statistics and Informatics (INEI) and the UN Population Fund (UNFPA). It was prepared on the basis of the 2007 National Census: XI Population and VI Housing and 2007 II Census of Indigenous Communities of the Peruvian Amazon.
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Traducción para Servindi de Sylvia Fisher. Publicado en español el 28 de junio: http://servindi.org/actualidad/47169