Attending to the Burden of Disease for Isolated Indigenous Populations of the Amazon: An Experience with Expedicionarios da Saude

Abstract

Background: Indigenous People around the world experience inequalities in health care. In Brazil, Indigenous inequalities in health are exacerbated by the poor system of health care delivery. The aim of this study is to understand barriers to care as defined from the Indigenous perspective.Methods: This study was conducted on three Indigenous reserves of the Xavante people in Mato Grosso, Brazil. We utilized a mixed methods approach. In the quantitative portion of the study, we surveyed 50 individuals using an adapted version of the World Health Organization 2002 World Health Survey. Participants for the quantitative survey were recruited from a randomized list of prospective patients for a medical outreach mission. In the qualitative portion of the study, we interviewed 37 individuals, including patients, health care providers, and village chiefs, about their experiences with health care. Participants for the qualitative interviews were recruited randomly from a medical outreach patient listing (Expedicionários da Saúde). Results: Overall, participants reported dissatisfaction with health-seeking experiences. We identified five barriers to obtaining satisfactory care: lack of transportation, lack of health care services and medication, attitudes of health care workers, lack of culturally appropriate services, and social determinants.Conclusions: Given an overall sense of dissatisfaction with health care use among indigenous people, future research should focus on identifying interventions to help overcome key barriers to accessing care. Private-public partnerships and other innovative health systems models should be explored to meet the needs of underserved indigenous communities.