As the mother of three children under the age of 12, Raquel Tello faces the difficulty of providing healthy meals on a daily basis to her family in Huallhua, a tiny farming community in Peru's Andes Mountains. Although child malnutrition and anemia rates have generally dropped in Peru over the past half-dozen years, they remain stubbornly high in the southern Andes.
A program operated by the Lima-based non-profit Chirapaq (Centre for Indigenous Cultures of Peru), helps families like Tello's combat child malnutrition by increasing the use of traditional foods. Tello and her neighbours participated in the program and learned how to prepare a more varied, balanced diet using traditional or local Andean crops such as quinoa, wheat, beans, and tubers. “I used to just make soup with those foods, but I learned to make main courses, too,” she says.
In Peru and other Latin American countries, health authorities are committed to implementing intercultural health programs as a means to eliminate the health differences between indigenous peoples and the rest of the population. IDRC-supported researchers are studying Chirapaq and other initiatives to understand the implementation challenges facing these programs. Learning from good practices and addressing the factors that hinder implementation, including social inequity, is essential to their success.
Nutrition and cultural identity
Chirapaq works to improve the health of Andean families and reinforce their cultural identity by increasing food security, said Newton Mori, who heads the indigenous organization’s Advocacy, Culture, and Policy Program.
Government health centres provide regular checkups and nutritional supplements for these families’ children, but mothers rarely take advantage of them. Some avoid health centres because the staff do not speak Quechua, the local language. Others skip the supplements, fearing side effects or criticizing the unpleasant taste.
Chirapaq has successfully promoted and increased the consumption of traditional crops for better nutrition. But their impact on child malnutrition and healthy eating habits was muted by factors beyond their control, underscoring the need for policies to ensure the gains are not lost, said medical anthropologist Carmen Yon, the researcher who coordinated the studies carried out by the Instituto de Estudios Peruanos (IEP). Her study found that good nutrition goes beyond diet and depends on socio-economic factors such as good living conditions, safe water, and health centres where staff are sensitive to cultural issues and speak the local language.
Tello explained that in her village of about 180 families, the nearest spring is just a trickle. It can take hours to fill a bucket, making it difficult to collect enough water to ensure good hygiene and keep vegetables from shriveling in the dry mountain air. Other nutrition-related tasks, such as raising small animals for protein, add work to the women's already long days of tending to children, home, and crops.
Training in intercultural health
Part of the IDRC-supported effort, Yon’s assessment also included a training program in intercultural approaches for indigenous nurse technicians working in remote Amazonian villages. Led by AIDESEP, an indigenous umbrella organization, the training program aims to bridge the gap between "Western-style" medicine and traditional practices in government-provided health services.
The curriculum includes the study of plant-based and indigenous medicines, which form a vital part of Amazonian culture, as well as indigenous practices for delivering babies, caring for newborns, and treating illnesses. The training also emphasized respect for indigenous medical knowledge and practices; dialogue with the community and its leaders; mutual understanding between indigenous and conventional health care practitioners; and the ability to speak, read, and write the local language.
In villages where intercultural nurse practitioners were assigned, the relationship between health centres and local residents improved and trust in health services increased, the IEP study found.
Practitioners who reach out and understand
Ever Mucushua, a graduate from the AIDESEP program, said in an interview recorded by the IEP researchers that he was initially met with resistance, especially from pregnant women. “But after I explained that I was trained in intercultural health, spoke their language, and was just another member of the community, that solved the problem.”
The villagers that IEP surveyed said the intercultural nurse technicians listened to them talk about their needs, fears, and reasons for distrust; provided better explanations; understood them; and respected their knowledge and culture. The nurse technicians also served as intermediaries with colleagues who lacked intercultural training.
Gerardo Tukup, who was also trained in the AIDESEP program, adapted his health centre’s birthing room to accommodate the traditional vertical delivery position. He also worked closely with traditional midwives and community health promoters to increase the number of births attended by health personnel in his jurisdiction. These measures can improve the safety of deliveries by reducing the risk of complications for both mother and newborn.
But the study found that the AIDESEP program could not compensate for the shortcomings of a system where cultural sensitivity is a value stated in its policies, but missing from the fundamental design. The lack of incentives for intercultural health illustrates this disconnect. Turnover is high in Amazonian health posts that are remote and poorly equipped. In addition, the health system uses results-based performance evaluations that only measure services offered to insured patients. Uninsured indigenous patients who received care that may have included intercultural approaches are omitted from the health system’s calculations for funding renewal, the IEP study reported.
Making intercultural health policies work
Yon and her team are ensuring that the study’s findings and recommendations for improvements reach health authorities. As part of their advocacy efforts, they held a national meeting where indigenous nurse technicians shared their experiences, achievements, and difficulties with health ministry officials.
Decision-makers are beginning to listen to their message. In the Amazonas region, an ordinance issued in June 2016 added intercultural training and knowledge of indigenous language to the evaluation criteria in the recruitment of healthcare personnel in the region. As well, the Amazonas Regional Education Office agreed to recognize intercultural healthcare as a specialty and to issue certificates. Official recognition makes the program more valuable to the participants — and makes the intercultural nurse technicians more valuable to the health system, said Nery Zapata, a member of AIDESEP's national leadership board.
“Intercultural health means that conventional medicine and indigenous medicine must go hand in hand,” said Zapata. “That concept and practice must be effectively incorporated into national health policies.”
Thanks to assessments like this one, evidence is guiding efforts to integrate intercultural practices and approaches into Peru’s health system, and helping to address the bottlenecks that keep people from using these vital services.
Projects in Peru
- Promoting Latin American engagement in research collaborations for recovery via the Trans-Atlantic Platform for Social Sciences and Humanities
- Justice in a changing climate
- Tapping into local research expertise to deepen evidence-based impact investing
- Playing and learning: scaling a math digital game across Peru
- One Amazon: A one-health assessment of emerging epidemic threats and resilience among Amazonian indigenous peoples
- Latin American open data for gender-equality policies focusing on leadership in STEM
- Validation of rapid molecular testing for COVID-19 and integration with tuberculosis diagnostics
- Addressing the socioeconomic impacts of COVID-19 with a gender lens: food systems, labour markets, and social protection in Latin America
- Shaping the macro-economy in response to COVID-19: a responsible economic stimulus, a stable financial sector, and a revival in exports
- Opening data for inclusive practices in migration, public contracting, and combatting gender-based violence
Working with small farmers in the highlands, IDRC-funded researchers developed early maturing frost-tolerant potatoes. In Lima and other Latin American cities, research helped to integrate urban agriculture into municipal development plans, boosting food security.
Our support has also focused on the link between agriculture and health. Tests in rice paddies in Northern Peru have shown that intermittent irrigation reduces the number of malaria-carrying mosquitoes. Not only did the number of mosquito larvae decrease by 80–85%, farmers also conserved water and increased rice yields by up to 25%.
Following this success, we funded research on how to spread this safer and more profitable farming technique. In July 2014, the Government of Peru endorsed the project’s broader implementation through a presidential decree.
Peruvians are reaping the benefits of IDRC support to the Economic and Social Research Consortium, including improved labour laws and unemployment insurance, and stronger consumer protection. Peru’s leaders rely on the Consortium’s expert advice when setting policy to promote micro and small business development, to manage natural resources, and to keep citizens safe.
The Consortium has grown from a handful of institutes in Lima to astrong national network of 48 members, including Peru’s most prestigious universities. IDRC and Global Affairs Canada have supported many of their research activities.
Protecting indigenous knowledge
IDRC-supported research has also focused on the Amazon rainforest, which covers half of Peru. For example, researchers addressed the need to protect indigenous knowledge from unlawful use, and ensure continued access to useful plants. The group worked with the patent office to establish procedures that biotech companies follow to patent genetic material found in plants and crops, and related traditional knowledge.
329 activities worth CAD $83.2 million since 1974
Our support is helping to:
- give vulnerable women and youth access to financial institutions
- address the lack of public health services
- establish local scientific research capabilities for development
- promote innovative irrigation techniques to limit malaria outbreaks
Explore research projects we support in this region.
Projects in South America
- Justice in a changing climate
- Regenerative agribusiness and investment with a gender lens in the Amazonia and Central America dry corridor
- Playing and learning: scaling a math digital game across Peru
- Strengthening partnerships and collaborative learning in social systems to improve evidence-informed policies in LMICs
- Supporting research and innovation in Latin America and the Caribbean through enhanced regional collaboration
- Enhancing the resilience of alternative food systems in informal settings in Latin America and the Caribbean through bottom-up initiatives
- Enhancing the design of the Adaptation Futures conference for a more distributed participation in the context of limited international mobility
- Adaptation research alliance towards COP26
- Partnership for Equity, Evidence, and Rapid Response in Social Systems (PEERSS) Coordinating Organization (previously RREP coordinating organization)
- An agenda for action – Transitioning to a healthy sustainable food system in Latin America