Weibe Tapeba (Tapeba) is part of the Indigenous leadership of the Tapeba Peoples, originally from the municipality of Caucaia, Ceará, in the northeast region of Brazil. He is a professor and lawyer currently serving as Special Secretariat for Indigenous Health (SESAI) at the Ministry of Health, where he is responsible for coordinating and implementing the National Indigenous Health Policy—a program that aims to assist approximately 800,000 Indigenous people from the 305 recognized Indigenous Peoples in Brazil through primary care services and comprehensive Indigenous health services. He is one of several Indigenous leaders in the Northeast that Cultural Survival has partnered with since the COVID-19 pandemic. Cultural Survival recently spoke with Tapeba about the challenges and changes in Indigenous health after years of intense struggles, particularly those under the Bolsonaro administration (2019-2022).
Edson Krenak: How did you come to take over SESAI? What was the state of Indigenous health?
Weibe Tapeba: I took over SESAI in early January 2023 after the election of President Lula, succeeding the administration of former President Bolsonaro. The situation in Indigenous health was one of complete neglect. Budgets were reduced, there was a lack of staff in the intermediate sector and health professionals in the final areas, precarious infrastructure in most Indigenous villages, a scenario of collapse in access to drinking water in the communities, institutional isolation, and guidance for the institution not to invest in unapproved areas.
During my administration, we restored the capacity to carry out construction work on health units and basic sanitation in the villages. We have increased the number of health professionals and are increasing the budget every year, from R$1.6 billion in December 2022 to over R$3 billion in 2025. We approved the first resolution on Indigenous health in the history of the World Health Organization under Brazil’s leadership and decided to propose a new, more effective Indigenous health policy based on the comprehensive care guideline.
EK: How does SESAI serve the different regions, considering the unique challenges of such a vast territory?
WT: Our intention is that SESAI, starting in 2026, will operate with the effective participation and responsibility of municipalities and states. [In a] break with the current model, which is limited to primary healthcare for Indigenous Peoples, our intention is to include specialized care services, including medium and high complexity services, in the policy so that Indigenous people, when they leave their territories, can receive care that respects their specific cultures, traditions, and needs. The need to review normative acts will be necessary so that the Unified Health System can also incorporate issues related to the valorization of Indigenous medicines and the holders of Traditional Knowledge of the Indigenous territories themselves.
EK: How can we ensure equality of care and resources while ensuring the continuity of services?
WT: Regarding funding, we are preparing the first National Indigenous Sanitation Program, which is expected to be launched at COP30, as a tool to ensure the universalization of basic sanitation in Indigenous territories in Brazil. Currently, approximately 65% of Indigenous villages lack access to drinking water, a fact that causes Indigenous communities to suffer from numerous health problems. We are also seeking new sources of funding. During our administration, we have already accessed resources from the Growth Acceleration Program and the Development Support Program, expanded parliamentary amendments for Indigenous health, established partnerships with
several state governments and cooperation agencies, and are submitting projects to the National Bank for Social Development through the Amazon Fund and establishing a partnership with FORCEN [Fund for Structural Convergence of the Southern Common Market]. Our intention is to ensure that Indigenous health has the budgetary resources to change the reality in all Indigenous territories in Brazil.
EK: What is the role of local leadership and governance in Indigenous health policies in partnership with SESAI?
WT: The importance of Indigenous governance is a reality in President Lula’s administration, which created the Ministry of Indigenous Peoples, the first Indigenous ministry in the history of the Republic, and appointed an Indigenous person to the presidency [Joenia Wapichana] of the National Foundation for Indigenous Peoples, the institution responsible for coordinating Brazilian Indigenous Policy, and our Secretariat of Indigenous Health. In these three main areas, Indigenous specialists are part of the teams, formulating actions, programs, and policies for the inclusion and promotion of Indigenous Peoples’ rights, as well as the appreciation of Indigenous Health Agents.
We are proposing to the Brazilian government a public selection process to strengthen management in the 34 Special Indigenous Health Districts, our decentralized regional units spread throughout Brazil that are responsible for implementing Indigenous health policies. We are also changing the hiring model for the entire Indigenous health workforce in the villages, moving away from hiring private entities that previously contracted health professionals. We are replacing these entities with the Brazilian Agency for Support to the Management of the Unified Health System, an agency created by the government whose objective is to strengthen Indigenous health. Under this project, we expect to train more than 20,000 Indigenous health workers and regulate the professional categories of more than 7,000 Indigenous health agents and sanitation agents.
We also expect to value Indigenous care, which includes the central role of Indigenous medicines and the holders of Traditional Knowledge. We understand that the diversity of cultures and knowledge needs to interact and integrate the practice of care in our health facilities. The support of prayer houses, delivery rooms, and other facilities should be understood as health facilities that can receive public funding.
EK: What actions is SESAI taking to care for the mental health of Indigenous Peoples?
WT: SESAI is developing a Psychosocial Program for Indigenous Health to propose suicide prevention measures, harm reduction in the territories, and strategies to mitigate harm resulting from the use of alcohol and other drugs in Indigenous villages. The program should include the coordination of the existing psychosocial network, professional training, and the incorporation of spiritual care measures and Indigenous medicines.
EK: The Yanomami Peoples’ crisis has been an open wound for decades, marked by invasions by gold miners and State neglect, among other things. Yanomami leader Davi Kopenawa warns that the destruction of the forest is also damaging the mental, spiritual, and physical health of his people. How has SESAI acted to address the Yanomami issue?
WT: Regarding the Indigenous health situation in the Yanomami Indigenous Territory, it is important to emphasize that we are facing the first Public Health Emergency of National Importance within an Indigenous territory in Brazil’s history. The Yanomami Indigenous Territory is the largest in Brazil, with almost 10 million hectares, larger than dozens of countries around the world. Access to the territory is almost entirely by air. The Yanomami population is made up of 33,000 people spread across 380 communities, many of which are recently contacted. Early in our efforts, we identified a shortage of healthcare professionals and medical equipment, high mortality rates, a malaria outbreak in dozens of communities, and socially determined diseases such as tungiasis and river blindness spreading throughout the territory. Food insecurity resulting from the mining invasion [caused] severe malnutrition, which impacted the Yanomami’s productive capacity, [along with] mercury contamination of rivers and a wave of violence in the territory sponsored by miners and organized crime. Our efforts resulted in an increase from 690 existing professionals to 1,800, including specialist physicians. We went from just 4 doctors to 47. We built or renovated 23 new Indigenous health units. We implemented Telehealth in 5 regions of the territory. We expanded connectivity and photovoltaic energy in health units, combined with the efforts of other government agencies responsible for malnutrition in the area, which resulted in the removal of over 90% of the miners, the delivery of food baskets and support for productive projects, and the reopening of Indigenous schools.
Weibe Tapeba Photo courtesy of www.gov.br.
