Comprehensive Health Care Model (MIAS) Guainía pilot: intercultural health for dispersed territories
Description
First national pilot of the MIAS (2016-2023), designed by the Ministry of Health with support from the IDB for the department of Guainía (Amazon region, ~41,000-50,000 inhabitants, 85% indigenous, 0.54 inhabitants/km2). A single insurer (Coosalud EPS, Decree 2561 of 2014) and the Manuel Elkin Patarroyo Hospital in Inírida operated an intercultural primary care model: health posts staffed with indigenous personnel, integration of traditional healers and midwives, river-based outreach teams and expanded insurance coverage. Evaluations record improvements in morbidity and mortality, coverage and access to specialists, along with persistent gaps (payment to traditional knowledge holders never resolved, river logistics for medicines, telemedicine limited by connectivity). Coosalud withdrew on October 31, 2023 and Nueva EPS took over the population on November 1, 2023, closing the pilot cycle as designed.