The same week in which indigenous peoples occupied the headquarters of the National Health Foundation (Funasa) in Manaus, nearly 40 Karajá indigenous leaders also resolved to occupy a district office of Dsei (Distrito Sanitário Especial Indígena). Leaders seek fundamental changes to the failing indigenous health care structure.

 

What is a Dsei?

The Dsei structure was created in 1986 directly under the Ministry of Health. By 2004, as a result of the policy of decentralization and outsourcing of services, contractual criteria, licensing and interrelated administrative procedures were thrown into such a state of disarray that today virtually every indigenous community is impacted. Over the years, with administrative hierarchies expanded to include municipal, and state government representatives, nationwide incidences involving resources and decline in services have reached crisis levels. Salaries are frequently late or not paid and suspended sanitation projects are just some examples of systemic chaos.

 

Records show that in many areas there is political opposition to the Constitutional right to Indigenous Lands and that often times administrative patterns reflect anti-indigenous perspectives arising from failure to respect principles of prior and informed consultation and participation of indigenous peoples.

Among critiques is the failure to recognize, utilize and support the longstanding call for inclusion of traditional indigenous health practices in official policy.

 

In 2004, Yanomami and Yekuana leaderships of Roraima uncovered a deeply embedded scheme of diversion of FUNASA funds. The Federal Police verified this in 2007 to be in the range of R$ 34 Million and 35 persons were arrested. There are numerous cases where budgets for health services that appear on paper do not reach the communities for which they are designated, amid a serious lack of transparency.

 

In 2008 CIMI received reports of at least case where an unresolved land question was used as rationale not to provide care to a child who subsequently died (of the Guarani people). Other examples: untreated or inadequately treated epidemics of malaria and other illnesses; infant mortality; political/administrative interference including arbitrary use of power – and in one case an attempt to impose a dress code (Tikuna, 2005); suspension of contracted services with no alternate provision for care (Yanomami, 2008); misrepresentation of available hospital services (Oro Wari, 2008); court ordered installation of water treatment ignored; inaction in cases of fiscal malfeasance by non-indigenous functionaries; diagnostic failures that both  compound health problems and even result in death.

 

A portion representative of the spectrum of failings that do reach the stage of reporting is presented annually in the CIMI Report on Violence Against Indigenous Peoples.

 

According to published reports, outsourcing (third party contracting) of indigenous health care services initiated by the National Health Foundation (Funasa) has resulted in disastrous conditions in indigenous communities throughout Brazil. In response, indigenous leaders continue to press for fundamental changes and a Special Secretary of Indigenous Health directly under the Ministry of Health. This determination by Indigenous leaders was announced at the VI Acampamento Terra Livre in Brasilia, in April of this year.

 

In São Félix de Araguaia

Nearly 40 indigenous leaders decided to occupy the offices of the Distrito Sanitário Especial Indígena (Dsei), in São Félix of Araguaia, MT. They are protesting so that Funasa maintains the indigenous associations providing health services in the area. According to the leaders, Funasa is calling for nationwide bidding on contracts in order to choose another institution that would undertake this work.

 

One Karajá leader, João Werreria Karajá, who has been wrestling with the situation since 2003, noted that as Indigenous services attempted to interface, the situation worsened. “We are afraid that as occurred as in another case, another organization will be contracted by Funasa for health services, but not provide care, keeping the money that was disbursed”.

 

Amid rumors of an order to vacate, Karajá said,  “We are here peacefully, but if we have to leave here without their at least hearing our claims and not reaching an agreement, we will return, but in a different form, with more indians and with another spirit.” At present the Association of the Indigenous Peoples Tapirapé (APOITE) provides services with the contract ending in July. The Karajá Associação Inymahandu previously provided services.

 

 

In Manaus

In Manaus, indigenous representatives had been camped since June 6 at Funasa offices. More than 500 persons from 13 different peoples arrived from various regions of Amazonas, protesting neglect by the indigenous health service.

 

In a meeting in Brasília, on Tuesday, 23 June, representatives of the indigenous peoples, Funasa, Funai and of Secretary of the Environment and Sustainable Development of the State of Amazonas, reached an agreement for the disoccupation of the agency headquarters.

 

Some of the demands were met. Leadership had called for the replacement of the regional coordinator, substitute coordinator and administrative chief of the Manaus District office of the DESAI. According to a memo released by Funasa, all were dismissed.

 

Decree

On Thursday, June 6, Funasa issued Decree 6.878, which closes with the stipulation that prior to initiation of any changes to attend to indigenous demands and subsequent legislation, FUNASA governance is to be concerned with administrative appeasement. The new decree addresses the June 9, 2003, Annex I of Decree 4.727, which approves the existing Statute and both changes and expands on administrative tables for charges and commission, remuneration functions by the Funasa, as well as related provisions. (Quadro Demonstrativo dos Cargos em Comissão e das Funções Gratificadas da Fundação Nacional de Saúde – FUNASA.)

 

Cimi Vice President, Roberto Liebgott, addressed the situation noting, “it is fundamental that there be denunciations made to supervisory agencies, especially the Ministério Público Federal and the Ministerio Público do Trabalho regarding the inoperability and negligence of the agents who have the responsibility to assist and to provide services in indigenous health care”.

 

                                                                        ***