title: Community-based health care for indigenous women in Mexico: a qualitative evaluation.
abstract: BACKGROUND
  Indigenous women in Mexico represent a vulnerable population in which three kinds of discrimination converge (ethnicity, gender and class), having direct repercussions on health status. The discrimination and inequity in health care settings brought this population to the fore as a priority group for institutional action. The objective of this study was to evaluate the processes and performance of the "Casa de la Mujer Indígena", a community based project for culturally and linguistically appropriate service delivery for indigenous women. The evaluation summarizes perspectives from diverse stakeholders involved in the implementation of the model, including users, local authorities, and institutional representatives.
  
  
  METHODS
  The study covered five Casas implementation sites located in four Mexican states. A qualitative process evaluation focused on systematically analyzing the Casas project processes and performance was conducted using archival information and semi-structured interviews. Sixty-two interviews were conducted, and grounded theory approach was applied for data analysis.
  
  
  RESULTS
  Few similarities were observed between the proposed model of service delivery and its implementation in diverse locations, signaling discordant operating processes. Evidence gathered from Casas personnel highlighted their ability to detect obstetric emergencies and domestic violence cases, as well as contribute to the empowerment of women in the indigenous communities served by the project. These themes directly translated to increases in the reporting of abuse and referrals for obstetric emergencies.
  
  
  CONCLUSIONS
  The model's cultural and linguistic competency, and contributions to increased referrals for obstetric emergencies and abuse are notable successes. The flexibility and community-based nature of the model has allowed it to be adapted to the particularities of diverse indigenous contexts. Local, culturally appropriate implementation has been facilitated by the fact that the Casas have been implemented with local leadership and local women have taken ownership. Users express overall satisfaction with service delivery, while providing constructive feedback for the improvement of existing Casas, as well as more cost-effective implementation of the model in new sites. Integration of user's input obtained from this process evaluation into future planning will undoubtedly increase buy-in. The Casas model is pertinent and viable to other contexts where indigenous women experience disparities in care.
authors.forename: Blanca
authors.initials: B
authors.lastname: Pelcastre-Villafuerte
authors.forename: Myriam
authors.initials: M
authors.lastname: Ruiz
authors.affiliation: Regional Center for Public Health Research, National Institute of Public Health, 19 Poniente Esquina 4ª Norte s/n, Colonia Centro, Tapachula, Chiapas C,P, 30700, Mexico. sergio.meneses@insp.mx.
authors.forename: Sergio
authors.initials: S
authors.lastname: Meneses
authors.forename: Claudia
authors.initials: C
authors.lastname: Amaya
authors.forename: Margarita
authors.initials: M
authors.lastname: Márquez
authors.forename: Arianna
authors.initials: A
authors.lastname: Taboada
authors.forename: Katherine
authors.initials: K
authors.lastname: Careaga
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000458:organization & administration / Q000592:standards*; D017579:Domestic Violence / Q000517:prevention & control; D005260:Female; D006303:Health Services, Indigenous / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007198:Indians, North American; D008800:Mexico / Q000208:ethnology; D010043:Outcome and Process Assessment, Health Care; D044382:Population Groups; D036301:Qualitative Research; D034121:Reproductive Health Services / Q000458:organization & administration; D014932:Women's Health Services / Q000458:organization & administration / Q000592:standards*