Implementation challenges in public policies towards indigenous peoples: the impact of health policies in urban contexts

Abstract

How are indigenous public health policies implemented in contexts of diversity? The rural-urban migration processes that indigenous people have experienced since the mid-19905 in Latin American countries have affected the implementation of public policies, especially in the field of health. These processes have put pressure on ancestral practices of territorial representation, challenging traditional mechanisms that have supported western health policies. Based on a case study in urban Chile, this article examines the implementation processes of indigenous public policies in field of intercultural health. The analysis is informed by data collected from in-depth interviews with 35 key actors (Indigenous health practitioners, managers, health professionals, users, indigenous leaders), who have played a role in different stages in the implementation process of 'Indigenous Peoples Special Health Program (PESPI)'. The data points to some challenges that persist with the implementation and adaption to this policy into a Western Health Model, where indigenous practices do not always find space to develop. The data collected reveals the efforts that indigenous people make in order to maintain their traditions and practices in different territorial contexts. The findings have the potential to enrich discussion and decision-making on intercultural and or indigenous health policies in other countries experiencing similar issues.