Indigenous health care initiatives in Brazil

The CMAJ Analysis article by Allen and colleagues1 has shown the disparity in health access between Indigenous Peoples and the general population in Canada.

In a review of the literature from Brazil on this topic, we find a similar situation: the predominantly biomedical approach does not fully meet the needs of the Indigenous population. This approach distances Indigenous Peoples from this basic right to access appropriate heath care not only by not including practices and rituals inherent to their ethnicity, but also because of the absence of interpreters who would allow them to communicate with the health care team and due to discrimination by some professionals.2

In an attempt to overcome these obstacles, the government implemented measures to allow greater Indigenous participation in the management of the health services offered to their communities. These measures included the establishment of councils that are formed equally by Indigenous Peoples and workers involved in the administrative and medical part of health services3 (aiming to discuss and better meet the concerns of the Indigenous patients), and the creation of the role of Indigenous health agent,4 a professional who is Indigenous and works not only as a translator, but also promotes the integration between the knowledge of their tribe and biomedical science, acting in a similar way to the Indigenous-led health care partnerships in Canada.

Unlike the Canadian initiative, the projects applied in Brazil offer little autonomy to Indigenous Peoples, because they were established by the State, which determines the scope and the forms of Indigenous participation and constantly ignores the cultural particularities of each tribe. This may explain the unsatisfactory outcome of these policies in some regions of Brazil,2 in contrast to the good results achieved in parts of Canada.