Guarantee the right to health of indigenous peoples through socio-cultural adaptation.

Colombia has made significant efforts to guarantee the right to health of its population. In 2015, Law 1751 was issued, aimed at regulating this right. It consolidates the advances developed by international, regional and national jurisprudence. It establishes the essential elements of the right - availability, acceptability, accessibility, quality and professional suitability -, as well as a set of interrelated principles. In the case of indigenous ethnic groups, the principles of equity, interculturality and protection of indigenous peoples are particularly relevant.

Within this framework, there is a need to move towards local operationalization with a view to guaranteeing the right to health. Cultural or sociocultural adaptation is one of the strategies to put into practice the element of acceptability, understood as the adjustment according to medical ethics and sociocultural particularities, in the case of indigenous peoples, of actions oriented to health care. From the organization of which I am a member, adequacy has been conceptualized as a dynamic participatory and constructive process in three dimensions: political, epistemic and operational.

The first of these, the political dimension, refers to the realization of human rights, the recognition and compliance with the existing legal and juridical framework regarding indigenous peoples and their own legal systems, on the basis of which actions are taken to guarantee appropriate participation in the definition of public policies at the different territorial levels.

The epistemic dimension refers to the co-construction of knowledge on health care, in a democratic, egalitarian, participatory framework, and in accordance with the previous dimension. Finally, the operational dimension constitutes the materialization in the design, implementation and evaluation of health care services, respectful of the historical, social and cultural processes of indigenous peoples, which must correspond to what is established in the previous dimensions.

During 2015, together with the Departmental Health Secretariat of Huila and the Association of Traditional Authorities of the Regional Indigenous Council of Huila, we conducted an exercise aimed at the Sociocultural Adaptation of the Clinical Practice Guidelines for the Prevention, Early Detection and Treatment of Complications of Pregnancy, Childbirth and Puerperium.

For this purpose, a process of prior consultation and agreement was carried out with the authorities of the Nasa, Misak and Yanacona indigenous peoples attached to the regional organization; mechanisms for co-construction of knowledge were established - Circles of Words, Dialogues of Knowledge, Collective Workshops per people -; and personnel from the communities themselves were incorporated into the research exercise.

At the end of this exercise, recommendations for sociocultural adaptation were obtained, which were added to the Clinical Practice Guidelines established at the national level, which may have a local application led by both the Departmental Secretariat and the Association of Authorities.

Several of the results obtained are similar to those reported for other regional and national experiences. These peoples require humanized care during pregnancy, which involves developing “intercultural intelligence” in professionals and technicians in charge of follow-up.

During childbirth, the preference for the vertical position makes it necessary to generate competencies in care, as well as to make some changes in the physical plant of health institutions. In the Puerperium, guaranteeing the ritual exercise is a fundamental need, especially considering that it rarely conflicts with biomedical knowledge.

This experience leaves some relevant lessons learned within the framework of the development of innovative models:

• The first, and perhaps the most important, is that Sociocultural Adaptation should be taken seriously, since when it is carried out appropriately, it is evident that most of the obstacles can be overcome.

  
  

• Secondly, it is necessary to advance in the incorporation of this as an axis in the development of health care models.

  
  

• Finally, it is necessary to incorporate all the actors of the health system in the process, as a way of generating territorial competencies in the implementation of this Adequacy.

During 2016, the Departmental Secretariat is expected to proceed with the implementation, follow-up and evaluation process, which will undoubtedly provide new lessons learned.

Text and photographs: Pablo Andrés Martínez Silva.

* Pablo Andrés Martínez Silva is a Surgeon, Specialist in Economics, Master in Anthropology and PhD Candidate in Public Health.

Taken from: http://blogs.iadb.org/salud/2016/05/02/colombia/