Examining health system performance for indigenous people in the Peruvian Amazon through the lens of tuberculosis control.

该项目将调查和确定秘鲁卫生系统为弱势群体提供高质量卫生服务所需的主要特点。为了做到这一点，我们将重点关注一个特别脆弱的群体：亚马逊土著人民，他们不成比例地遭受包括结核病在内的几种健康问题的困扰。该项目将侧重于在一个特定的土著群体中提供适当、可行和尊重文化的服务以检测、诊断和治疗结核病的障碍、促进因素和促进因素：位于朱宁地区的秘鲁亚马逊河中部的Ashaninkas人，Ashaninkas人是秘鲁亚马逊河流域最大的土著群体，与秘鲁其他城市地区相比，他们的结核病发病率更高。秘鲁的大多数卫生保健政策，包括结核病政策，都是从城市的角度制定的，这使得这些政策在亚马逊等农村地区不适当和无效。本项目旨在通过研究秘鲁亚马逊地区的结核病卫生政策和实施做法，解决农村地区目前卫生系统提供战略的局限性。通过与土著结核病患者、社区领导人、土著组织代表、区域和国家卫生保健官员等不同利益攸关方的访谈，我们旨在确定为弱势群体提供服务的限制因素以及进行可行改变的机会。我们将重点关注贯穿各领域的系统性问题，以提供高质量的医疗保健。通过对收集到的数据进行系统分析，并与每种类型的残疾人举办一次研讨会，我们的目标是采用参与式方法，制定一套全面的可扩展干预措施，以提高NTP向秘鲁亚马逊社区和其他弱势群体提供的护理质量。

This project will investigate and identify the key features required by the Peruvian health system to provide high-quality health services to vulnerable populations. In order to do this, we will focus on one particularly vulnerable group: Indigenous People from the Amazon who suffer disproportionately from several health problems including tuberculosis (TB). The Project will focus on the barriers, enablers and facilitators of deliverying context appropriate, feasible and culturally respectful services to detect, diagnose and treat TB among one particular indigenous group: the Ashaninkas from the Central Amazon of Peru, located in the región of Junin.Ashaninkas are the largest Peruvian Amazonian IP group, and have a higher prevalence of TB compared with other urban areas in Peru. Most health care policies in Peru, including TB policies have been designed with an urban approach making such policies inappropriate and ineffective in rural areas such as the Amazon.This Project aims to address the limitations of current health system delivery strategies in rural areas through the study of TB health policies and implementation practices in the Peruvian Amazon. Through interviews with different stakeholders such as indigenous TB patients, community leaders, representatives of indigenous organizations, regional and national health care officials we aim to identify the constraints in service delivery for vulnerable groups and the opportunity to make feasible changes. We will focus on cross-cutting systemic issues to provide high quality health care. Through a systematic analysis of the data collected and one workshop with each type of stakehodler we aim to develop using a participatory approach, a comprehensive package of scalable interventions in order to improve the quality of care delivered by the NTP to Peruvian Amazonian communities and other vulnerable groups.