Integrating Traditional Indigenous Medicine and Western Biomedicine: A Case Study of Health Policy Implementation Impact on Miskitu Health Services in Nicaragua

In 2007, the more than 370 million people representing 5,000 distinct Indigenous Peoples throughout the world had their fundamental human right to health affirmed with the adoption of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). UNDRIP Article 24 affirms the rights of Indigenous Peoples to access traditional medicines and health practices as well as to all social and health services. Although not a legally binding instrument, UNDRIP encourages nation states to comply and implement measures to support and uphold its provisions and internationally accepted norms and principles. Within this context, Nicaragua serves as an important case study to measure UNDRIP Article 24 compatibility and implementation within national and regional health policies with the goal of achieving equal rights to health for all Nicaraguans, including specific policies supporting the integration of traditional medicine and biomedicine. To explore this case study, we conducted a policy review of health policies, law, and service delivery for the Miskitu Indigenous Peoples of the North Atlantic Autonomous Region (RAAN). Our review found that although measures to create therapeutic cooperation are woven into Nicaraguan health plans at the national and regional level, in practice integrated health services delivery has been implemented with uneven efforts and results among the RAAN. The most successful integration efforts have fostered an intercultural collaborative approach with Miskitu community members to integrate both traditional and biomedicine into accessible health services, in contrast to the less successful efforts that have relegated traditional medicine as mostly a supplementary or inferior resource to biomedicine. These results suggest that the method of policy implementation and level of respectful community engagement are key elements for successful traditional medicine and biomedicine integration that also require sufficient resources and funding in order to ensure that indigenous health rights and access are properly carried out in national health planning. In further support of indigenous health rights and access we also propose that other nation states 1) adopt national and local policies that directly support and seek to implement UNDRIP Article 24 and periodically review progress towards implementation; 2) provide sufficient resources and training for intercultural health care provisioning; and 3) engage indigenous community members in the health policy development and services delivery process.