Implementation of the National Health Policy for Indigenous Peoples: Challenges and Prospects in Brazil

Abstract

This study analyzed the main challenges and perspectives for the implementation of Brazil’s National Policy for the Health Care of Indigenous Peoples (PNASPI) through an integrative literature review. The SciELO and BVS databases were searched, resulting in 13 studies published between 2014 and 2025. The synthesis identified four central axes that hinder policy implementation: structural and organizational weaknesses of the Indigenous Health Care Subsystem; insufficient intercultural training and difficulties in retaining health professionals; political-institutional disarticulation and setbacks in governance; and tensions between the hegemonic biomedical model and traditional Indigenous health practices. The studies highlight persistent inequalities, inadequate infrastructure, high staff turnover, logistical fragilities, and limited intersectoral coordination. They also show that biomedical practices often disregard Indigenous cosmologies, affecting bonding and the effectiveness of care. The findings suggest that strengthening PNASPI requires structural improvements, stable governance, continuous intercultural training, Indigenous participation, and the integration of traditional knowledge as essential elements of differentiated care.