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“Five hundred years of medicine gone to waste”? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes

BACKGROUND: In Ecuador, indigenous women have poorer maternal health outcomes and access to maternity services. This is partly due to cultural barriers. A hospital in Ecuador implemented the Vertical Birth (VB) policy to address such inequities by adapting services to the local culture. This include...

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Autores principales: Llamas, Ana, Mayhew, Susannah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987654/
https://www.ncbi.nlm.nih.gov/pubmed/29866186
http://dx.doi.org/10.1186/s12889-018-5601-8
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author Llamas, Ana
Mayhew, Susannah
author_facet Llamas, Ana
Mayhew, Susannah
author_sort Llamas, Ana
collection PubMed
description BACKGROUND: In Ecuador, indigenous women have poorer maternal health outcomes and access to maternity services. This is partly due to cultural barriers. A hospital in Ecuador implemented the Vertical Birth (VB) policy to address such inequities by adapting services to the local culture. This included conducting upright deliveries, introducing Traditional Birth Attendants (TBAs) and making physical adaptations to hospital facilities. METHODS: Using qualitative methods, we studied the VB policy implementation in an Ecuadorian hospital to analyse the factors that affect effective implementation of intercultural health policies at the local level. We collected data through observation, in-depth interviews, a focus group discussion, and documentation review. We conducted 46 interviews with healthcare workers, managers, TBAs, key informants and policy-makers involved in maternal health. Data analysis was guided by grounded theory and drew heavily on concepts of “street-level bureaucracy” to interpret policy implementation. RESULTS: The VB policy was highly controversial; actors’ values (including concerns over patient safety) motivated their support or opposition to the Vertical Birth policy. For those who supported the policy, managers, policy-makers, indigenous actors and a minority of healthcare workers supported the policy, it was critical to address ethnic discrimination to improve indigenous women’s access to the health service. Most healthcare workers initially resisted the policy because they believed vertical births led to poorer clinical outcomes and because they resented working alongside TBAs. Healthcare workers developed coping strategies and effectively modified the policy. Managers accepted these as a compromise to enable implementation. CONCLUSIONS: Although contentious, intercultural health policies such as the VB policy have the potential to improve maternity services and access for indigenous women. Evidence-base medicine should be used as a lever to facilitate the dialogue between healthcare workers and TBAs and to promote best practice and patient safety. Actors’ values influenced policy implementation; policy implementation resulted from an ongoing negotiation between healthcare workers and managers.
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spelling pubmed-59876542018-06-20 “Five hundred years of medicine gone to waste”? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes Llamas, Ana Mayhew, Susannah BMC Public Health Research Article BACKGROUND: In Ecuador, indigenous women have poorer maternal health outcomes and access to maternity services. This is partly due to cultural barriers. A hospital in Ecuador implemented the Vertical Birth (VB) policy to address such inequities by adapting services to the local culture. This included conducting upright deliveries, introducing Traditional Birth Attendants (TBAs) and making physical adaptations to hospital facilities. METHODS: Using qualitative methods, we studied the VB policy implementation in an Ecuadorian hospital to analyse the factors that affect effective implementation of intercultural health policies at the local level. We collected data through observation, in-depth interviews, a focus group discussion, and documentation review. We conducted 46 interviews with healthcare workers, managers, TBAs, key informants and policy-makers involved in maternal health. Data analysis was guided by grounded theory and drew heavily on concepts of “street-level bureaucracy” to interpret policy implementation. RESULTS: The VB policy was highly controversial; actors’ values (including concerns over patient safety) motivated their support or opposition to the Vertical Birth policy. For those who supported the policy, managers, policy-makers, indigenous actors and a minority of healthcare workers supported the policy, it was critical to address ethnic discrimination to improve indigenous women’s access to the health service. Most healthcare workers initially resisted the policy because they believed vertical births led to poorer clinical outcomes and because they resented working alongside TBAs. Healthcare workers developed coping strategies and effectively modified the policy. Managers accepted these as a compromise to enable implementation. CONCLUSIONS: Although contentious, intercultural health policies such as the VB policy have the potential to improve maternity services and access for indigenous women. Evidence-base medicine should be used as a lever to facilitate the dialogue between healthcare workers and TBAs and to promote best practice and patient safety. Actors’ values influenced policy implementation; policy implementation resulted from an ongoing negotiation between healthcare workers and managers. BioMed Central 2018-06-04 /pmc/articles/PMC5987654/ /pubmed/29866186 http://dx.doi.org/10.1186/s12889-018-5601-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Llamas, Ana
Mayhew, Susannah
“Five hundred years of medicine gone to waste”? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes
title “Five hundred years of medicine gone to waste”? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes
title_full “Five hundred years of medicine gone to waste”? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes
title_fullStr “Five hundred years of medicine gone to waste”? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes
title_full_unstemmed “Five hundred years of medicine gone to waste”? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes
title_short “Five hundred years of medicine gone to waste”? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes
title_sort “five hundred years of medicine gone to waste”? negotiating the implementation of an intercultural health policy in the ecuadorian andes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987654/
https://www.ncbi.nlm.nih.gov/pubmed/29866186
http://dx.doi.org/10.1186/s12889-018-5601-8
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