The state, Mapuche communities, and multicultural social policy: a comparative study of three intercultural hospitals in Chile

Multicultural social policy in Latin American countries surfaces as a new form of social policy reform aimed at 1) reforming social sector reform in order to reduce the cost and increase the effectiveness of the service; and 2) expanding citizenship of indigenous populations. This new way of delivering social services invites different actors into the social programs. In this dissertation, I examine how multicultural social policy actually works in the ‘local’ arena, where participants struggle, vie and negotiate with each other.
I also address the impact of interactions among actors on social policy. To do so, I look at three intercultural hospitals which had different levels of participation from communities, the state, and NGOs. While Makewe Hospital was run by a Mapuche organization, Nueva Imperial Hospital launched a state sponsored intercultural health program. Nueva Extremadura Clinic installed an intercultural health program implemented by NGOs. These different types of interactions among actors emerged in the three cases and ultimately shaped each of the programs.
In Makewe Hospital, where there was strong participation from communities, the program had better results in expanding cultural rights as well as in increasing the effectiveness of the program. However, the strong participation from communities did not necessarily transcend into sustainability of the program. With strong state involvement in the program of Nueva Imperial Hospital, there was tension between the state and the communities, which resulted in limited improvement of the quality of the service and the expansion of cultural rights. However, the state sponsorship provided the program sustainability. In the case of Nueva Extremadura Clinic, the effectiveness and flexibility of the program increased significantly but the program did not have any impact on the expansion of the cultural rights of local Mapuche population. These findings show that the constant negotiation and struggle among these actors ultimately shape the content of the policy and its outcomes. Multicultural social policy as a state action is not uniform and has diverse implications for multiculturalism, depending on the actors involved and their capacity for independent actions.