A/HRC/27/52/Add.1 peoples and the Ministry of Education have identified a lack of funding as a factor that hampers the development of programmes in that field. Moreover, even though the introduction of a curriculum suited to the needs of indigenous peoples is required by law, teachers still tend to follow the national curriculum. Health 66. Both government representatives and representatives of indigenous peoples acknowledge that the health status of indigenous peoples are negatively affected by poverty and extreme poverty, low levels of education, limited access to drinking water and sanitation, and the geographical isolation of many indigenous communities in Panama. 67. The available figures point to a gap between the indigenous and non-indigenous populations in terms of health conditions. For example, nationally, the average infant mortality rate stands at 13.2 deaths per 1,000 live births. The averages for the Kuna Yala and Ngobe-Bugle comarcas are 19.5 and 20.8,51 respectively. The national average maternal mortality indicator for Panama is 80.5 deaths per 1,000 live births, while the averages for the Kuna Yala and Ngobe-Bugle comarcas are 542.3 and 300.5,52 respectively. 68. Indigenous peoples also tend to suffer from higher rates of infectious diseases. The incidence of tuberculosis has been identified as an issue of particular concern, with the Kuna Yala and Ngobe-Bugle comarcas having the highest rates: 163.3 cases per 100,000 inhabitants and 85.3 cases per 100,000 inhabitants, respectively (compared to the national average of 41.2).53 The indigenous areas also have the highest rate of malnutrition among children of preschool age (under 5 years of age), and this situation has worsened over the past few years.54 69. In general, the indigenous peoples expressed concern at the limited availability of health services in rural areas. The number of health workers in the comarcas and other areas with large indigenous populations remains low, although the situation is improving. In 2011, medical-worker density in the Ngobe-Bugle comarca was 2.6 (an increase of 0.8 as of that year) and 13.0 in the Kuna Yala comarca (up from 10.9 in 2001).55 A study on the health status of the indigenous peoples of Panama showed that 64.2 per cent of the indigenous persons who were interviewed identified distance as being an obstacle in terms of access to health services.56 70. The Government runs a number of programmes designed to facilitate access to health services. For example, it provides subsidies and transportation to clinics for midwives, has set up hostels and homes for expectant and new mothers close to major health-care centres and arranges for visits to indigenous communities by health workers trained to provide basic services. However, much remains to be done in this regard. One issue raised by the representatives of the Ministry of Health is that non-indigenous health workers are often unwilling to work in the comarcas despite the higher wages on offer. Cultural and linguistic factors also can interfere with access to health services. According to representatives of the Ministry of Health, most health workers in the comarcas should be indigenous persons who are familiar with the comarca laws. One of the many problems in this area has to do with the sensitization of health workers. 51 52 53 54 55 56 GE.14-07234 Ibid., p. 74 (figures for 2011). Ibid., p. 80. Ibid., p. 101. Ibid., p. 124. Ibid., p. 162. Ministry of Health and Pan American Health Organization, Diagnostico Situacional y Plan de Salud para los Pueblos Indígenas de Panamá, p. 45. 17