Advancing Healthcare Equity for Indigenous Peoples through Community Dialogue - Incite at Columbia University

This year, through its Global Change Program (GCP), Incite supported a team at the University of San Agustin dedicated to enhancing healthcare access for Indigenous Peoples (IPs) in the Philippines.

In July, the team hosted a three-day event, the first of two planned Indigenous Health Equity Conversations, connecting representatives from over 20 distinct Indigenous groups to lead discussions about healthcare needs and inequities faced amid the rollout of universal healthcare. 

In 2019, the Philippines enacted the Universal Health Care Act, providing all Filipinos with national health insurance. However, even after the Act’s implementation, marginalized communities still experience significant health and social inequities. Indigenous people from remote neighborhoods must commute long distances to healthcare facilities, difficult terrain prevents travel for patients and healthcare workers, cultural and language barriers persist, and understaffed healthcare facilities continue to challenge universal access.

In response to these challenges, Professors Romulo (Jong) de Castro, John Paul Petrola, and Roselle Rivera of the University of San Agustin's Center for Informatics (CFI) developed solutions to address healthcare gaps in 12 underserved Indigenous communities. The CFI team designed and executed the ATIPAN Project, a digital healthcare service initiative for marginalized communities and Ati Indigenous Peoples in Western Visayas, Philippines. Since 2021, the ATIPAN Project has enabled over 7,000 telehealth consultations and trained 23 community health workers to strengthen local healthcare capacity.

This year, Incite awarded the team, directed by de Castro, a GCP grant supporting their efforts to expand on this local work by hosting a series of IP-led dialogues to identify specific healthcare barriers encountered by Indigenous communities. Begun in 2023, the GCP program gives grants to leaders tackling global challenges from within communities facing those challenges, and provides intellectual support from Columbia to both aid the execution of the project and to advance scholarly understanding of the issues at play. With the GCP grant, the CFI team planned two Indigenous Health Equity Conversations (IHEC) events designed to unite IP representatives from across the Philippines in community conversations capable of informing advocacy for healthcare equity and policy reform. 

The first IHEC, held on July 23-25, with IPs from the Northern Philippines, delivered on the project’s promise, placing IP voices at the center of conversations about health equity.  The IP discussants connected through shared experiences and concerns, united in solidarity and focused on their collective future. These conversations, along with the CFI’s observations on the community conversation format, will inform the second IHEC planned for 2026.

Despite heavy monsoon rains, representatives from over 20 distant IP groups arrived in San Agustin on July 23rd, eager to connect with other IP members. For many representatives, this type of gathering is rare, making this event an important opportunity for collective dialogue. The attendance of several IP groups at one forum came after months of work by Petrola, the team member responsible for IP relations, who extended invitations and built trust through a series of personal visits to IP groups across the region. At the outset, the participants discussed and agreed to give consent for the IHEC dialogue.

The first and second days of the event focused on building connections among participants through collaborative, artistic activities to ensure comfort and ease between discussants. The first day included initial meetings, a portrait exercise, and a screening of the Cannes-selected indigenous film BUSONG. The second day included a community visit to Guimaras, conversations with Ati community elders, cultural dances, storytelling exercises led by Dr. Roselle Rivera, and bonding activities at Alubihod Cove. The team’s approach proved effective: participants and organizers emphasized a comfortable balance between informal relationship-building and guided conversations. Participants praised the atmosphere as "honest, open, and respectful," laying the foundation for trust that would support the dialogue to follow.

The third day concluded with a guided discussion on healthcare inequities and actionable items to inform policy changes. Ati facilitators led this discussion, ensuring that Indigenous youth and elders felt comfortable voicing the difficulties they have faced. The discussants shared their struggles and perspectives on the current state of healthcare in their respective communities. Although the group members were culturally distinct and came from vastly different locations, they were able to pinpoint universal experiences and shared frustrations of healthcare inequity. 

Although the discussion centered on experiences of inequity, the participants transformed their frustrations into hope and action. IP members collectively mapped out collective needs and possible solutions they wish to see in future healthcare policies. Although the conversation itself was entirely among IPs, de Castro and his team invited a few non-Indigenous people to observe, in hopes of informing discussions about health care access at the policymaking level. Specifically, attendees included workers from NCIP (National Commission for Indigenous Peoples), DOH (Department of Health), and PhilHealth (Philippine Health Insurance Corporation, a government corporation under the DOH). 

Among the outcomes of the discussion, the IP representatives  unanimously expressed the  need for Indigenous representation among healthcare workers. Within this demand, participants identified three critical policy recommendations: first, linguistic facilitators fluent in community languages to eliminate communication barriers between patients and healthcare providers; second, healthcare approaches that integrate modern medical practices with traditional Indigenous healing methods; and third, training local Indigenous community members as healthcare workers to improve accessibility, as they would be embedded within the communities they serve.

Reflecting on the conversation, de Castro and his team noted that as the discussion turned to the topic of mental health, generational differences emerged among representatives. Alanna Panes, a researcher on the CFI team, detailed how younger Indigenous members in their 20s had greater exposure to Western mental health concepts and diagnostic frameworks and approached the topic differently than Indigenous elders. Indigenous elders primarily drew from traditional cultural understandings of mental wellness and healing practices. The team identified the need for nuanced definitions and measurements of mental health in various Indigenous communities. 

Out of this event, de Castro and his team anticipate that the government officials will carry forward the IPs' needs as policy priorities, and include these communities within the universal healthcare rollout. Moving forward, the team plans to convene these government officials to ensure that the insights gathered translate into concrete policy actions and systemic change.

Despite funding challenges, the team recognizes the need for more strategic and creative solutions to healthcare issues while maintaining the voice of IP communities. De Castro emphasized, “The goal is not just to listen, but to act.” The next step for the team is to transform the valuable insights from the dialogues into meaningful action, while recognizing the significant work that remains ahead. The team's next IHEC plans to reach more IP members and will expand on the discussion's impact by gathering additional experiences and solutions to ensure comprehensive healthcare for indigenous communities.