International Journal of Health Policy and Management

International Journal of Health Policy and Management

Preparing Health Systems for Therapeutic Hybridization; Comment on “Routes of Well-Being, Spiritual Harmony and Recovery in Mental Health: The Community as a Policy-Maker”

Articles in Press

Document Type : Commentary

Authors
Marcela Guapacha-Montoya 1
Diana Carolina Aguirre-Flórez 2
1 Department of Pediatrics, Faculty of Health Sciences, University of Caldas, Manizales, Colombia
2 Faculty of Health Sciences, University of Manizales, Manizales, Colombia
Abstract
This commentary builds on a policy-oriented understanding of recovery as a co-produced route of well-being, spiritual harmony, and community participation. It examines therapeutic hybridization: the negotiated articulation of biomedical care, ancestral practices, spiritual resources, family support, territorial meanings, and communitybased recovery. Rather than treating these arrangements as informal adaptations or cultural supplements, health systems must govern, finance, evaluate, and protect plural forms of care without subordinating Indigenous knowledge. Drawing primarily on Colombian cases and wider literature on community health systems, cultural safety, and intercultural policy, the commentary proposes six domains of preparedness: governance, care pathways, financing, workforce, clinical safety, and learning systems. The agenda is intended as an adaptable, non-exhaustive framework for settings where plural therapeutic systems already interact and where communities can share authority over design and evaluation. Therapeutic hybridization is therefore presented as a test of whether health systems can redistribute legitimacy, resources, and decision-making authority.

Keywords
Indigenous Peoples
Mental Health Services
Cultural Competency
Community Participation
Health Policy
Colombia
1.     Agudelo-Hernández F, Giraldo-Álvarez AB. Routes of well-being, spiritual harmony and recovery in mental health: the community as a policy-maker. Int J Health Policy Manag. 2025;14:8390. doi:10.34172/ijhpm.8390
2.     Lang C. Translation and purification: Ayurvedic psychiatry, allopathic psychiatry, spirits and occult violence in Kerala, South India. Anthropol Med. 2018;25(2):141-161. doi:10.1080/13648470.2017.1285001
3.     Bartlett C, Marshall M, Marshall A. Two-Eyed Seeing and other lessons learned within a co-learning journey of bringing together Indigenous and mainstream knowledges and ways of knowing. Journal of Environmental Studies and Sciences. 2012;2(4):331-340. doi:10.1007/s13412-012-0086-8
4.     Agudelo-Hernández F, Plata-Casas LI, González-Abril K. “The territory has its ways of warning us”: cultural practices and belief systems of two Indigenous peoples in Colombia and their role in public mental health. Cult Med Psychiatry. 2025;49(4):1205-1225. doi:10.1007/s11013-025-09936-1
5.     Isarama R, Aguirre-Flórez DC, Mecha-Chamorro J, Guapacha-Montoya M, Agudelo-Hernández F. Traditional Elements for recovery and therapeutic hybridizations in displaced Embera Dobidá youth: a longitudinal mixed study in Colombia.  J Immigr Minor Health. doi:10.1007/s10903-026-01940-w
6.     Mathias K, Rawat M, Thompson A, Gaitonde R, Jain S. Exploring community mental health systems: a participatory health needs and assets assessment in the Yamuna Valley, North India. Int J Health Policy Manag. 2022;11(1):90-99. doi:10.34172/ijhpm.2020.222
7.     Michelo C, Hurtig AK, Schneider H. Working towards inclusive, socially accountable and resilient community health systems: an introduction to a special issue. Int J Health Policy Manag. 2022;11(1):1-4. doi:10.34172/ijhpm.2021.166
8.     Tetui M, Hurtig AK, Jonsson F, et al. Strengthening research and practice in community health systems: a research agenda and manifesto. Int J Health Policy Manag. 2022;11(1):17-23. doi:10.34172/ijhpm.2021.71
9.     Schneider H, Olivier J, Orgill M, et al. The multiple lenses on the community health system: implications for policy, practice and research. Int J Health Policy Manag. 2022;11(1):9-16. doi:10.34172/ijhpm.2021.73
10. Gartner JB, Lemaire C, Côté A. Learning Care Pathways Framework: A New Method to Implement, Learn, Replicate, and Scale up Care Pathways for and With the Patient. Int J Health Policy Manag. 2025;14:8517. doi:10.34172/ijhpm.8517
11. Ministerio de Salud y Protección Social. Decreto Ley 480 de 2025: por el cual se establece e implementa el Sistema Indígena de Salud Propia e Intercultural (SISPI) como la Política de Estado en salud para los pueblos indígenas de Colombia. Bogotá: Ministerio de Salud y Protección Social; 2025.
12. D’Souza NA, Field M, Supino T, Messer M, Aleck E, Kirmayer LJ. Mental health implementation research in Indigenous communities: creating culturally safe space to enhance collective strengths. AlterNative. 2024; 20(1):194-204. doi:10.1177/11771801241235373
13. Redvers N, Lokugamage AU, Barreto JPL, Bajracharya MB, Harris M. Epistemicide, health systems, and planetary health: re-centering Indigenous knowledge systems. PLoS Glob Public Health. 2024; 4(8):e0003634. doi:10.1371/journal.pgph.0003634
14. World Health Organization, United Nations. Mental health, human rights and legislation: guidance and practice. Geneva: World Health Organization; 2023.
15. Ministerio de Salud y Protección Social. Informe de seguimiento al cumplimiento de lo dispuesto en la Sentencia T-302 de 2017, vigencia I semestre de 2025. Bogotá: Ministerio de Salud y Protección Social; 2025.
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 28 July 2026

  • Received Date 06 June 2026
  • Revised Date 21 July 2026
  • Accepted Date 24 July 2026
  • First Published Date 28 July 2026
  • Published Date 28 July 2026