Dialogue of knowledge 

As a fundamental element to guarantee the implementation of the intercultural approach in health plans, programs and services, it is proposed to establish horizontal intercultural dialogues based on respect and mutual understanding between the health systems and models of indigenous, Afro-descendant, Roma and other ethnic populations and the national health model (allopathic/Western) of the countries.

Intercultural dialogue implies the recognition of cultural diversity, of the other without barriers or social distinctions (1); it is understood as a dialogue in search of consensus between different cultures and their medical practices (2); it seeks recognition and respect for the existing differences between cultures in the field of health and disease (3).

In some countries of the Americas, intercultural dialogues have become meeting places between representatives of ethnic communities and institutional health personnel, usually with the support of a facilitator, in order to: generate intercultural health models that incorporate elements of traditional medicine (Panama) (4); reduce cultural barriers and discrimination against traditional therapists (Guatemala) (5); regain the confidence of ethnic populations to share their knowledge (Argentina) (6); reach agreements and enable mutual learning (Peru) (7).

Also, in some countries, such as Peru, intercultural dialogue, as a methodological tool, is not exclusive to the health sector, since it implies an “…open and respectful exchange of opinions between people and groups with different ethnic, cultural, religious and linguistic traditions and origins, in a spirit of mutual understanding and respect” (8). (8). 

According to the Pan American Health Organization PAHO/WHO, “knowledge dialogues, also called intercultural dialogues, are processes of communication and exchange between individuals, groups or communities of different origins or cultures. In the case of the health sector, exchanges take place between specific groups or individuals and trained health professionals. They aim, among other things, to improve access to health services and to build intercultural health, with emphasis on solving previously identified problems and their causes, mutual understanding and the creation of solid link

For this reason, in the framework of the Policy on Ethnicity and Health (https://www.paho.org/en/documentos/politica-sobre-etnicidad-salud-29a-conferencia-sanitaria-panamericana), PAHO recommends that the countries of the Americas, in the priority line of recognition of ancestral knowledge and traditional and complementary medicine, strengthen the dialogue of knowledge as a useful tool for health institutions and entities to plan joint actions with indigenous, Afro-descendant, Roma, and other ethnic populations, develop intercultural health policies, implement intercultural health models, or promote sociocultural adaptations in health services (10).

In order to promote these dialogues, the officials of the health institutions of the countries of the Region and those who become facilitators of these dialogues must be willing to recognize and respect the existing cultural differences, as well as the different conceptions and logics of the health systems of these populations, and to allow for the participation in these dialogues not only of the people designated by these populations for the dialogue, but also of their own health personnel (such as physicians or traditional therapists, midwives, health promoters, intercultural mediators, among others) (11).

Since 2021, PAHO has been conducting, among others, knowledge dialogues with midwives and birth attendants in Bolivia, Colombia, Ecuador, Honduras and Peru on topics related to family planning, prenatal control, identification of danger signs and childbirth care (https://www.paho.org/es/historias/parteras-tradicionales-salvar-vidas-conjugando-saberes-medicinas-ancestral-occidental), demonstrating how the combination of traditional and Western medical knowledge can help solve health problems and improve the living conditions of the population.

For more information on the methodology used to conduct these knowledge dialogues, see the following documents published by PAHO: Methodology of the Dialogues of Knowledge (https://www.paho.org/es/documentos/metodologia-dialogos-saberes) and Methodology of the Dialogues of Knowledge. Manual for facilitators (https://www.paho.org/es/documentos/metodologia-dialogos-saberes-manual-para-facilitadores).

On the other hand, in the Andean Intercultural Health Policy of ORAS CONHU (https://www.orasconhu.org/es/content/pol%C3%ADtica-andina-de-salud-intercultural), as a strategic line of its Action Plan, emphasizes the importance of conducting these intercultural dialogues to promote actions to incorporate the intercultural approach into health plans and programs, in a participatory manner with ethnic populations (12).

Thus, within the framework of the Andean Plan and the Andean Intercultural Health Policy, and the PAHO Policy and Action Plan on Ethnicity and Health, on October 28, ORAS held a webinar (https://www.youtube.com/watch?v=dIPwEObYhrU) on knowledge dialogues, with the participation of PAHO and experts from the Ministries of Health of Bolivia, Ecuador, and Peru, highlighting the contribution of traditional medicines to improving the quality of life of ethnic populations.

References.

1. Agudelo Ortiz, Diana Marcela. Intercultural health. Crossroads of living well and sumak kawsay in Bolivia and Ecuador. Master’s Thesis in Cultural Studies, Mention in Cultural Policies. 2014. [Internet] 108 pp. Available at: https://repositorio.uasb.edu.ec/handle/10644/4268
2. Campos Navarro, Roberto. “Experiences on Intercultural Health in Latin America,” in Salud e Interculturalidad en América Latina. Anthropology of Health and Intercultural Criticism”. [Internet] 2004 Abya-Yala/UCLM/AECI/FCSICIII/JCCM, p. 129-151:129. Available at: https://dialnet.unirioja.es/servlet/libro?codigo=559818
3. Oyarce, Ana Maria. “Política intercultural en salud: elementos de una propuesta”, Primer Encuentro Nacional Salud y Pueblos Indígenas, Saavedra, región de la Araucanía (Chile). 1996. Available in:
4. Ministry of Health of Panama. Guide for intercultural dialogue, reproductive health. In the framework of the Program to Improve Equity and Strengthen Health Services (IDB 2563/OC-PN) and the Salud Mesoamerica Initiative. [Internet] 2015 (IDB GRT/HE-13116-PN). Available at: https://www.saludmesoamerica.org/sites/default/files/2018-05/1.%20Guia%20Dialogo%20Intercultural.pdf
5. Ministry of Public Health and Social Assistance of Guatemala. Methodology of Intercultural Dialogues. [Internet] 2019. 28 pp. Available at: http://bvs.gt/eblueinfo/GP/GP_003.pdf
6. Ceriani, Sara Victoria (2015). The relevance of intercultural dialogue in the accessibility to the health system in communities of native peoples of Formosa. VII International Congress of Research and Professional Practice in Psychology XXII Jornadas de Investigación XI Encuentro de Investigadores en Psicología del MERCOSUR. Available at: https://www.aacademica.org/000-015/584
7. Ministry of Health. Diálogo intercultural en salud: documento técnico, prepared by Dionisio Astuhuamán, Doris Irene; Portocarrero Gutiérrez, Julio; Salaverry García, Oswaldo. [Internet] 2014. 41 p. Available at: https://repositorio.ins.gob.pe/handle/20.500.14196/549
8. Ministry of Culture. Intercultural Dialogue. Guidelines for better dialogue in contexts of intercultural diversity. [Internet] First edition, April 2015. Pp46. Available at: https://centroderecursos.cultura.pe/es/registrobibliografico/di%C3%A1logo-intercultural-pautas-para-un-mejor-di%C3%A1logo-en-contextos-de-diversidad
9. Pan American Health Organization. Dialogues of Knowledge. Web page: https://www.paho.org/es/dialogos-saberes
10. Methodology of knowledge dialogues. Washington, D.C.: Pan American Health Organization; [Internet] 2021. License: CC BY-NC-SA 3.0 IGO. https://doi.org/10.37774/9789275324707.
11. Methodology of the dialogues of knowledge. Manual for facilitators. Washington, D.C.: Pan American Health Organization; [Internet] 2022. License: CC BY-NC-SA 3.0 IGO. https://doi.org/10.37774/9789275324707.
12. Andean Health Organization – Hipólito Unanue Agreement. Andean Intercultural Health Policy. [Internet] 2019. 2nd edition. 26 pp. Available at: https://www.orasconhu.org/es/content/pol%C3%ADtica-andina-de-salud-intercultural