Community-based health care for indigenous women in Mexico: a qualitative evaluation

Abstract

IntroductionIndigenous women in Mexico represent a vulnerable population in which three kinds of discrimination converge (ethnicity, gender and class), having direct repercussions on health status. The discrimination and inequity in health care settings brought this population to the fore as a priority group for institutional action. The objective of this study was to evaluate the processes and performance of the “Casa de la Mujer Indígena”, a community based project for culturally and linguistically appropriate service delivery for indigenous women. The evaluation summarizes perspectives from diverse stakeholders involved in the implementation of the model, including users, local authorities, and institutional representatives.MethodsThe study covered five Casas implementation sites located in four Mexican states. A qualitative process evaluation focused on systematically analyzing the Casas project processes and performance was conducted using archival information and semi-structured interviews. Sixty-two interviews were conducted, and grounded theory approach was applied for data analysis.ResultsFew similarities were observed between the proposed model of service delivery and its implementation in diverse locations, signaling discordant operating processes. Evidence gathered from Casas personnel highlighted their ability to detect obstetric emergencies and domestic violence cases, as well as contribute to the empowerment of women in the indigenous communities served by the project. These themes directly translated to increases in the reporting of abuse and referrals for obstetric emergencies.ConclusionsThe model’s cultural and linguistic competency, and contributions to increased referrals for obstetric emergencies and abuse are notable successes. The flexibility and community-based nature of the model has allowed it to be adapted to the particularities of diverse indigenous contexts. Local, culturally appropriate implementation has been facilitated by the fact that the Casas have been implemented with local leadership and local women have taken ownership. Users express overall satisfaction with service delivery, while providing constructive feedback for the improvement of existing Casas, as well as more cost-effective implementation of the model in new sites. Integration of user’s input obtained from this process evaluation into future planning will undoubtedly increase buy-in. The Casas model is pertinent and viable to other contexts where indigenous women experience disparities in care.

Providers of antenatal care services in Ghana: evidence from Ghana demographic and health surveys 1988–2014

“…This is in line with [13, 29]. The findings also show that women from rural areas were more likely not to utilise antenatal care services from any provider compared to those from the urban areas (OR = 3.51, p  < 0.001).…”

Labor and delivery service use: indigenous women’s preference and the health sector response in the Chiapas Highlands of Mexico

“…An example of how the Mexican health systems should respond to these findings may be the implementation and/or strengthening of the Project Casa de la Mujer Indígena or Casas Model [ 41 ] an initiative that brings together the local indigenous community, civil society organizations (NGO’s) and public institutions, in order to create a physical space to improve health care and patient satisfaction among indigenous women. This initiative intents to bridge the cultural distance between institutionalized, hegemonic forms of health care and indigenous forms of understanding and tending to health – especially reproductive health– within each community.…”

“…Previous studies had identified some limitations and opportunity for improvement in this model. According to Pelcastre's evaluation [ 41 ], the model may be strengthened through the following elements: community ownership and participation; inter-agency partnership and networks; budget oversight and external advisor or advisory board, responsible for supporting training activities and generating applicable evaluation and research agendas [ 41 ].…”

Building Capacity to Address Women's Health Issues in the Mixtec and Zapotec Community

“…Promotoras or Community Health Advisors have been employed in health promotion studies in many different racial/ethnic communities, including indigenous communities (Ramirez, McAlister et al 1995, Navarro, Raman et al 2007, Han, Lee et al 2009, Kobetz, Menard et al 2009, Nguyen, Love et al 2010, Nelson, Lewy et al 2011, Maxwell, Danao et al 2013, Messias, Parra-Medina et al 2013, Pelcastre-Villafuerte, Ruiz et al 2014). To our knowledge, this is one of the first studies that employed promotoras for conducting research among indigenous immigrants from Mexico that have settled in California.…”