Review of the National Policy on Health Care for Indigenous Peoples in Brazil: Indigenous leadership, institutional constraints, and challenges to policy effectiveness
1
National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1525
ABSTRACT
INTRODUCTION:
The National Policy on Health Care for Indigenous Peoples (Política Nacional de Atenção à Saúde dos Povos Indígenas – PNASPI) is the main regulatory framework of the Indigenous Health Care Subsystem within Brazil’s Unified Health System (SasiSUS). After more than two decades of implementation, significant epidemiological, territorial, and institutional transformations have reinforced the urgency of revising the policy. This study analyzes the stages and dynamics of the PNASPI revision process, emphasizing the leadership of an Indigenous woman and examining structural and institutional constraints encountered in building a more comprehensive, integrated, and effective policy.
METHODS:
This qualitative, analytical, and reflective study is based on an experience report by the Indigenous coordinator of the PNASPI revision process. The coordinator organized five regional Indigenous health seminars and led the Working Group established within the Secretariat of Indigenous Health of the Brazilian Ministry of Health between June 2024 and July 2025. The methodological approach combined thematic analysis with a critical examination of institutional arrangements, decision-making processes, and power relations informing the policy revision.
RESULTS:
The revision process was characterized by strong Indigenous leadership and broad social participation, including territorial hearings conducted through regional seminars, public consultations, systematization of contributions submitted by Indigenous organizations and the general public, and use of documentary evidence. The process also revealed longstanding technical and conceptual gaps within the policy, persistent challenges in interinstitutional coordination, regulatory constraints, and limited shared responsibility among state agencies. Insufficient governmental engagement undermined agreements required for effective implementation, reflecting enduring forms of structural and institutional racism that delegitimize Indigenous knowledge and constrain public policy effectiveness.
CONCLUSIONS:
The revision of the PNASPI represents a significant political and conceptual advancement due to Indigenous leadership. Its effectiveness depends on confronting structural inequalities, strengthening institutional capacity, and sustaining long-term intersectoral commitment to ensure Indigenous peoples’ right to health.
The National Policy on Health Care for Indigenous Peoples (Política Nacional de Atenção à Saúde dos Povos Indígenas – PNASPI) is the main regulatory framework of the Indigenous Health Care Subsystem within Brazil’s Unified Health System (SasiSUS). After more than two decades of implementation, significant epidemiological, territorial, and institutional transformations have reinforced the urgency of revising the policy. This study analyzes the stages and dynamics of the PNASPI revision process, emphasizing the leadership of an Indigenous woman and examining structural and institutional constraints encountered in building a more comprehensive, integrated, and effective policy.
METHODS:
This qualitative, analytical, and reflective study is based on an experience report by the Indigenous coordinator of the PNASPI revision process. The coordinator organized five regional Indigenous health seminars and led the Working Group established within the Secretariat of Indigenous Health of the Brazilian Ministry of Health between June 2024 and July 2025. The methodological approach combined thematic analysis with a critical examination of institutional arrangements, decision-making processes, and power relations informing the policy revision.
RESULTS:
The revision process was characterized by strong Indigenous leadership and broad social participation, including territorial hearings conducted through regional seminars, public consultations, systematization of contributions submitted by Indigenous organizations and the general public, and use of documentary evidence. The process also revealed longstanding technical and conceptual gaps within the policy, persistent challenges in interinstitutional coordination, regulatory constraints, and limited shared responsibility among state agencies. Insufficient governmental engagement undermined agreements required for effective implementation, reflecting enduring forms of structural and institutional racism that delegitimize Indigenous knowledge and constrain public policy effectiveness.
CONCLUSIONS:
The revision of the PNASPI represents a significant political and conceptual advancement due to Indigenous leadership. Its effectiveness depends on confronting structural inequalities, strengthening institutional capacity, and sustaining long-term intersectoral commitment to ensure Indigenous peoples’ right to health.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
