Coproduction of Indigenous Women’s Health Care in the Great Chaco

• In Event: Indigenous Studies & Political Science Mini-Conference: The Institutional Determinants of Indigenous Political Representation in the Americas

Abstract

Coproduction between state and civil society in the delivery of public services raises a host of questions that go from capture of the state, to cooptation of civil society, and efficiencies or accountability in the delivery of public services. Moreover, when this cooperation focuses on vulnerable and historically marginalized indigenous populations, ethical concerns arise about intercultural sensitive care. We tackle these thorny issues by analyzing a recent collaboration among the states of Argentina, Bolivia, and Paraguay and two health care non-governmental organizations (NGOs) that provide prenatal care to women in the Great Chaco region, where a majority of the population is indigenous and maternal and infant mortality have been historically high. Based on participant observation and in-depth interviews, we analyze the opinions of public health care providers regarding the NGOs’ intervention. In particular, we focus on their opinions and evidence regarding the extent to which there is complementarity and/or embeddedness between the state and the NGOs, which we evaluate along four dimensions: 1) patients’ access to health care, 2) diagnostic and treatment of patients, 3) human resources in the health care sector, and 4) financial resources in the health care sector. We argue this intervention is a valuable strategy to significantly improve access and delivery of health care to pregnant women and to attend neglected diseases. We also raise concerns about institutional racism and the absence of an intercultural approach to health care. The paper will contribute to the literatures on coproduction and on the provision of public services, health care in particular, to indigenous populations.

Authors

• Tulia G. Falleti, University of Pennsylvania

• Santiago Lujan Cunial, University of Pennsylvania

• Selene Ileana Bonczok Sotelo, University of Pennsylvania