COPASAH Thematic Hub
Indigenous People’s Rights and Accountability:  a COPASAH thematic hub

Background:
The 400 million indigenous people worldwide represent a wealth of linguistic and cultural diversity, as well as traditional knowledge and sustainable practices that are invaluable resources for human development [1]. However, indigenous people remain on the margins of society in high, middle and low-income countries, and they bear a disproportionate burden of poverty, disease, and mortality compared to the general population [2,3]. These inequalities have persisted, and in some countrieshave even worsened,despite the overall improvements in health indicators in relation to the 15-year push to meet the Millennium Development Goals [4,5]. Attention garnered by the social determinants of health framework has enriched the understanding we have of the complex conditions that give rise to inequalities in indigenous health. This lens has brought into focus the structural and socio-political factors that contribute to health inequalities, illuminating the intersecting conditions of poverty, social and political exclusion, discrimination and land loss that shape indigenous people’s health [6,7,8]. Historically, indigenous health has been framed as a problem of poor health indicators to be solved through targeted service delivery.  This approach is simplistic and ignores the political and legal barriers described above. Our argument is that an accountability framework offers a better approach and strategies to tackle the political, social, economic and legal causes of inequitable indigenous health.
Objectives:
1. Establishing the thematic hub with an initial concept, objectives and action plan.
2. To build alliance and networking of the thematic hub with global and regional networks, academia and with policy makers and policy space.
3. Strengthening the practice around indigenous health and accountability through production of knowledge and enhancing the analytical skills of practitioners.
4. To generate knowledge of academic standard and dissemination to global audience
5.  To develop a thematic component for the  Global Symposium (GS)on Social Accountability in Health to be held in early 2019
 
Knowledge hub anchor:
The anchor  will be the  Center for the Study of Equity and Governance in Health Systems (CEGSS by its initials in Spanish), based in Guatemala. CEGSS has over a decade experience  engaging with the governance structures and conditions of marginalization that impact indigenous health. Indigenous people of 23 ethnicities make up 45% of Guatemala’s 14 million inhabitants. They experience stark inequalities in income, health and education resulting from decades ofsocial and economic exploitation, and were particularly targeted by the country’s military dictatorships during the 36 year-long internal war. This conflict left 200,000 victims, who were predominantly indigenous, and contributed to the worsening of already weak public services in rural and impoverished areas [9]. In our primary line of work, CEGSS supports the development of a citizen-led initiative for state accountability for the right to health in rural indigenous municipalities. Through our experiences, we have gained critical insights into the complex nature of pathways to redressing inequity and the potential of systems thinking approaches to enhance efforts to promote indigenous health. To meet the challenge of engaging with the conditions underlying inequalities and promoting transformational change, equity-oriented research and practice in the field of indigenous health requires: engaging power, context-adapted strategies to improve service delivery, and mobilizing networks of collective action.  The experience gained by CEGSS will be shared through this knowledge hub. Also other organization and individuals members of the hub will share their own learning and experiences. Within CEGSS, the specific persons responsible to coordinate the hub will be Dr. Walter Flores
Knowledge hub core members:
At the moment, the following individuals have communicated their interest to become part of the core group that will lead the knowledge hub together with CEGSS:

NAME	ORGANIZATION and COUNTRY ​	EMAIL
Claudia Lema	Salud sin limites, Perú	​claudialema@gmail.com
Ariel Frisancho	​MMNB, Perú	​AFrisancho@cmmb.org
​Mauricio Torres	​Universidad Nacional, Colombia	maot99@yahoo.es
​Alison  Hernández	​CEGSS, Guatemala	alray00@yahoo.com
​Lorena Ruano	​CEGSS, Guatemala	​alruano@gmail.com
​Walter Flores	​CEGSS, Guatemala	wflores@cegss.org.gt
Alex Shankland	​IDS, UK	a.shankland@ids.ac.uk
Regina Tames	GIRE, Mexico	regina@giremx.org.mx
Brando Flores	​ ILSB, Mexico	investigacion@ilsb.org.mx

​References
1. United Nations. State of the World’s Indigenous People.United Nations.2009. http://www.un.org/esa/socdev/unpfii/documents/SOWIP/en/SOWIP_web.pdf.Accessed 31 Dec 2016.
2. Anderson I, Robson B, Connolly M, Al-Yaman F, Bjertness E, King A, Tynan M, Madden R, Bang A, Coimbra CE, Pesantes MA. Indigenous and tribal people' health (The Lancet–Lowitja Institute Global Collaboration): a population study. Lancet. 2016;388(10040):131–157.
3. Mitrou F, Cooke M, Lawrence D, Povah D, Mobilia E, Guimond E, Zubrick SR. Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health. 2014;14(1):1.
4. Kabeer N. Can the MDGs provide a pathway to social justice? The challenges of intersecting inequalities.Institute of Development Studies.2010. https://www.ids.ac.uk/files/dmfile/MDGreportwebsiteu2WC.pdf.Accessed 31 Dec 2016.  
5. Heineke C, Edwards S. Health inequities of indigenous people and ethnic and cultural minorities – Turning the tide through the post-2015 development framework. Health Poverty Action. 2012. http://www.medicusmundi.org/topics/pnfp-sector-and-global-health-initiatives/thematic-guide-health-in-the-post-2015-un-development-agenda/inbox-health-beyond-2015/health-poverty-action-inequalities.pdf. Accessed 31 Dec 2016.
6. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374(9683):65-75.
7. Crivelli V, Hautecouer J, Hutchison C, Llamas A, Stephens C. Improving indigenous maternal and child health. In: Walker, B, (ed.) State of the World's Minorities and Indigenous People Minority Rights Group International. 2013. http://minorityrights.org/wp-content/uploads/old-site-downloads/download-1274-Improving-indigenous-maternal-and-child-health.pdf.Accessed 31 Dec 2016.
8. Kirmayer LJ, Brass G. Addressing global health disparities among Indigenous people. Lancet. 2016;388:105–106
9. Flores W, Ruano AL, Funchal DP. Social participation within a context of political violence: implications for the promotion and exercise of the right to health in Guatemala. Health Hum Rights. 2009;11(1):37-48.