Discoordination promoting institutional racism: considerations on indigenous access to health policy

Abstract

The Brazilian Policy for Indigenous Health has its efficacy conditioned by the promotion of intergovernmental coordination between SESAI, municipal, and regional health services. This coordination should be done both in the policy formulation and in its implementation – between medium and street-level bureaucrats. Based on the literature that discusses federalism and intergovernmental coordination mechanisms, this paper investigates the mechanisms and difficulties of cooperation in the frontline of health services offered to indigenous peoples. 6 semi-structured interviews were done with professionals of the SESAI in the DSEI Mato Grosso do Sul. It was identified that the difficulties are related mainly to institutional racism, the overload of the Brazilian health system, the unaccountability of municipal services, and the (weak) communication between SESAI and hospitals. The cooperation mechanisms are personal relations, situated agency of SESAI professionals, and a monetary incentive. I conclude there is a need for more intergovernmental collaboration mechanisms that consider these difficulties in the frontline integration of the health services offered to indigenous peoples.