Programmes and Strategies

3.3.3.1 The National Health Strategy for Indigenous Peoples

The work with and for indigenous peoples is a concern of the Peruvian state explicitly stated in important documents. There are statements collected in the National Agreement and State policies, which are implemented in the corresponding area in MINSA, in the lineamientos de política sectorial (Sector Policy Guidelines) for 2002- 2012. This intention is materialized in the creation of the National Health Strategy for Indigenous Peoples (ESNSPI) of 2004, applied within the 15 national health strategies.

The strategy looks for the “cultural appropriateness of healthcare services, to allow greater access of the population’s ethnic minorities through the subsidiary system, and the decreasing of existing health gaps” (MINSA 2002a:5, t. sp.).

CENSI, in charge of the INS, is responsible for the coordination of ESNSPI, which seeks the incorporation of interculturality in health services annexing the representatives

design, implementation and evaluation of health models developed at the local level. In this sense, the national coordination of ESNSPI and CENSI, who assumes its leadership, has assumed by ministerial mandate the objective to achieve the formulation of proposals for regional intercultural health policy at the regional level, enabling the implementation of regional plans on the subject.

ESNSPI undertakes the development of strategies to set up the cultural appropriateness of health services. In that sense, its main feature is the transversality of the intervention, in all the strategies and provision of services by segments that MINSA offers.

According to the strategy, the incorporation of the concept of interculturality in health services for the indigenous population begins with respect for their culture and their practices, since they have resolved their health problems “from ancient times, when the isolation of Western societies did not alter the balance that is maintained between man and his environment”. Due to the contact with the Western society –so the strategy–

other health problems were added to their environment, and they tend to be poorer and less protected, since they also have geographic, cultural, and economic factors acting as barriers and limiting their access to health services. National initiatives to act on specific problems concerning indigenous peoples have been prompted several times.

However, they were dispersed, atomizing their impact, and preventing, i.e., their replication in other areas. Thus, another element of the National Strategy on Indigenous Health is the development of the ability to systematize experiences of public and private institutions that have been successful, and can be adapted to other people with the same needs.

The approach of the strategy is developed in the context of decentralization; the implementation of intercultural adaptation at the local level must be conducted, executed, and evaluated by local authorities from the Regional Departments of Health (DIRESA) to the establishments in which this type of care is implemented. The technology transfer from central levels of MINSA and its regulatory capacity to enable the regional level design and implement changes should accompany the process, respecting the previous experiences of working in the field of intercultural health. That is why the plan of the National Strategy on Indigenous Health is designed to be the

framework on which the regional level can plan their intervention and technical assistance, maintained as a permanent process (MINSA/INS/CENSI 2010). In the opinion of some experts, although promissory, less than eight years after the introduction of the strategy basic tasks have not yet been attained, including the design of a policy of intercultural health in Peru, the health situation analysis of the Andean populations (Quechua and Aymara), and bringing the national health system to the indigenous culture, among others:

In CENSI there is a research area on traditional medicine. Do you know that there are no anthropologists there? Who understands this knowledge? There are only medical and health professionals who make attempts, but they do not manage this.

Until now they’ve investigated absolutely nothing. The leaders there do not have any idea what they are doing, and when they want to defend positions in academic discussions, they hide under the table. Instead of protecting and validating this knowledge, they hamper it. Traditional medical systems of the communities do not have a political or academic voice in their decisions. For this reason, I think that the extinction of indigenous medicine is a matter of time. So the concern of the anthropologists is to register what remains of the cultural evidence of these health systems (Anthropologist iw/2010)

3.3.3.2 The Indigenous Health Programme of AIDESEP

The largest indigenous organisation in the country, the Asociación Interétnica de Desarrollo de la Selva Peruana AIDESEP¹²⁹ (Interethnic Association for the Development of the Peruvian Forest) aims to represent and defend the historical and present interests of the indigenous peoples of the Amazonia by ensuring the conservation and development of their cultural identities, territories, and values, and promoting sustainable human development, facilitating the exercise of self- determination of indigenous peoples recovered in the Peruvian and international law (AIDESEP 2005:3). In 1991, AIDESEP implemented the Programme of Indigenous Health (PSI) as an important proposal for intercultural health in the Peruvian Amazon that aims to raise the living standards and the re-evaluation of the health culture of indigenous people by strengthening and developing existing intercultural approach in THSs.

One statement of AIDESEP is that the programmes established in accordance with a Western perspective have shown to be ineffectual in alleviating the health problems of