Who'll Care for Them?

Under ex-President Fernando Collor de Mello
the indigenous health care system was decentralized.
Since then jurisdiction conflicts began to emerge
causing a lot of confusion.

The news was subtly announced by the Brazilian media on February 19th. The National Health Foundation (Funasa), the agency in charge of implementing the national indigenous health policy, was officially closed down. The Indigenous Health System and the Federal Agency for Disease Prevention and Control (APEC) were created to replace it. According to Provisional Measure 33, published in the Official Gazette, the Indigenous Health System will be directly linked to the Ministry of Health and inspected by the APEC.

Closing down Funasa is part of the policy adopted by the Fernando Henrique Cardoso administration, which has been replacing governmental structures with control agencies. The way the foundation was closed down, however, gave rise to an odd feeling, because the decision was not based on comprehensive discussions around the Special Indigenous Sanitary Districts (DSEIs). Health professionals have no idea of what will happen to the districts, to the training programs for Indigenous Health Agents, to the so-called Homes for Indigenous People (Casas do Índio, which provide emergency care to indigenous people), and to the hospitals that provide health care to indigenous people exclusively.

The indigenous health care system has been dismantled for the second time. Under the administration of ex-President Fernando Collor de Mello (1990-1992), the indigenous health care system was decentralized. Public policies for health and education, which used to be centralized at Funai, were placed under the responsibility of the ministries of Health and Education. The Ministry of Health delegated health care actions to Funasa, an independent governmental agency operating within the ministerial framework. Funai remained in charge of a health sector and as a result jurisdiction conflicts began to emerge. In the regions, technicians and indigenous people have been trying to contact the two agencies for assistance, causing a lot of confusion.

For some time CIMI (Conselho Indianista Missionário—Native Missionary Council), has been warning that outsourcing indigenous health care services is dangerous. Responding to requests of indigenous communities, the government created the DSEIs, but other segments can provide health care services to indigenous populations, such as NGOs and city halls. The policy for agreements between the agencies and the Ministry of Health has been defined.

Complaints and problems are piling up. Indigenous peoples began to report cases of corruption, misappropriation of equipment, neglect, professional incompetence, and prejudicial treatment. The last report reached CIMI last week. The Indigenous Council of Roraima (CIR) reported that the budget earmarked for health care agreements was sharply reduced as a result of the standardization of salaries—which may lead to the dismissal of part of the staff.

The fact that Funasa was closed down raised doubts in relation to the future of the indigenous health care system and gave rise to apprehension in indigenous villages. In February, about 250 indigenous people representing 42 peoples of states of the Northeast, Minas Gerais and Espírito Santo held a meeting in Caruaru, state of Pernambuco, to evaluate the indigenous health care system, define strategies to deal with the new national policy adopted by the federal administration for the sector, and debate the consequences of closing down Funasa.

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