Panama, 21–23 November, 2011
Health and its promotion and preservation have been prime concerns of human society throughout history. From the very beginnings of humanity, caring about health lies at the center of human activity. There has always been concern over the principles of healthy human behavior and actions to be taken to establish an optimal equilibrium between body and mind (“mens sana in corpore sano”). Equally important, all societies have identified members from amidst communities who provided advice on how to interpret signs of ill-health and, given their special talents and aptitude, to serve their fellow community members with guidance on how to remedy periods of ill-health and which medications to use.
Numerous studies throughout the Americas have noted that health systems are not meeting the needs of Indigenous Populations. While there are numerous reasons for the generally lower health status of Indigenous Populations, one particular concern is the health system’s ability to provide high quality, effective, patient-centered services that depend on the right mix of health care workers, with the right skills, in the right place, at the right time to Indigenous Populations who often live in rural areas and are often separated by unique cultural norms, practices and languages that are unfamiliar to the majority of non-indigenous health professionals. Additionally, due to the health professional shortages in most countries, recruiting and retaining health workers to work in Indigenous communities present significant challenges.
In order to make the health care system more responsive to their Indigenous Populations, a number of countries of the Americas have implemented a variety of strategies and initiatives to address Indigenous health human resources issues. Most current strategies focus on increasing the cultural competence of non-Indigenous health workers while at the same time providing incentives to recruit and retain them to work in Indigenous communities. Others have taken a more comprehensive approach related to self-sufficiency with a focus, as well, on increasing the number of Indigenous health professionals, para-professionals and allied health workers working in Indigenous health services.
On could observe in recent years a growing proximity between traditional and “western” medicine and their providers. This evolving congruence and openness resulting from a greater understanding of the value of integrated approaches leads the way to designing more adequate systems of health care – particularly in communities which continue to live more traditional life styles. Thus, the concept of health and health services providers based on mutual recognition of health practice being culture-bound could quite rightly be seen as being in a phase of paradigm shift towards acceptance that intercultural health in its practice is already a fact in many ways of life experience.
A review of the service providers available to indigenous populations, their traditional providers of care and the contribution of human resources based on training in the medical sciences will pave the way for a better understanding of this more comprehensive and more appropriate approach to service provision.
2. To share experiences and innovative approaches in the development of comprehensive IHHR Policies, Strategies and Interventions;
3. To analyze promising IHHR practices and interventions that could be evaluated, adapted and replicated in other environments;
4. To promote the development of a community of practice on IHHR in the Region of the Americas;
5. To produce a report / publication / policy document.
Reasonable access to quality and culturally appropriate health services
Management culture and approaches which reflect and articulate cultural diversity
Community involvement in IHHR
Framework for IHHR Policies and Interventions
In order to promote comprehensive approaches to IHHR problems and issues, five (5) key areas of intervention are proposed. Taken together, they provide a useful framework for the thematic organization of the Forum and the previous mapping of relevant country and community experiences from a variety of institutions and organizations. The framework should be of assistance to identify areas in greater need of development and the necessary synergies between government, indigenous, academic and civic society organizations.
The proposed core areas for policy interventions are:
1.Planning of IHHR
Composition of Primary Healthcare Care (PHC) workforce: competency profiles needed (inter-cultural facilitators and interpreters; community health workers; indigenous health professionals; indigenous healers; pharmacists with knowledge of traditional medicines and plants, others);
Needs for health personnel: gaps in availability (measuring gaps through community approaches, health needs approaches, etc.)
2. Support education programs and institutions in health sciences (including public health and health administration) to increase the number of indigenous health professionals
Improving access of indigenous students to health sciences education (medicine, nursing, allied health professionals, public health etc.)
Supporting the development of specific programs in health sciences education on indigenous health, cultural diversity and intercultural approaches
Bringing health sciences education programs closer to indigenous communities
3.Support the development of intercultural and indigenous health competencies for health workers
Supporting the development and access to training programs for in-service non-indigenous health workers
Increasing the competencies of community-based indigenous health workers
4.Increase the availability of health workers to indigenous communities and health centers
Develop systems of incentive to recruit and retain health workers in indigenous communities
Provide incentives for social service in indigenous communities
Provide incentives for basic residency programs (family medicine, pediatrics etc.) in indigenous community settings and health centers
Provide incentives for health sciences indigenous graduates to practice in their community of origins
Develop contractual arrangements for traditional indigenous healers
5.Ensure adequate management and supportive working environments
Develop special training programs in indigenous health for health care managers
Identify the competencies required by health managers working in Indigenous communities
Develop mechanisms that involve indigenous communities in the selection and evaluation of health care providers.
Working Groups Reports (in Spanish)
Pan American Health Organization
Inter-American Development Bank
Regional Office for the Americas of the World Health Organization