Decolonization and Its Paradoxes

Abstract

In one of the most traditionally hierarchical and “colonial” of the Bolivian state apparatuses, the official health sector, attempts since 2006 by Evo Morales and the MAS government at radical restructuring have proved innovative but inconclusive and divisive. Reflecting a series of conflicts and contradictions, a number of often fundamentally competing scenarios are at work: the institutionalization of traditional medicine, the reinterpretation of previous primary health care and community participation models, social and “socialized” medicine, and the durability of a deeply ingrained vertical health system. The challenges and risks inherent in what at heart may be a struggle between cultural and political factions and ideologies among the government’s public health authorities and planners are emblematic of many paradoxes in the effort to decolonize the Bolivian state as a whole.