The Autonomous Region of the North Atlantic of Nicaragua (RAAN) gained political autonomy in 1987 after indigenous Miskitu took up arms against the Nicaraguan government. As part of the autonomy process RAAN officials developed a policy document, The Health Model of the RAAN, that guides regional health system reform. The Health Model is guided by the concept of interculturalidad which is meant to simultaneously represent cultural difference, inter-connectedness and inequalities based on ethnic relations as historically constituted in society.
Drawing on fourteen months of participant observation in health meetings and workshops, and interviews with national and RAAN health officials, indigenous leaders, indigenous community members and health providers, this study examines the role of discourses of the indigenous movement, interculturalidad and cultural difference in the development and implementation of health policy in the RAAN. Analysis of interview material, health policy documents and meeting transcripts shows that although both Nicaraguan and RAAN health officials agree that the health system of the region should be guided by the notion of interculturalidad, the concept and process it represents is interpreted differently by the actors involved. For national health officials interculturalidad is simply recognition that culture is an important variable in health and that indigenous medicine should be accepted. For RAAN health officials interculturalidad is a political concept that also refers to the transfer of decision making power to the region. These interpretations lead to different policy propositions and conflicts in the negotiations between the national government and the RAAN. The concept of interculturalidad is broad and vague which makes it open to multiple interpretations, manipulations and degrees of control. The Nicaraguan government can therefore co-opt the discourse of interculturalidad and promote the image of a Nicaragua that recognizes its multi-ethnic character and its inclusiveness without implementing concrete policy changes that deal with resource distribution and political power.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12062006-174845 |
| Date | 26 January 2007 |
| Creators | Ruiz, Edgardo |
| Contributors | Dr. Martha Ann Terry, Dr. Harry Sanabria, Dr. Joseph S. Alter, Dr. Kathleen M. DeWalt |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12062006-174845/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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