I.
INTERNATIONAL AUTHORITIES AND PRECEDENTS
1.
Draft United Nations Declaration on the Rights of Indigenous Peoples
(UN 1994)
Article
24: "Indigenous peoples have the right to their traditional
medicines and health practices, including the right to the protection of
vital medicinal plants, animals and minerals.
They also have the right to
access, without any discrimination, to all medical institutions, health
services and medical care."
2.
C 169, Convention on Indigenous and Tribal People (ILO Convention
1989)
Article 24: "Social security
schemes shall be extended progressively to cover the peoples concerned, and
applied without discrimination against them."
Article 25:
1. Governments shall
ensure that adequate health services are made available to the peoples
concerned, or shall provide them with resources to allow them to design and
deliver such services under their own responsibility and control, so that
they may enjoy the highest attainable standard of physical and mental
health.
2. Health services
shall, to the extent possible, be community-based. These services shall be
planned and administered in co-operation with the peoples concerned and take
into account their economic, geographic, social and cultural conditions as
well as their traditional preventive care, healing practices and medicines.
3. The health care
system shall give preference to the training and employment of local
community health workers, and focus on primary health care while maintaining
strong links with other levels of health care services.
4. The provision of such
health services shall be co-ordinated with other social, economic and
cultural measures in the country.
3.
Additional Protocol to the American Convention on Human Rights in the
Area of Economic, Social And Cultural Rights (OAS 1988)
Article 10: "Right to Health
1. Everyone shall have
the right to health, understood to mean the enjoyment of the highest level
of physical, mental and social well-being.
2. In order to ensure
the exercise of the right to health, the States Parties agree to recognize
health as a public good and, particularly, to adopt the following measures
to ensure that right:
f. Satisfaction of
the health needs of the highest risk groups and of those whose poverty makes
them the most vulnerable."
4. American Declaration
on the Rights and Duties of Man (UN 1948)
Article XI: “Every person has
the right to the preservation of his health through sanitary and social
measures related to food, clothing, housing and medical care, to the extent
permitted by public and community resources.”
5. International
Covenant on Economic, Social and Cultural Rights (UN 1966)
Article 11(1): “The State
Parties to the present Covenant recognize the right of everyone to an
adequate standard of living for himself and his family, including food,
clothing, housing and to the continuous improvement of living
conditions...”
Article 12(1): “The State
Parties to the present Covenant recognize the right of everyone to the
enjoyment of the highest attainable standard for physical and mental health.
(2). The Steps to be taken by the State Parties to the present Covenant to
achieve the full realization of this right shall include those necessary
for:
(a) the provision for the
reduction of the still birth-rate and of infant mortality and for the
healthy development of the child;
(b) the improvement of all
aspects of environmental and industrial hygiene;
(c) the prevention, treatment
and control of epidemic, endemic, occupation and other disease;
(d) the creation of conditions
which would assure to all medical service and medical attention in the event
of sickness.”
6. International Convention on the Elimination of all Forms of Racial
Discrimination (UN 1965)
Article
5(e)(iv): “...States Parties undertake to prohibit and to eliminate racial
discrimination in all its forms and to guarantee the right of everyone to
public health, medical care, social security and social services."
7.
Universal Declaration of Human Rights (UN 1948)
Article 25(1): “Everyone has
the right to a standard of living adequate for the health and well-being of
himself and of his family, including food, clothing, housing and medical
care and necessary social services, and the right to security in the event
of unemployment, sickness, disability, widowhood, old age or other lack of
livelihood in circumstances beyond his control.”
8. African Charter on Human and Peoples’ Rights (Banjul Charter 1981)
Article 16: “(1) Every
individual shall have the right to enjoy the best attainable state of
physical and mental health. (2) States parties to the present Charter shall
take necessary measures to protect the health of their people and to ensure
that they receive medical attention when they are sick.”
9. Copenhagen Declaration on Social Development and Programme of Action
of the World Summit for Social Development (Copenhagen, Denmark, March 6-12,
1995)
C. Commitments.
Commitment
6. "We commit ourselves to promoting and attaining the goals of
universal and equitable access to quality education, the highest attainable
standard of physical and mental health, and the access of all to primary
health care. The purpose of
these activities is to eradicate poverty, promote full and productive
employment and foster social integration.
To this end, at the national level, we will:
(g) Recognize and support the right of indigenous people to education
in a manner that is responsive to their specific needs, aspirations and
cultures, and ensure their full access to health care"
10. World
Bank Operational Directive 4.20 (OD 4.20) (September 1991)
Para.
15(e): “Plans that draw upon indigenous knowledge are often more
successful than those introducing entirely new principles and institutions.
For example, the potential contribution of traditional health
providers should be considered in planning delivery systems for health
care.”
11. World Bank Operational Manual, "Description and Sample Outline
of an Environmental Action Plan, Operational Directive 4.02 , (July 1992)
Para. 4: "A Comprehensive
EAP [Environmental Assessment Plan] normally covers a broad range of topics
similar to those listed below. The
weight accorded to each item covered depends on local circumstances.
(b) An analysis of major
cross-sectoral issues (e.g., demography, public health and safety, cultural
and natural heritage) and socioeconomic factors important to the environment
and resource use. Basic
information required for the cross sectoral analysis includes the following:
(iii)
Cultural and natural heritage: Data on environmental or human induced risk
to the preservation of specific major sites, structures, and remains of
archeological, historical, cultural, religious, or aesthetic value;
identification of natural resources of particular biological, ecological,
medical, or touristic value."
12.
Alliance for Sustainable Development documents signed
by signed the Presidents of Costa Rica, El Salvador, Guatemala,
Honduras, Nicaragua, and Panama and a Representative of the Prime Minister
of Belize, at the Central American Ecological Summit for Sustainable
Development in Managua, Nicaragua (October 12, 1994)
Annex II: Commitments of the
Alliance:
"Social Commitments:
Education and Health. We pledge
to place priority on providing education and health for the people of
Central America, as prerequisites for sustainable development in the region.
Food
and Nutritional Security. We aim to guarantee and effective food and
nutritional security system for the peoples of Central America, in
accordance with the characteristics and customs of each country..."
13. Program of Immediate Actions Derived from the Declaration of San
Salvador II for the Investment in Human Capital signed by the Presidents of
Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama and the
Prime Minister of Belize, and El Costa Verde, in the Republic of El Salvador
(March 30, 1995)
"To
develop a Promotion and Education Program for Health that stimulates
integral health, strengthens healthy life styles, and develops
responsibility for individual and collective health, while encouraging
community participation and horizontal cooperation."
14.
Summit of the Americas Plan of Action, signed by 34 heads of state
participating in the Summit of the Americas (Miami, Florida 1994)
III. "Eradicating Poverty
and Discrimination in Our Hemisphere.
17. Equitable Access to Basic
Health Services. Despite
impressive gains in the Hemisphere, limitations on health services access
and quality have resulted in persistently high child and maternal mortality,
particularly among the rural poor and indigenous groups. ...Develop or
update country action plans or programs for reforms to achieve child,
maternal and reproductive health goals and ensure universal,
non-discriminatory access to basic services, including health education and
preventive health care programs.
The plans and programs will be
developed according to a mechanism to be decided upon by each country.
Reforms would encompass essential community-based services for the poor, the
disabled, and indigenous groups; stronger public health infrastructure;
alternative means of financing, managing and providing services; quality
assurance; and greater use of non-governmental actors and
organizations."
II.
DOMESTIC AUTHORITIES AND PRECEDENTS
15. Argentina
Ley 23.302 de 1985
Article 18: ”La autoridad de salud coordinará con
los gobiernos de provincia las realizaciones de planes intensivos de salud
para las comunidades indígenas, para la prevención y la recuperación de
la salud física y psíquica de sus miembros, creando unidades sanitarias móviles
para la atención de las comunidades dispersas. Se promoverá la formación
del personal especializado para el cumplimiento de la acción sanitaria en
las zonas de radicación de las comunidades”.
Artículo 19: ”Se declara prioritario el diagnóstico
y tratamiento mediante control periódico, de las enfermedades contagiosas,
endémicas y pandémicas en toda el área de asentamiento de las comunidades
indígenas. Dentro del plazo de sesenta días de promulgada la presente ley
deberá realizarse un catastro sanitario de las diversas comunidades indígenas,
arbitrándose los medios para la profilaxis de las enfermedades y la
distribución en forma gratuita bajo control médico de los medicamentos
necesarios”.
Artículo 20: ”La autoridad de aplicación llevará
a cabo planes de saneamiento ambiental, en especial para la provisión de
agua potable, eliminación de instalaciones inadecuadas, fumigación y
desinfección, campañas de eliminación de roedores e insectos y lo demás
que sea necesario para asegurar condiciones higiénicas en los lugares de
emplazamiento de las comunidades indígenas promoviéndose, a ese efecto, la
educación sanitaria de sus integrantes y el acceso a una vivienda digna”.
Artículo 21: ” En los planes de salud para las
comunidades indígenas deberá tenerse especialmente en cuenta:
a)
La atención bucodental;
b)
La realización de examenes de laboratorio que complementen los
examenes clínicos;
c)
La realización de examenes cardiovasculares, a fin de prevenir la
mortalidad prematura;
d)
El cuidado especial del embarazo y parto y la atención de la madre y
el niño
e)
La creación de centros de educación alimentaria y demás medidas
necesarias para asegurar a los indígenas una nutrición equilibrada y
suficiente;
f)
El respeto por las pautas ofrecidas en la Directiva de la Organización
Mundial de la Salud, respecto de la medicina tradicional indígena
integrando a los programas nacionales de salud a las personas que a nivel
empírico realizan acciones de salud en áreas indígenas;
g)
La formación de promotores sanitarios aborígenes especializados
en higiene preventiva y primeros auxilios.
Las medidas indicadas en este capítulo lo serán sin
perjuicio de la aplicación de los planes sanitarios dictados por las
autoridades nacionales, provinciales y municipales, con carácter general
para todos los habitantes del país.”
16. Bolivia
Ley 1.493 de 1993
Artículo
19: ”Compete al Ministro de Desarrollo Humano actuar en todo lo inherente
al desarrollo, la formación, el bienestar y calidad de vida de la persona,
asegurando la compatibilidad de sus actos con las estrategias probadas por
el Presidente de la República, y en particular: ... (f) Formular,
instrumentar y fiscalizar políticas y programas en salud incluyendo la
prevención, protección y recuperación de la salud, así como nutrición,
saneamiento e higiene; en el desarrollo rural y social de las comunidades y
pueblos originarios, preservando su identidad y organización; en el
desarrollo urbano con el estímulo de la construcción de la vivienda
social, y atender los problemas de la marginalidad urbana y rural”.
17. Brazil
- Decreto 1.141 de 1994
Art.
11: ”As açoes de saúde para as comunidades indígenas destinam-se ao
alcance do equilíbrio bio-psico-social e dar-se-ão para valorizar e
complementar as prácticas da medicina indígena, tendo como finalidades:
I.
Reduçao da mortalidade geral, em especial a materno-infantil;
II.
Interrupçao do ciclo de doenças transmissíves;
III.
Comabate à desnutriçao.”
Art. 12: ”Será garantido aos índios e às comunidades indígenas a acesso às açoes de nível
primário, secundário e terciário do Sistema Ünico de Saúde.”
Art. 13: ”São assegurados os serviços de atençao
primária à saúde no interior de terras indígenas.”
Art. 14: ”O órgãno federal de assistência ao índio
integrará o Sistema Único de Saúde-SUS, a partir da utilização da rede
pública e conveniada, bem como dos seus mecanismos de financiamiento, para
asegurar meios outros que viabilizem assitência integral e diferenciada,
consideradas as especificidades das comunidades indígenas.”
- Estatuto das sociedades indigenas
(Proyecto de ley)
Art. 117: “É assegurado aos índios e as comunidades
indígenas a assisténcia especial nas ações de saúde, eduçapo, e de
apoio as atividades produtivas, em observáncia ao reconhecimento das
comunidades indígenas como grupos etnicamente diferenciados.
Parágrafo único. A assisténcia especial de que trata
o caput deste artigo npo exclui o acesso dos fndios e das comunidades indígenas
aos meios de assisténcia assegurados aos demais brasileiros.”
Art. 121: “O sistema de prevenção e assistência a
saúde para as comunidades indígenas destina-se a complementar as práticas
de medicina indígena, visando a redução do risco de doenças e outros
agravos e o estabelecimento de condições que assegurem aos índios e as
comunidades indígenas o acesso universal e igualitário as atividades e aos
serviços de saúde.”
Art. 122: “As ações de saúde voltadas para os índios
e suas comunidades terão como príncipio:
I.
o respeito e a valorização das diferentes práticas da medicína
indígena:
II.
o perfil epidemológico, a situação sanitária, as condições de
bem-estar físico, mental e social e as formas de interação dessas
comunidades com a sociedades envolvente.
III.
a participação da comunidade indígena, através de seus
representantes, na formulação da política de saúde, e em todas as fases
das ações de saúde.”
Art. 123: “-É reconhecido e garantido o sistema
tradicional de saúde de cada comunidade indígena, componente de sua
organização social, costumes, crenções e tradiçcões.”
18. Canada
- Royal Commission on Aboriginal Peoples, Vol 3 Recommendations,
3.2.1
“The
government of Canada acknowledge a fiduciary responsibility to support
Aboriginal nations and their communities in restoring Aboriginal families to
a state of health and wholeness.”
3.3.2
“Governments recognize that the
health of a people is a matter of vital concern to its life, welfare,
identity and culture and is therefore a core area for the exercise of
self-government by Aboriginal nations.”
- Nisga’a Agreement
“Nisga'a
Lisims Government may make laws in respect of the authorization or licensing
of individuals who practice as aboriginal healers on Nisga'a Lands, but,
this authority to make laws does not include the authority to regulate
products or substances that are regulated under federal or provincial laws
of general application.”
19. Ecuador
Constitución Política del Estado
Ecuatoriano
Artículo
44: El Estado formulará la política nacional de salud y vigilará su
aplicación; controlará el funcionamiento de las entidades del sector;
reconocerá, respetará y promoverá el desarrollo de las medicinas
tradicional y alternativa, cuyo ejercicio será regulado por la ley, e
impulsará el avance científico-tecnológico en el área de la salud, con
sujeción a principios bioéticos.
Artículo 84: El Estado reconocerá y garantizará a
los pueblos indígenas, de conformidad con esta Constitución y la ley, el
respeto al orden público y a los derechos humanos, los siguientes derechos
colectivos a los pueblos indígenas: (12)
A sus sistemas, conocimientos y prácticas de medicina tradicional, incluido
el derecho a la protección de los lugares rituales y sagrados, plantas,
animales, minerales y ecosistemas de interés vital desde el punto de vista
de aquella.
20. Colombia
Resolución No. 10.013 de 1981
"Considerando
...[q]ue la población indígena amerita un tratamiento preferencial por sus
condiciones socio-culturales especiales”.
Artículo 2: "Los programas de prestación de
servicios de salud de atención primaria que se desarrollan en comunidades
indígenas deberán adaptarse a la estructura organizacional, política,
administrativa y socio-económica, en forma tal que se respeten sus valores,
tradiciones, creencias, actitudes y acervo cultural.
Artículo 3: Antes de iniciar cualquier programa de
atención primaria con participación de comunidades indígenas, deberá
realizarse en cada una de éstas un estudio previo que permita conocer la
cultural, soci-económica y sanitaria y su concepción mítica de la salud y
la enfermedad.
Artículo 4: Con base en el estudio a que se alude en
el artículo segundo, se elaborarán modelos conducentes a prestar servicios
eficaces de atención primaria de salud ya proponer la forma de integrar la
medicina tradicional autóctona con la medicina institucionalizada.
Artículo 12: Para [efectos] de la organización y
participación de la comunidad, se tendrán en cuenta ante todo los
diferentes tipos de organización existentes en las comunidades indígenas.
21. Panama
-Régimen Especial de la Comarca Kuna Yala
Artículo
20: "Son atribuciones del Congreso General Kuna;...18) Velar y tomar
medidas conducentes a la salud de la población, solicitando a las
Autoridades Nacionales competentes para la instalación y equipamento del
Centro de Salud y el Hospital en la Comarca”.
Artículo 62: "El Estado, a través del
Ministerio de Salud garantizará a la Comarca el adecuado y efectivo equipo
y recursos humanos idóneos a los Centros de Salud y Hospitales.
Igualmente el abastecimiento de los medicamentos”.
Artículo 63: "Los médicos, las enfermeras, las
auxiliares y otros funcionarios que laboren en dichos establecimientos de
salud, procuran observar las normas consuetudinarias vigentes, tratando lo
posible la compatibilización con las prácticas de etnomedicina, que sirven
como medio para reabilitar la salud e la población”.
Artículo 64: "En las comunidades de la Comarca
se crearán Comité de Salud, sujeto a las autoridades establecidas en la
presente Ley y el mismo procurará promover, proteger, recuperar, participar
en la planificación y la ejecución de los Programas del Ministerio de
Salud en las Comunidades”.
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