The The interfederative relations and integrality in the indigenous health care system: a fragmented history

Abstract

The Federal Constitution establishes health as social citizenship right under the responsibility of the State. The indigenous peoples had an important achievement to assure their right to health with Indigenous Health Care System. Twenty years after this legal framework, this article aims to identify how the Brazilian State organizes the Indigenous Health Care System and the reference and counter-referral agreements in order to analyze the existing gaps and the main challenges for the protection of the right to indigenous health in Brazil. The qualitative methodology used with several sources and materials: documenta analysis of legislations and 24 in-depth interviews with Indigenous Peoples, managers, indigenists and Federal Prosecution Service.  The results demonstrate that a normative fragmentation and the complexity hinder the implementation of the policies that should assure the integrality of the indigenous health assistance. The federal management and territorialization of the Special Indigenous Health Districts are specificities that also impact in the federative articulation. Therefore, even though progress has taken place legally recognizing health as indigenous right, it is still fundamental to progress the legislation to advance in compromises that assure health as a right with equity to indigenous populations.