A New Hope: Perspectives on Implementing the Pilot of a New Comprehensive Health Care Model in Guainía, Colombia

Thesis (Master's)--University of Washington, 2018The 1993 health reform in Colombia structured a General System of Social Security in Health that fragmented the national health system creating the current health care crisis in this country, especially within indigenous communities living in disperse rural areas. The Ministry of Health, in collaboration with Colombian research institutions and other ministries, designed a Comprehensive Health Care Model with an approach based on the principles of ethnic and cultural diversity within primary health care. In 2016, the Ministry of Health selected the Province of Guainía to host the five-year pilot of this model to target disperse rural communities, due to its diverse population and adverse topographic, health, and economic conditions. This research explores the perspectives of key stakeholders, directly or indirectly involved in implementing this model for indigenous populations living in disperse areas in Guainía, Colombia. The two main goals of this thesis research are to describe how different stakeholders perceive the model’s implementation in the local indigenous population of Guainía, and to identify to what extent this model is addressing the needs of indigenous populations living in disperse areas of this Province. In this descriptive qualitative research, 23 semi-structured interviews were conducted during July and September 2017. The term “Interculturality” was identified as the main overall theme. Specific sub-themes derived from Interculturality including 1) contextual disconnect, 2) prior consent, 3) “traditional” medicine, 4) transit homes, and 5) SISPI vs MIAS. Narratives collected for this project suggested that the model is promising, but it could increase success by adjusting some of its community-based participation, methodological, and epistemological approaches