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 the Special Secretariat for Indigenous Health (SESAI), municipal, and regional health services. This coordination should be done both in the policy formulation and in its implementation-which should occur between medium and street-level bureaucrats. Based on the literature that discusses federalism and intergovernmental coordination mechanisms, this article investigates the mechanisms and difficulties of cooperation in the frontline of health services offered to Indigenous peoples. A total of six semi-structured interviews were carried out with professionals of the SESAI in the Mato Grosso do Sul DSEI. It was identified that the difficulties are related mainly to institutional racism, the overload of the Brazilian National Health System (SUS), 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. In conclusion, there is a need for more intergovernmental collaboration mechanisms that consider these difficulties in integrating the implementation of these services.