Victories and challenges in Colombia’s health model

On Mar. 7, Javier Mignone, associate professor in the University of Manitoba faculty of human ecology’s department of family social sciences, gave a presentation at the U of M titled “Health care organizations in Colombia: an indigenous success story within a system in crisis.” Mignone specializes in intercultural, community, and Aboriginal health in addition to researching the social determinants of health and family well-being,

The lecture was part of the Arthur V. Mauro centre for peace and justice’s Brown Bag Lecture Series, which has been regularly featuring speakers on a range of domestically and internationally-geared political topics since 2006.

The lecture began with an introduction to the story of the Colombian health-care system and the Wayuu indigenous tribes of La Guajira and northwest Venezuela. They make up around 80 different ethnic groups and approximately 144,000 (or 20 per cent) of the indigenous population of Colombia.

In Colombia, the health-care system is effectively controlled by the Empresas Promotoras de Salud (EPS), six of which are non-profit and specific to the indigenous (EPSI) community. These organizations are, in essence, insurance companies.

As a whole, Colombia’s is often considered to be a system in crisis, with frequent protests brought on by a lack of adequate care, non-universal coverage, regular accusations of corruption, a lack of proper accountability within the companies themselves, and a burden of high debt.

However, within the damaged system, some have managed to succeed, and one such organization is Anas Wayuu EPSI, an organization that services the indigenous peoples of La Guajira, and in 2012 was rated the best EPS in all of Colombia. Its secret is community-based programs organized by local politicians.

Anas Wayuu EPSI promotes traditional medicine and the development of intercultural childbirth programs with traditional Wayuu midwives, as well as local community health programs. Furthermore, it has a partnership with the Universidad de Antioquia as part of a prevention and research initiative for HIV/AIDS.

It is also focused on building a computer information database to provide better care – a topic of great interest to Mignone.

“There’s a lot of young people interested in these things,” he said.

“Young people could learn [statistics] and so this is my main interest, seeing if we could get a bit more funding to develop this kind of thing.”

Mignone acknowledged, however, the difficulty in getting the funding for such initiatives, citing donors being uncomfortable with the idea of giving money to a small, local organization over a large, internationally-known one.

“I think donors tend to shy away, and I think that it’s because they don’t have as much control over [community-based initiatives],” he said.

“While of course we can collaborate, and have technical exchanges, [in the end] it’s run through them and not through us.”

Mignone also acknowledged the challenges faced by many of the EPS organizations, some of which are very unpopular with locals. Colombia lacks political stability, and is recurrently the site of conflict between entities like militias, paramilitaries, guerrilla fighters, and the legitimately recognized government military. There are also internal disagreements between various EPSs, which can hinder progress.

Colombia is, furthermore, a site of major exploitation by foreign mining corporations, entities that frequently take over large sections of land, driving out the population and mining the area for gold and other resources. Canada is a significant contributor to the practice, which creates political tension over what is seen as the exploitation of ancestral lands, and particularly damages the indigenous peoples.

“[The indigenous peoples of Colombia] face tremendous obstacles,” said Mignone.

“But that is where the strength of the organization has mattered so much [ . . . ] if it weren’t for the strength of the organization, I think that they would have been long since run over.”

The next Mauro Brown Bag Lecture, which will take place March 21, is called “Canadian Wilderness in n’Daki Menan,” and will be presented by Jocelyn Thorpe.