In June 2012 researchers from IDS and the Royal Tropical Institute (KIT), with funding from Rockefeller Foundation and the Wellcome Trust, organised a meeting to discuss issues around inequities in universal health coverage that particularly affect indigenous and minority peoples and identify effective strategies for addressing those inequities.
Background
Almost a third of the world’s poorest people are indigenous and minority peoples living in Asia, Africa and Latin America. A wealth of evidence shows that governments fail in their responsibility to fulfil the right to health of these peoples. In fact, health inequities between majority groups and indigenous people are increasing, both in poorer nations and in countries experiencing rapid economic growth, such as Brazil and India. Often the discrepancies are worse in states where indigenous peoples are engaged in a struggle over land or in their pursuit to be recognised as having distinct rights.
In 2007, the United Nations Declaration on the Rights of Indigenous Peoples stipulated that indigenous people have the same rights to the highest attainable standard of physical and mental health as majority populations. Yet health care coverage in most countries fails to take into account the specific challenges that confront efforts to ensure indigenous people’s access to their health rights.
The process
In June 2012 a conference brought together 19 key stakeholders and experts from Asia, Africa and Latin America to share their expertise and establish a common agenda to address inequities in universal health coverage. The conference explored three themes that highlighted critical issues at the interface between dominant medical norms and practices in state health systems and the socio-cultural realities of indigenous groups:
- territory, mobility and access;
- traditional medical knowledge and intercultural, culturally sensitive, health care;
- gender and sexual and reproductive health, including maternal and child health (MCH).
Participants used ‘mind-mapping’ techniques to identify the current state of health systems and their vision of what health care for indigenous groups should look like, in order to develop an ambitious agenda for future collaborative work on bridging divisions.
The conference results
The discussions and outcomes of the conference are available in the conference report.
The conference facilitated a better understanding of what interventions to transform health systems have worked and why. Participants shared their experiences with significant and promising efforts in improving health access. These experiences included working with and strengthening networks of healers and indigenous selfhelp groups, developing mobile and cross-border programmes, reducing stigma, and promoting initiatives to facilitate community empowerment. Health financing, good governance, poverty alleviation and protection of lands and livelihoods were widely recognised as important across the three themes. Yet in reality, few initiatives actually link or integrate health, livelihoods and governance.
There was agreement on the need for improved systematic documentation and recognition of indigenous peoples’ knowledge, including their medical expertise. There was also an emphasis on the need to improve engagement between indigenous health care practitioners and biomedical providers. The relationship of pharmaceutical companies to traditional medicine was also explored.
Identifying the Need for a global network
Participants identified the need for a global network to share information about what works and why, when it comes to addressing the health challenges faced by indigenous and minority peoples. Such a network would help strengthen advocacy for international policy responses to these challenges. Recognising the need for a global network, participants decided to establish the Indigenous and Minority Peoples Health Alliance (TIMPHA). The mission of TIMPHA is to transform health systems to serve the wellbeing and health of indigenous and minority groups and help ensure universal health coverage in Africa, Asia and Latin America for all citizens. Members of the network developed a research agenda and potential joint action research projects to address key knowledge gaps and pilot innovative responses to indigenous health challenges.
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