CONTEXTUALIZATION
The 5th phase of PPCDAM (2023–2027) reaffirmed the recognition of the central role of Indigenous peoples in preserving the integrity of territories and the importance of supporting the management of Indigenous Lands, making reference to PNGATI (National Policy for Territorial and Environmental Management of Indigenous Lands). This policy adopts a holistic approach, recognizing that the preservation of natural resources is directly linked to improving quality of life and ensuring conditions for the physical and cultural continuity of current and future generations of Indigenous peoples.
In 2023, the Amazon Fund Steering Committee (COFA) approved new guidelines for the allocation of resources, with an intersectoral vision for supporting PNGATI implementation. For the thematic focus of July 2023–July 2025, under the Land and Territorial Management axis, the priorities include: (i) Support for Indigenous peoples, quilombolas, and traditional communities through intersectoral actions, including food security, health, culture, education, sanitation, energy, among others; (ii) Support for the development and implementation of territorial and environmental management plans for Indigenous Lands, aligned with PNGATI and other traditional populations in socio-biodiversity territories; (iii) Comprehensive support for Indigenous health, including care outside Indigenous Lands, as a way to maintain the traditional ways of life of Indigenous peoples.
The Indigenous Health Care Subsystem (SasiSUS), coordinated by the Special Secretariat for Indigenous Health (Sesai) of the Ministry of Health, operates through 34 Special Indigenous Health Districts (DSEIs) across all regions of Brazil. The National Policy for Indigenous Peoples’ Health Care (PNASPI) aims to ‘ensure Indigenous peoples’ access to comprehensive health care, in accordance with the principles and guidelines of the Unified Health System (SUS), considering social, cultural, geographic, historical, and political diversity, in order to overcome factors that make this population more vulnerable to major health issues, while recognizing the effectiveness of their traditional medicine and their right to cultural identity.’ Providing care within Indigenous territories is a key strategy for achieving these objectives.
The Alto Rio Negro DSEI Indigenous Health Plan for 2024–2027 reiterates this strategy, due to logistical challenges for patient transportation and the impact caused by removing Indigenous patients and their companions from their territories. In the Alto Rio Negro region, health is a critical issue for Indigenous peoples, which is why it was included in the Territorial and Environmental Management Plan (PGTA) of the Alto Rio Negro Indigenous Land, coordinated by the Federation of Indigenous Organizations of Rio Negro (FOIRN).
The Health Expeditions Association (EDS) is a civil society organization of public interest (OSCIP) that works in partnership with the Indigenous public health system, Funai, and Indigenous organizations to promote Indigenous health. Project activities are carried out by EDS based on demands from Indigenous communities and managers of the Indigenous public health system, with whom the organization maintains technical cooperation agreements.
THE PROJECT
The project aims to preserve the integrity of the territories of Alto Rio Negro/AM by improving the physical, social, and economic well-being of communities in Indigenous Lands, strengthening the local health system, and conducting expeditions for surgical care and specialized medical and dental services.
The project is structured into three components.
The first component provides complementary support to the Indigenous Health Care Network, including improvements to three public Indigenous health units within the territory, acquisition of equipment, training of local health teams, diagnostic support, itinerant care, and an orthopedic prosthesis donation service.
The second component consists of nine expeditions to perform surgeries and specialized medical care within communities in remote areas of the Amazon, offering culturally appropriate care and enabling early diagnosis and treatment without transferring Indigenous patients outside their territories. These services are delivered by volunteer doctors mobilized by EDS, with a primary focus on cataract and hernia surgeries. Other clinical services are also offered, such as dentistry, gynecology, and more.
The expeditions are carried out using the Mobile Surgical Center, an innovative technological solution adapted to the extreme conditions of the forest (thermal efficiency and modularity) and a self-sustaining structure developed and improved over time by EDS.
Finally, the third component focuses on interinstitutional coordination and project communication. Actions, technologies, and work methods adapted to the geographic and climatic conditions of the Amazon will be disseminated and shared, while promoting their incorporation into public health policies to maximize the project’s impact.
INTERVENTION LOGIC
The project falls under the ‘Land and Territorial Management’ component (3) of the Amazon Fund Logical Framework, with the expected outcome aligned with the Action Plan for the Prevention and Control of Deforestation in the Legal Amazon (PPCDAM), which advocates for supporting the management of Indigenous Lands and refers to the National Policy for Territorial and Environmental Management of Indigenous Lands (PNGATI). This policy adopts a holistic approach, recognizing that improving quality of life and ensuring conditions for the physical and cultural continuity of current and future generations of Indigenous peoples are directly linked to the preservation of natural resources in the Amazon biome.
