The United Nations estimates there are 370 million indigenous people living in over 70 countries. However, this population remains one of the most marginalized groups in the world. Inequalities in health status lead to higher rates of maternal and child mortality, malnutrition, cardiovascular disease, HIV/AIDS, malaria, and tuberculosis among indigenous people.
While an official definition of “indigenous” has not been adopted by the UN, the World Health Organization generally defines indigenous populations as “communities that live within, or are attached to, geographically distinct traditional habitats or ancestral territories, and who identify themselves as being part of a distinct cultural group, descended from groups present in the area before modern states were created and current borders defined." Distinct geography and culture can lead to social exclusion of indigenous peoples and moreover health inequities. Through the CHMI database, we found 12 programs that directly address care for indigenous populations by facilitating services and improving care with traditional healers, transportation services, financing care models, and other innovative practices.
Traditional Healers: Supporting Community Members to Effectively Deliver Care
Because traditional medicine and healers play an important role in the care strategies of indigenous communities, programs have taken advantage of this trusted use of medicine to deliver quality care to these populations.
The Wayo-Nero Strategy in Uganda works with traditional healers in local communities to bring mental health care to post-conflict settings. “Uncles” (Wayos) and “Aunties” (Neros) are trained as lay mental health workers who can assist in early-case detection, a simplified referral process, recovery support, and changes in stigma surrounding mental health. The program also uses ICT to communicate mental health information between biomedical professionals and traditional healers as well as increase community engagement with mobile SMS and voice capabilities.
The Baptist Missionary Association of America’s Cambodia Mission is a project focusing on the Kachok indigenous tribe of the remote northeastern Ratanakiri Province. By establishing and supporting tribal relationships, the program works to improve the living conditions and welfare of indigenous communities by training and coaching key tribal members in community health management and basic case management. These leaders can then promote healthy activities and inform providers of health situations of the community in case special interventions are needed.
Cambodian Medicinal Plants Project trains and works with traditional healers (Kruu Boran) to deliver care with the assistance of village health workers, and volunteers refer cases when they recognize interventions beyond their expertise are needed. This program respects the importance of natural medicine to the community and works to preserve medicinal plants. Kruu Boran are given compensation for their work through donations from the community, which can include money, food, or labor.
Transportation: Connecting Communities with Essential Care
Because the environment of Kenya’s North Eastern Province (NEP) consists of vast, sandy pastures with poor road infrastructure unsuitable for vehicles, many women of the semi-nomadic communities in this region have difficulties reaching clinics for delivery. The Donkey Cart Ambulances assist in transporting pregnant women in labor to nearby clinics, enabling them to give birth in equipped facilities while maintaining their nomadic lifestyle.
Conversely, the Motorbike Outreach Model brings healthcare directly to these communities in the NEP. With a motorcycle to travel the rough terrain, healthcare professionals can reach the nomadic communities throughout the seasons. This program has been able to transport staff, supplies, and immunizations to distant health clinics on a regular basis and have a positive impact on community health behaviors. Through their efforts, the motorcycle has become associated with a positive image of saving lives.
Financing Care: Making Services Affordable and Accessible
Klinik ASRI, a partner program of the U.S.-based nonprofit Health In Harmony, works with the indigenous communities of the remote Indonesian Gunung Palung Rainforest to provide healthcare while conserving the national park. The clinic is the result of Health In Harmony’s conversations with village leaders about their greatest needs: affordable, high-quality healthcare and training in organic, sustainable farming. Open four days a week and offering services such as free birth control and immunizations, general medicine, and a comprehensive pharmacy, the clinic works with the patients to pay for services with goods or labor. According to Darya Minovi, Communications and Outreach Manager at Health In Harmony, “ASRI never turns a patient away because they cannot pay. They work with the patients to find a payment option that works for them.”
“In a 2007 survey of the loggers, a vast majority said that they wanted the forest to be there for future generations,” said Minovi. “The problem was that if a health emergency arose, logging was the best way to get fast cash and many didn’t have training in an alternative livelihood.” By selling seedlings or goat manure, community members are able to earn a living while conserving the rainforest, not destroying it. Health In Harmony is currently working with ASRI to open a new Community Hospital and Training Center in the fall of 2016 to enhance emergency and surgical care and conservation education and training.
CHMI will continue to profile programs working with indigenous communities increasing access and affordability of quality healthcare, supporting traditional healers and tribe members, and encouraging partnership between communities and health professionals.
Photo: Getting Treatment in Northern Kenya ©Marisol Grandon/Department for International Development