“We know how to eliminate many childhood diseases and improve nutrition. The problem is reaching those who are in need, which is often a matter of money. The Foundation is expert at putting money to work where itís most needed.”

Dr. Malden Nesheim, PAHEF Trustee; Provost Emeritus, Cornell University in New York

Grants Program » Small Grants Program 2005-2006 

II. Priorities for 2005-2006

Theme B. Improving the Health of Indigenous Peoples

Indigenous Peoples in the Americas
In the Americas there are approximately 45 million indigenous people, comprising more than 400 different ethnic groups and contributing to the Regionís multicultural, multiethnic and multilingual character. As a group, indigenous people represent nearly ten percent of the Regionís total population. Their numbers relative to national populations vary significantly. In Bolivia, Ecuador, Guatemala, and Peru, indigenous people account for 40 percent or more of the total country population.

The Regionís indigenous populations live mainly in remote, rural communities. They are younger and have higher fertility rates than the national averages. Indigenous peoples are also over-represented among the most poor and disadvantaged; this translates into substandard living and health conditions. For example, indigenous people, especially children, are more likely to die sooner or suffer the effects of diseases that are largely avoidable such as nutritional deficiencies, diarrhea, respiratory problems, and communicable disease, which is preventable with immunization. Overall, life expectancy for indigenous populations is typically 10 to 20 years less than for the general population.

Indigenous peoples continue to face geographic, economic and cultural barriers that block their access to food, health and needed services. Of the estimated 120 million persons living in the Americas who are without regular access to health services, an estimated 40 percent are indigenous. These populations also often lack access to safe water, food and sanitation. In addition, the ongoing loss of ancestral territories and environmental changes not only impact their economic livelihood and cultural survival but also affect the food supply thereby increasing the likelihood of malnutrition or starvation.

Healthy Indigenous Communities: What Works Well and Why
One of the persistent challenges in working with indigenous communities has been the failure of public health interventions proven to be effective in the general population. Operations research is needed to understand the adaptations which are necessary to make these interventions culturally appropriate. Key issues are the:

  • Introduction of an effective intervention into an indigenous community analyzing the factors that influence its successful development; or
  • Demonstration of effective new interventions when a problem has developed following the introduction of a public health intervention that works in the general population.

Possible Areas of Project Activity
  • Indigenous communities have low immunization rates relative to others
  • Pregnant women do not use prenatal services
  • Recently installed latrines are not used by community members
  • Increased deaths are reported from malaria but services are not utilized and treatment is not used as prescribed
  • High rates of discontinuation of TB treatment are reported
  • Low coverage of family planning and high fertility rates
  • Consistently high HIV infection rates among Garifuna populations in spite of intervention
  • The incidence of sexually transmitted infections has increased
  • Women do not return for post partum care and contraception
  • Indigenous people do not use health services in a timely manner
  • Consideration of quality indicators of care from an indigenous perspective
  • Incorporation of indigenous perspectives, medicines and practices into conventional health care

The PAHEF Small Grants Program could be of great value to an organization that has the:
  • Technical and financial resources to design, execute and evaluate an intervention that can be completed in 12 to 24 months;
  • Experience working with indigenous communities; and
  • Capacity to carry out small demonstration projects.

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