How is it possible to generate a participatory health model in dispersed rural areas?

Very few people know that the concept of dispersed rural areas emerged in Law 691 of 2001 as a normative attempt to regulate the participation of indigenous ethnic groups in the General Social Health System (SGSSS), and thus generate spaces to create health models consistent with the development of the communities.

However, the lack of regulation of the Law generated a crisis in some departments, such as Vaupés, and motivated the creation (from the peoples) of an alternative: the Indigenous System of Own and Intercultural Health (SISPI). Sinergias contributed to the debate on the way in which the health problems of the majority of the country are currently faced, and based on the experience in Vaupés in the 1980s, rescued lessons learned and challenges of the SISPI.

For the organization, it is fundamental to recognize that these areas are territories of population, cultural and ecological diversity that imply generating dialogues with local actors when implementing health models within the framework of Law 100 of 1993, which constituted a setback to processes that had been integrated with an ethno-development approach in territories such as Vaupés.

"With Law 100, the advances that had been achieved in the eighties were fragmented. In Vaupés, for example, there was a Colombo-Dutch Agreement that recognized the cosmovision, traditional care and their own notions of health for the implementation of health actions. However, with the new law, program costs became a problem and the available resources have not been allocated for this purpose," says Pablo Montoya, director of Sinergias.

The proposal developed by Sinergias is a health care model comprising the following concepts:

• Coverage: it is what is covered and how this is guaranteed to be covered. In the system we usually talk about Benefit Plans, which should be adequate to biomedical and traditional care, as well as it should be integrated due to the difficulty and cost of having separate equipment.

  
  

• Financing: these are the resources to guarantee that the elements established by the Coverage are provided. For this purpose, it is suggested to sectorize the territories in order to replace the Per Capita Payment Unit by a Payment Unit per Territory, which contemplates the reality of the costs of carrying out the actions.

  
  

• Care: these are the ways in which the health care of the population is guaranteed, which implies taking into account the Coverage. Here, the construction of Intercultural Health Standards, Guidelines and Protocols is essential, with a view to achieving the elements of acceptability and quality delimited by law.

  
  

• Management: is the planning, monitoring and evaluation of health action. It is proposed to articulate this to the very realization of the health components of the Integral Life Plans, a central input for the planning of the Indigenous Territorial Entities.

These four concepts are part of the proposal that Sinergias made based on a historical study of the experience accumulated locally from the review of documents and interviews with people who have been linked to the health sector or to the department's traditional indigenous authorities.

“It is an attempt at simplification, with a view to facilitating the discussion between experts and the population of the indigenous ethnic groups, within the framework of the SISPI,” adds Montoya.