“Sacha implementación”: analysis of the implementation of the intercultural approach in Diresa Loreto through the program to reduce maternal-neonatal deaths in Nauta (2018-2020)

Abstract

The approval of the National Policy for the Mainstreaming of the Intercultural Approach established guidelines to define intercultural services and generate synergies in the public sector around this issue. This article analyzes its implementation through the program to reduce maternal and neonatal deaths in Nauta, led by the Regional Health Directorate (DIRESA) of Loreto. Therefore, this research is developed through a case study that examines the implementation strategies from the discretionality of the actors involved, identifying gaps and challenges from the perspective of the street bureaucrats. The research argues that the existence of a window of opportunity and political will favored interculturality in health through partnerships between public officials, NGO and civil society. However, it is argued that challenges persist arising from unequal rationalities between health officials and budget, along with a disconnect with indigenous specialists. It is concluded that increasing the budget is not enough to improve this experience. On the contrary, it is only part of the solution, since it is necessary to articulate it with the distribution of power, territorial management and indigenous policy to achieve an effective implementation of the intercultural approach in health.