Indigenous Peoples and the Challenges of Greater Interculturality in Health

Different cultures around the world have developed their own understandings of health and illness. In the case of Indigenous peoples, this has involved the development of practices passed down from generation to generation, enabling them to survive and remain as distinct human groups. While today our understanding of health is generally governed by the standards of modern, often Western, medicine, Indigenous peoples have managed to preserve much of their ancestral practices in functional and effective ways.

The existence of Indigenous peoples’ own health systems is recognized in legislation and international agreements. For example, the United Nations Declaration on the Rights of Indigenous Peoples states:

“Indigenous peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals. Indigenous individuals also have the right to access, without any discrimination, to all social and health services.”

Indigenous Worldview: A Foundation for Understanding Their Health Systems

To understand Indigenous notions of health and illness, it is essential to first understand their worldview—or way of interpreting the world. For example, Mesoamerican peoples such as the Aztecs and Mayas developed a complex system of astronomical observation, which allowed them to create a highly precise calendar.

This system (Tz’olkin for the Mayas or Tonalmatl in central Mexico) was used as a basis for naming individuals. It functioned according to the day a person was born, which was a combination of numbers from 1 to 20 and the 13 energies that, according to these cultures, govern human beings.

These energies are also associated with specific parts or organs of the body and, therefore, with a greater predisposition to certain illnesses. For example, Tz’i governs the brain and is linked to neurological diseases; Qej governs the limbs and related conditions. Illness is often understood as a disruption of the person’s internal and external balance. This notion of balance is central to the worldview of many Indigenous peoples.

Relevance of Indigenous Health Practices for Maternal and Child Care

Despite the dominance of Western medicine in public health systems, Indigenous peoples continue to uphold certain health practices that remain effective. One such example is maternal and child health care, which is often provided by traditional midwives (known as comadronas in Guatemala).

This practice has been passed down through generations and is often associated with a calling that is believed to be connected to a person’s cosmic energy. The role of comadronas in Guatemala is highly significant in prenatal, childbirth, and postpartum care. According to the most recent National Maternal and Child Health Survey conducted in 2015, over 40% of births among Indigenous women are attended by comadronas. In some predominantly Indigenous municipalities, this figure can exceed 75%.

How can We Promote Coordination between Health Systems in Guatemala?

In Guatemala, there are important experiences with Indigenous health practices that have proven effective. These practices focus especially—but not exclusively—on maternal and child health. They have been promoted or supported by civil society organizations or by Indigenous communities themselves. However, these initiatives are often small-scale and geographically limited. For these efforts to be scalable and have greater impact, it is important to strengthen their coordination with the official health system.

Some opportunities include:

1. Promoting knowledge about Indigenous health practices. While the work of traditional midwives (comadronas) and certain healers—such as bone specialists—is relatively well known, there is still limited understanding of other specialties. Despite receiving little recognition from the official health system, these practitioners continue to be a resource due to their low cost, immediate access, and cultural affinity. It is therefore essential to implement training processes on this topic for health service providers. Likewise, this knowledge should be included in university education for future health professionals, incorporating Indigenous medical perspectives into the curriculum.
2. Ensuring coordination from the first level of care. The community is the ideal space for health system coordination, as it is where traditional healers, official health personnel, and patients converge. Thus, the first level of health care must be strengthened to create the conditions and capacities needed for system integration.
3. Generating knowledge about the health practices of other Indigenous peoples. While the health systems of the Maya people are the most documented, further studies are needed to understand the health systems of the Xinka and Garífuna peoples.
4. Strengthening the implementation of the existing regulatory framework. The country has made progress in developing a regulatory framework related to intercultural health. This includes the National Policy for Midwives of the Four Peoples (2015–2025), the Culturally Relevant Health Service Standards, and the National Plan for Interculturality in Health. To achieve the expected outcomes and improve the health of Indigenous peoples, it is essential to increase actions that support broader implementation and monitoring of these instruments.

Indigenous peoples possess an invaluable wealth of practical health knowledge. This knowledge has enabled them to adapt to their environment without losing their customs and heritage. To enhance this knowledge, it is important to recognize, promote, and coordinate it with the official health system.