Sharing knowhow and joining forces towards Health for All
Contribution to the Annual Report 2012 of the MMI Network

A new Healthcare Model for Latin America

(c) Medicus Mundi Navarra
(c) Medicus Mundi Navarra

Medicus Mundi (medicusmundi) Navarra is promoting an intercultural, comprehensive and inclusive healthcare model in Guatemala, Bolivia and Peru which aims to transform the continent’s healthcare systems in order to guarantee universal coverage for communities that are traditionally excluded.

Florentina, a woman who lives in Las Barrancas community (Guatemala) is worried because for days she has been very tired, has had a fever, has been feeling generally unwell, has had difficulty opening her eyes and lifting her head, and has suffered a loss of appetite and weight. She says in her native language (“mam”) that she has “ojeado”. Elena has just given birth in Churcampa (Peru). She looks proudly at her baby and feels satisfied because her husband, by grasping her waist with the “chumpi”, has managed to prevent the “profundo suspiro”. According to the quechua’s world view this can cause the mother to die. Humberto, from an Aymara community, is worried because he has “Karkati”. In other areas of Bolivia they call it a “tembladera”. He feels worse and worse.

It is difficult for these three people to be cared for in a healthcare system based purely on “modern biomedicine”. Not only economic, but also linguistic, cultural, social and gender barriers can present an obstacle to millions of people seeing their right to healthcare satisfied by the public healthcare system. In a continent like Latin America, with its great ethnic and cultural diversity, it can be worst: 40% of Guatemala is indigenous peoples, there are 36 ethnic groups in Bolivia, 64 in Peru...

An ambitious project which is being developed in three “pilot” areas of the continent

medicusmundi, with the support of the European Commission and the Government of Navarra, has been supporting the design and implementation of an intercultural, inclusive and comprehensive healthcare model in Guatemala, Bolivia and Peru for more than 10 years. This model could become a reference point for the whole Latin American continent. The initiative has an extensive plan of work in these three countries, with teams of local experts in public health coordinating with local authorities and international organisations. Advocacy activities are also planned at national, regional and European level.

The objective is to make operational a healthcare model designed to guarantee universal healthcare coverage for communities traditionally excluded from it. By combining “modern/western” medicine with traditional medicine, these pilot schemes are validating the model which is designed not only to benefit the 155,709 people in the community where it is working in the field, but also in the medium term to be extended to all society within these three countries (50 million people) and, in the long term, to a large part of the American continent which shares quite similar sociocultural characteristics (rural and/or indigenous communities). 

This project is reaching its most interesting point; As result of this, there have been interesting technical meetings, at local and international level, alternating with intense work in the pilot areas. Together with practical experience in the field, the initiative already has a long series of publications and technical documents at the level of theoretical consideration which will be put together in a key-document: a proposal to transform the primary healthcare models in the region of the Americas.

 

“If the problems are similar, the solutions will not be very different.”

medicusmundi has a huge amount of experience in promoting comprehensive healthcare schemes which look to ensure that no group, for reasons of gender, ethnicity or culture, remains outside of access to the basic right to healthcare. medicusmundi has been experimenting for a long time, with different rhythms and intensities, a comprehensive approach to healthcare with three axes (health right, intercultural and gender equity) and three levels (individual, family and community) in these countries. A comprehensive healthcare model which is inclusive. A model which adds (“modern/western” medicine and traditional) and does not take away.

In Guatemala, the model took on the name “Modelo Incluyente en Salud” (MIS – Inclusive Healthcare Model), and it has had 12 years of positive experiences in various healthcare districts as well as the support of the Ministry of Health. In Bolivia it has worked around SAFCI Model (Intercultural Community Family Health) in the last few years, and in Peru there are projects with a similar philosophy to comprehensive healthcare (MAIS-BFC) based on the family and the community. Acronyms don’t matter, what counts is the ideas and practices. And above all, that they are systematic models tested in real life situations which are exportable and can be extended given the same circumstances. This is the purpose of the multi-country project supported by the European Commission.

To achieve these results, it requires not only an exchange of experiences and a demonstration that the model works, but also that society and governments make this initiative as own. One key aspect is its connection to the public healthcare system in order to guarantee access to healthcare for the whole population. medicusmundi and its members are dedicating their efforts on it. This is a challenge as much ambitious as interesting. A utopia which can be made a reality, healthcenter to healthcenter, person to person, family to family, ministry to ministry, country to country. The road is long and plagued with obstacles.

 

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Key Aspects of the project

Comprehensive and community health, not vertical. The project deals with a multidimensional perception of health (individual, family and community) centred not only on the problem but also on the risks. It includes the areas of prevention, promotion, care and rehabilitation and is a new way on the cooperation scene which is more inclined towards vertical programmes with basic packages...

Inclusive healthcare for all. Health Systems in Latin America are imported from more homogeneous western societies, and it has excluded majority groups in the population, in particular women, rural and indigenous communities. The project includes these groups, bearing in mind their own uses of traditional medicine, but also provides a model for the entire population, beyond specific groups: hence its inclusive feature.

Health as a right, not a privilege. Health is a right without any exclusion for reasons of sex, age, race, economic condition or geographical situation. The public system has an obligation to guarantee health coverage. Bearing in mind the different levels and the components of interculturalism, gender and environment, it is a basic step to move from “words to actions” in a systematic and sustainable way.

 

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The protagonists speak

Juan Carlos Verdugo, from Inclusive Health Institute (ISIS) in Guatemala: “In Guatemala, we have spent 12 successful years working to promote inclusive and comprehensive healthcare models at the first level of healthcare with the aim that they will be incorporated as part of the healthcare policy. The exchange of mutual learning and experiences in the healthcare field with Peru and Bolivia will be fundamental for improving healthcare models in Guatemala; and it will enable a regional initiative for public healthcare policy in those countries and suggest an alternative way to develop the international cooperation in healthcare”.

Fernando Carbone, former Health Minister of Peru: “In Peru, maternal and infant deaths have decreased greatly in recent year due to interventions which mainstream gender, intercultural and family focus, experiences in which Medicus Mundi has participated. Now it wants to apply these focuses throughout its healthcare model. This moment of transition is an opportunity to share achievements and lessons learnt and incorporate the experience of neighbouring countries.”

Javier Román, from Medicus Mundi in Bolivia: “Bolivia can give much to, and receive a lot from, this project. In our country we are developing the SAFCI, a model which includes concepts such as interculturalidad. It is also planned in the project, but we can help to introduce others concepts like the environment and, above all, we can facilitate their effectiveness. At the same time, we have experience and accumulated tradition regarding models of comprehensive and inclusive healthcare which can help to develop a system which is not only applicable to our three countries but also to a large part of Latin America, especially wherever there are communities excluded from access to healthcare.”

 

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