Local action plan to promote access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus, Brazil: Analysis of the plan´s development, experiences, and impact through a mixed-methods study (2020).

Sonia Vivian De Jezus,Nahari De Faria Marcos Terena,Thiago Nascimento Do Prado,Priscila Carminati Siqueira,Daniel Souza Sacramento,Vania Maria Silva Araújo,Rogério Da Silva Lima,Ethel Leonor Noia Maciel,Ricardo Alexandre Arcêncio,Adriana Ilha Da Silva,Paula De Souza Silva Freitas,Jair Dos Santos Pinheiro,Helaine Jacinta Salvador Mocelin,Carolina Maia Martins Sales,Frederick Quinn

doi:10.1371/journal.pone.0259189

Abstract

BackgroundThe provision of care and monitoring of health are essential for indigenous Venezuelans from the Warao ethnic group, who are at risk of decimation.ObjectiveAnalyze a Local Action Plan (LAP) to promote access to the health system of indigenous Venezuelans from the Warao ethnic group (IVWEG) in Manaus, Brazil.MethodA mixed-methods study was performed. Quantitative data were collected to assess the provision of care and monitoring of health conditions in IVWEG through a survey that was self-completed by healthcare providers. Qualitative narrative data were collected to gain insight into IVWEG that seek care. We applied descriptive statistics, grouping analysis (GA) by hierarchical levels, and multiple correspondence analysis (MCA). Content analysis was applied to qualitative data.Results106 healthcare providers participated in the study, with the following characteristics: 94 (88.7%) females, 67 (63.2%) pardo race/color, 40 (37.7%) working in primary healthcare, and 49 (46.2%) nurses. In addition, 43 (40.6%) of the healthcare providers reported providing care to IVWEG. Among the providers, 89 (84%) had received training for assisting IVWEG. Additionally, 30 IVWEG were enrolled for interviews in the qualitative phase. The barriers to seeking care were language, distance to health units, and lack of money for transportation. The LAP proved to facilitate access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus. The study contributed to knowledge on a LAP addressed to IVWEG and helped improved their access to the health system, providing appropriate training for healthcare providers and other relevant actors by implementing a coherent and consistent public health policy at the local level.

Highlights

106 healthcare providers participated in the study, with the following characteristics: 94 (88.7%) females, 67 (63.2%) pardo race/color, 40 (37.7%) working in primary healthcare, and 49 (46.2%) nurses
The study contributed to knowledge on a Local Action Plan (LAP) addressed to IVWEG and helped improved their access to the health system, providing appropriate training for healthcare providers and other relevant actors by implementing a coherent and consistent public health policy at the local level
To achieve the objectives of the 2030 Agenda for Sustainable Development and to leave no one behind, as well as the health-related commitments outlined in the New York Declaration for Refugees and Migrants (NYDRM), it is mandatory for all countries across the world that the health needs of refugees and migrants are properly addressed for achieving their safety, welfare, human dignity, and regular migration according to the countriesethical responsibility [1]

Summary

Introduction

To achieve the objectives of the 2030 Agenda for Sustainable Development and to leave no one behind, as well as the health-related commitments outlined in the New York Declaration for Refugees and Migrants (NYDRM), it is mandatory for all countries across the world that the health needs of refugees and migrants are properly addressed for achieving their safety, welfare, human dignity, and regular migration according to the countriesethical responsibility [1]. It is truly important to countries to ensure the implementation and monitoring of the NYDRM, as part of a humanitarian global project mainly through the strategy of universal health coverage (UHC) and solidarity and humanitarian assistance [1]. The percentage of the total world population who are international migrants has remained stable at about 3% for the past 60 years, global migration has shown an increasing trend in absolute numbers, mainly due to conflicts, persecution, environmental degradation and change, and lack of human security and opportunity [1]. About five thousand are indigenous Venezuelans people belonging to the Warao ethnic group (IVWEG), besides the Pemon, Eñepa, Kariña, and Wayuu ethnic groups, living in Brazil as legal refugees or applicants for refugee status [4]. The provision of care and monitoring of health are essential for indigenous Venezuelans from the Warao ethnic group, who are at risk of decimation

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