State of the World’s Indigenous Peoples
It is clear that there are significant data gaps in the health of indigenous peoples in the African region. These can be addressed at the very outset by states recognizing indigenous peoples. This can then set the stage for strengthening health systems in data collection, disaggregating data according to ethnicity, and empowering the communities themselves by increasing access to education. Having indigenous peoples collecting data will increase accuracy of the data.
Affirmative action and training of indigenous health care workers Indigenous peoples often live in rural and remote areas where access to health services is reduced or simply not available. At the same time, where there are health facilities, staff are not able to communicate in indigenous languages, creating a further barrier. Training health workers from indigenous communities could address this challenge. At the same time, many of these communities have poor access to education, which makes it harder to target students for medical training colleges. Improving education and affirmative action for bright indigenous students to undertake bridging courses in order to enter training institutions is a possible solution. Another strategy is to have more rural-based training schools and tuition support for indigenous students. Increasing the proportion of medical students who come from rural backgrounds provides positive rural learning experiences in medical school. Further, specific rural residency/vocational training programmes will increase the number of graduating physicians who possess interest, knowledge and skills for rural practice. Recruiting and retaining physicians in rural practice requires attention to the environment, health system, financial constraints and other factors.71 Another strategy to attract and retain health care workers in rural and remote areas is to improve the working environment in these areas. A study undertaken in Zambia indicated that nurses considered satisfactory accommodation, access to continued education and motivation to work as important non-monetary incentives for working in remote areas.72
Development of responsive health policies The foundation of having best practices in delivering health care to indigenous peoples is for states to embrace multicultural health systems. The World Health Organization asserts that all people have the right to health. During the fiftieth anniversary celebration of the Universal Declaration on Human Rights on 8 December 1998 in Paris, the WHO Director General Dr. Gro Harlem Brundtland said: “It is no coincidence that the idea to establish a world health organization emerged from the same process that identified the universal value of human rights. The WHO constitution states the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political beliefs, economic or social condition”. In most state health systems cultures and views of indigenous peoples are ignored or dismissed as health systems are based exclusively on western medicine. This approach marginalizes indige-
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Bulletin of the World Health Organization 2010;88:395-396. doi: 10.2471/BLT.09.073072.
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http://wiredspace.wits.ac.za/handle/10539/9082.
028 ξ Chapter 1