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Health Surveillance and Disease Management / Communicable Diseases / Tuberculosis

An Integrated Approach to Controlling Tuberculosis in Indigenous Populations

(Cochabamba, Bolivia, 23–24 October 2007)


Meeting Report (in Spanish, PDF, 42 pp, 4 Mb, with links to the chapters; chapter heading translated below for user orientation)

- Introduction (text to right)
- Terms Used
- Global Panorama of Indigenous Health in Latin America
- Policies for Comprehensive Care for Indigenous Populations in Bolivia
- Perspectives of Indigenous Populations in Processes of Compliance with the Millennium Development Goals in Ecuador
- National Population Health Policies and Strategies to Address Barriers to the Health of Indigenous Populations in Chile
- National Population Health Policies: Strategies to Deal with Barriers to the Health of Indigenous Populations in Ecuador
- Intercultural Community Care in the Ecuadorian Amazon Region
- National Population Health Policies: Strategies Strategies to Deal with Barriers to the Health of Indigenous Populations in Peru
- Strategies to Deal with Barriers to the Health of Indigenous Populations in Bolivia
- Tuberculosis Control in Indigenous Populations in Latin America
- Neglected Diseases and Their Associations with Tuberculosis in Latin America
- Experiences in Applying an Intercultural Approach to Health Care in Mayan Populations
- National Population Health Policies: Strategies to Deal with Barriers to the Health of Indigenous Populations in Brazil
- National Population Health Policies: Strategies to Deal with Barriers to the Health of Indigenous Populations in Colombia
- National Population Health Policies: Strategies to Deal with Barriers to the Health of Indigenous Populations in Mexico
- Tuberculosis in the Highlands of Chiapas, Mexico
- Comprehensive Care with Emphasis on TB Control among Indigenous Peoples in Ecuador
- Working Groups
- Conclusions/ Recommendations and Next Steps towards Comprehensive Care with Emphasis on Tuberculosis Control in Indigenous Populations (text to right)
Annex I: Round Table (First Day)
Annex II: Round Table (Second Day)
Annex III: Agenda
Annex IV: Guidelines for Presentations
Annex V: List of Countries and Participants

- Regional Meeting to Analyze Access to Antitubercular Treatment in Indigenous Populations (Panama, 2004)
PAHO Tuberculosis Page

PAHO Gender, Ethnicity and Health Unit

Latin America is characterized as being a multi-ethnic and multi-cultural region of great diversity, where currently there are more than 650 indigenous populations recognized by the Region's Member States. Indigenous peoples' right to health is limited by a series of obstacles to care, for which reason their rates of morbidity and mortality from prevalent diseases are higher than among the general population. To overcome these barriers, there is a need to study them and identify specific control strategies and care models that will work in places where health systems have yet to reach, with the ultimate objective of reducing the risk of illness and death.

Introduction   |   Conclusions/Recommendations

Objectives

  • Analyze gaps in access to health care in areas with indigenous populations.
  • Analyze comprehensive care models for indigenous populations, with emphasis on TB.
  • Share successful experiences of addressing issues of overall health and TB control in indigenous populations.
  • Prepare recommendations to improve comprehensive health services in indigenous populations, with emphasis on TB.
  • Spread knowledge on the geospatial and epidemiological relationship between TB and various "neglected diseases" prevalent in indigenous communities, as part of a comprehensive strategy to address communicable disease control.

Expected Result: Produce a set of recommendations to guide improvements in implementing comprehensive healthcare models, with emphasis on TB in indigenous populations.

Participants

  • Representatives of national TB programs (NTPs).
  • Delegates from the ministries of health who work in the area of indigenous health.
  • Representatives from successful experiences in addressing indigenous health.
  • International experts in indigenous health.

Participating Countries: Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Panama, and Peru.

Conclusions/Recommendations

Barriers in Access to Healthcare among Indigenous Populations

Conclusions

  • Meeting discussions identified a series of barriers to healthcare in the indigenous populations: geographical, cultural, financial, etc.
  • Indigenous populations have the right to their own traditional medicines and to maintaining their own health practices, including the conservation of their plants, animals, and minerals of vital interest from a medical standpoint. Indigenous peoples also have a right to access to all social and health services, without discrimination.
  • The health of indigenous populations should be addressed comprehensively (intersectorally, interprogrammatically, interinstitutionally, with a multicultural focus) and aimed at their rights.
  • It is important to take into account social determinants and their influence on the health of indigenous populations, in order to promote healthy lifestyles.
  • During the presentations on health experiences among indigenous populations, it was demonstrated that when the community is the protagonist in all its health processes (planning, execution, and evaluation), the experience will be successful.
  • Human resources working in health services do not always offer quality care and compassion for the population; they are poorly remunerated, with little access to training and sustained sensitization; but this could be overcome through proper policies for human resource development.

Recommendations

  • Advocacy in the different agencies aimed at mobilizing financial resources for:
    1. ensuring the sustainability of programs geared to indigenous populations;
    2. implementing health programs where there do not exist; and
    3. carry out health promotion activities in indigenous communities, taking into account their technical and therapeutic resources.
  • Coordinate with other health providers and sectors (e.g. education, environment, production, tourism, and civil society) in terms of improving the quality of life of indigenous communities.
  • Formulate differentiated health strategies for communities in accordance with their geographical location, world view, and cultural practices.
  • Strengthen and develop multinational processes in consensus-building for strategies and activities in border areas occupied by indigenous communities.
  • Identify and implement comprehensive strategies to address health problems in indigenous populations, including community activities (extramural, e.g. planning, execution, and evaluation), thus creating and strengthening multiple health networks.
  • Review existing healthcare models, in order to reorient them in relation to ethnic, linguistic, epidemiological, and social diversity.
  • Design and to implement new care models where there are no existing health services, that will serve the needs of indigenous populations and make it possible for them to have improved access to health care.
  • Carry out a baseline for the more frequent causes of disease and death, which contains ethnic variables, in order to determine the epidemiological profile of indigenous populations; and in terms of results, to design comprehensive health programs.
  • Develop research methodologies for adequate diagnosis and treatment in indigenous populations, in order to expand explanatory models for the health and disease process-especially in highly mobile populations (i.e. migration).
  • Promote human resource education, incorporating into undergraduate and graduate curricula subjects of interculturalism, equity, ancestral knowledge, etc., for which it is advisable to develop agreements with centers that train human resources, such as the universities, institutes, and others.
  • Promote the development, design, and execution of human resources policies for health.
  • Facilitate and strengthen the recovery of ancestral medicine, with strategies and mechanisms identified with the indigenous populations themselves.
  • Publish and announce initiatives and research conducted on indigenous populations, in order to raise awareness among international organizations and mobilize the necessary financial resources to provide sustainability and continuity for health activities.

An Approach for TB Control among Indigenous Populations

Conclusions

  • Important work has been done on TB control in indigenous populations; however, their incidence rates are higher that among the general population, which should lead to program review in order to adapt them to the needs and various realities of indigenous populations.

Recommendations

  • Advocate for arrangements with indigenous authorities, governments (local, regional, national, and international), community leaders, community organizations, councils, etc., to prioritize TB control activities.
  • Conduct participatory situation assessments, to jointly detect health problems and stress of the importance of TB in indigenous populations.
  • Strengthen and develop consensus-building processes between western and traditional (indigenous community) medicine.
  • Ensure the financial and administrative sustainability of TB prevention and control activities.
  • With indigenous communities, strengthen the approximation and acceptance of, understanding for, and consensus-building with the healthcare system, in order to ensure the sustainability of tuberculosis prevention and control activities.
  • Apply experiences from other countries that allow for evaluating and strengthening work with health promoters and volunteers for the administration of and adherence to strictly supervised treatment in communities located at a distance from health services.
  • Promote strategies to incorporate and commit human talent (health promoters) in community actions for tuberculosis control.
  • Maintain a community-based information system, with a view to announcing the situation of health and of endemic TB at different levels.
  • Identify and characterize the problem of TB/HIV coinfection and facilitate access for TB patients to the counseling, voluntary HIV testing, and prevention and treatment measures for HIV infection.
  • Address the determinants of TB, such as nutritional status, alcoholism, and dwellings with high levels of household contamination in indigenous communities.
  • Conduct deparasitization studies in every respiratory symptomatic (RS) (during the TB diagnostic process) in countries that do not have a strategy for systematic deparasitization, for the purpose of improving the group's general health status.
  • Link to the patients and ex-patients, family members, and leaders as part of the DOTS strategy for supervised treatment in scattered communities.
  • Identify the social and cultural factors that affect compliance with the treatment on the part of indigenous communities.