Public policies and intercultural adaptations in health services

Since the 1990s, the countries of the Americas have taken steps to design and implement public health policies with an intercultural approach, and to develop intercultural adaptations in health services, in accordance with their cultural specificities and characteristics and their own health systems, initially focusing on indigenous peoples and later extending to other populations, such as Afro-descendants and Roma, with the aim of eliminating cultural barriers and facilitating access to national health systems for these populations (1).

In this process, they have adopted norms that recognise and protect the existence of traditional medicines and their articulation with the official national medical systems, and have developed plans, programmes, projects, guidelines, technical orientations, manuals, protocols and regulations, among others (2), in order to provide socio-culturally appropriate health services that allow people to have access to both optional medicine and traditional medicines, since these systems must be coordinated and develop complementary actions, through mutual understanding, appreciation and respect.

To this end, they have developed processes of articulation and participation with ethnic populations, through knowledge dialogues and taking into account their own organisational dynamics, in order to ensure that the provision of health services is comprehensive, relevant and of high quality, and where health is understood from a broader perspective, including the spiritual, physical, emotional and human relationship with nature, as well as the different perceptions and world views of health of these populations. It should also take into account not only the individual but also the family and the community to which the individual belongs, with the participation of the various health actors, both institutional and individual, and cover health protection and promotion as well as disease prevention, care and rehabilitation.

The formulation of public policies with an intercultural approach has also meant institutional adaptation in some countries of the region, with the opening of spaces for interaction between the entities and the ethnic peoples (translated into Vice-Ministries, Directorates, Offices or Coordination Centres for Traditional Medicine, Intercultural Health, Ethnic Affairs or Health for Indigenous Peoples, among others), for dialogue on the relationship and articulation between the various existing medical systems, as well as the specific allocation of budgets for the care of these populations in their territories or where access is facilitated.

Intercultural adaptation in the provision of health services, which has been promoted by some countries in the Region, has included the use of bilingual staff as intercultural facilitators or managers, community agents and health promoters, accompaniment in hospitals by midwives and traditional doctors, accommodation for accompanying persons, the inclusion of traditional foods and herbal medicines, and more flexible opening hours, signage and educational materials translated into the languages of the ethnic groups, as well as the use of their own architectural designs, traditional furniture (such as hammocks) (3) and equipment for hospital facilities and health infrastructure, adaptations to hospital rooms (such as for vertical delivery) (4), and standards and procedures for care that respond to the health needs, epidemiological profiles and socio-cultural realities of these populations (5).

For more information on the regulations adopted in the countries that allow the development of public policies with an intercultural approach and the development of intercultural adaptations in health services, see  https://mtci.bvsalud.org/regulaciones-y-politicas-en-mtci/.

Links to country experiences in policy design and socio-cultural adaptation will be posted.

References:

1. Pan American Health Organization PAHO/WHO. Policy on Ethnicity and Health. [Internet]. 2017. CSP29/7. Rev. 1. Available at: Policy on ethnicity and health (29th Pan American Sanitary Conference) – PAHO/WHO | Pan American Health Organization (paho.org).
2. Andean Health Organization, Hipólito Unanue ORAS-CONHU Agreement. Andean Intercultural Health Policy. [Internet]. 2019. 2nd ed. Available in: POLÍTICA ANDINA DE SALUD INTERCULTURAL ::: ORAS CONHU / Organismo Andino de Salud – Convenio Hipólito Unanue ::...
3. CAMPOS-NAVARRO, Roberto and RUÍZ-LLANOS, Adriana. Intercultural adaptations in hospitals for Indians in New Spain. [Internet]. 2001. Gaceta Médica de México, 137(6), pp. 595-608. Available in: Intercultural adequacies in hospitals for Indians in New Spain (anmm.org.mx).
4. Fernández-Juárez, Gerardo (Ed.) Health, interculturality and rights. Keys for the reconstruction of Sumak Kawsay-Buen Vivir. [Internet]. 2010. Ediciones Abya-Yala. Quito-Ecuador. Available in: HEALTH, INTERCULTURALITY AND RIGHTS – CSSR – Home – Human rights and interculturality … and beyond its borders. … … – [Download PDF] (vdocuments.mx)
5. Almaguer González, José Alejandro, Vargas Vite, Vicente and García Ramírez, Hernán José García. Interculturality in health. Experiences and contributions for the strengthening of health services. [Internet]. 2014. Programa Editorial del Gobierno de la República; 3rd ed. Available at: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-968759?lang=es.