An indigenous-centered methodology for health systems strengthening research and practice: Storytelling, relational accountability, and sovereignty
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Seven Directions, UW United States
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1002
After the 2005 United Nations Millennium Development Goals report revealed limited progress, decision-makers and researchers put their attention to “health systems strengthening” to increase access, use and responsiveness of national health systems for health equity. Inequities persist and were illuminated by disparities in mortality and morbidity due to COVID-19. Indigenous systems of governance and healing represent Indigenous knowledge, strength, resilience, and resistance. These systems continue to serve their communities. Yet, they are omitted from global and national public health initiatives. This is a qualitative study of the health system that serves the Yaqui Tribe in Sonora, Mexico to inform Yaqui-centered public health. It was co-created with elders under Traditional Authority approval of the Yaqui Tribe in Sonora, AZ. Design and Methods: This participatory study using a qualitative design, took place from 2012 – 2014. Eleven community health workers and healers participated in open ended interviews. Findings: Development of a viable and ethical methodology, with emphasis on Indigenous ways of knowing and being (i.e., inherently a “culture of health” and “health in all policies”). The methodology is visualized as a spiral, where connections and relationships build over time. For each point there is 1) a translation and interpretation of the point’s descriptor; 2) a description of the research process; and 3) a story that supports this aspect of the Indigenous-centered methodology. Conclusion: This approach may be used in the future collaborative studies that have meaning and use by tribal health systems within tribal nations and Indigenous communities globally. This study deconstructs existing public health concepts and supports health initiatives and public policy development.This approach is being applied at Seven Directions, we anticipate it will contribute to an increase in access, use, and delivery of culturally relevant and effective services and programs by and for Indigenous communities in México, U.S., and abroad