The Yukpa and Wayuu peoples' warning about the government's new health model: "They can't improvise like they did with the teachers."

Following the issuance of Decree 0858 , with which the Government officially adopted the " Preventive, Predictive, and Resolute Health Model" as public policy and proposed a reorganization of the system based on primary care, territorialization, and integrated service networks, several reactions within the health sector have been expressed regarding the risks this initiative may pose. One of these voices is that of representatives of the Yukpa and Wayuu indigenous peoples, for whom this transformation of the health system will mean jeopardizing care in these communities.

A situation about which the governing councils of the Yukpa indigenous people and the 13 authorities of the Wayúu people of the Upper and Middle Guajira reservation , representing the Association of Indigenous Councils of Cesar and La Guajira , had alerted, after the publication of the draft decree for comments, their concerns about the risks that this measure would represent for health care in their communities.

This is not only before the National Government and the Ministry of Health, but also before bodies such as the Constitutional Court, the Council of State, the Supreme Court of Justice, the Comptroller's Office, and the Attorney General's Office.

“We sent an extensive report of almost 300 pages to the Constitutional Court, the Council of State, the Supreme Court of Justice, the Ministry of Health itself, the Superintendency of Health, the Adres, the Attorney General's Office and the Comptroller's Office, the Inter-American Commission on Human Rights and the Special Rapporteur for Indigenous Peoples of the United Nations where we warned that if this decree was signed there would be a catastrophe for the indigenous peoples of Colombia and especially the Yukpa indigenous peoples and the Wayuu indigenous people ,” explains Edwar Álvarez Vacca, defender of human rights, indigenous peoples, environmental and territorial rights.

Despite these warnings, the Yukpa and Wayuu indigenous peoples are concerned that Decree 0858 was ultimately issued without taking their comments into account. " It is a backdoor health reform, without being processed as a law in the Congress of the Republic and without the due process of Prior Consultation with the Yukpa indigenous people, the Wayuu nation, and the other indigenous peoples of Colombia . By signing the decree, it would violate Sentence T-302 of 2017 in favor of the Wayuu Nation and the prior agreements between the highest authorities of the Yukpa people and the Vice Minister of Public Health, Dr. Jaime Hernán Urrego Rodríguez," the representatives of the indigenous communities stated in a statement.

According to the Yukpa and Wayuu peoples, the new health model ignores the progress that has been made in care for these communities. “Before Law 100, Indigenous peoples were treated at the doors of hospitals. Since that law, there has been progress. Indigenous peoples have their own health institutions that are protected by Articles 24 and 25 of ILO Convention 169 of 1989. These institutions, which are Indigenous EPSs, are protected by an international convention or international treaty on human rights and Indigenous peoples, a convention that the State signed and later ratified through Law 21 of 1991,” says Álvarez Vacca.

The indigenous peoples of the north of the country are concerned about the possibility of the disappearance of the EPS and IPS that currently serve them, as is the case with Dusakawi EPSI . “It is worth recalling the commitments made by the Ministry of Health and Social Protection with the Yukpa Indigenous People: at the Yukpa People's Dialogue and Interlocution Roundtable (Res. 039 of 2021, Mod. 308 of 2024), the senior official pledged that the Health Reform would not be regressive and would be agreed upon with our people through this Roundtable (the highest level of dialogue for the Yukpa people). Furthermore, it was agreed that issues related to the indigenous EPS and IPS to which the Yukpa Indigenous People are a part would be included, a process that would be defined within the framework of prior consultation with our people ,” they note.

For them, what is included in Decree 0858 represents the transfer of responsibilities to the health departments of the municipalities, districts, and departments. This measure, in their opinion, represents "a step back to a past in which access to health services depended on the political will of local governments ."

“This decree of July 30 is regressive for Indigenous peoples in Colombia, not only for the indigenous people, but also for the Wayú communities who have taken a stand, as well as for the Yukpa indigenous people. The decree has not changed compared to the proposed bill, and it incorporates many elements, such as the Primary Health Care Centers (CAPS) and the integrated networks of health territories, which basically leave the responsibility and provision of care in all territories to the territorial entities ,” says Álvaez Vacca.

Furthermore, it points out that the new model ignores realities such as the fact that these indigenous populations are in a situation of vulnerability and extreme poverty. "74.88 percent are at risk of physical and cultural extermination, and 96.88 percent belong to the subsidized regime, located in multi-dispersed rural territories in conditions of difficult access, armed conflict, in three departments, twenty-two (22) municipalities and in four large micro-regions, which in many cases are impenetrable, such as the Sierra Nevada de Santa Marta, the Serranía del Perijá, La Guajira Inmensa and 367.72 kilometers of border with the Bolivarian Republic of Venezuela," they indicate.

According to Álvarez Vacca, Indigenous communities are concerned about a situation similar to the crisis affecting the teachers' healthcare system. " The National Government cannot improvise a healthcare model for Indigenous peoples as it did for teachers , because unlike them, our people lack the resources to survive. This is compounded by the issue of violations and attacks on medical personnel. How does this preventative, predictive, and decisive model address the issue of armed actors in the conflict? What this decree exposes is, basically, a tombstone around the necks of more than 1.5 million Indigenous people in Colombia," concludes Álvarez Vacca.