A/HRC/27/52/Add.1 71. The creation in 2011 of the Directorate for Indigenous Health Affairs of the Ministry of Health marked a major step forward. The Directorate is responsible for providing comprehensive health care to indigenous peoples and for helping them to preserve their ancestral knowledge and uphold their fundamental rights.57 The Directorate provides health services such as vaccinations, dental care and the dispensation of medicines, as well as offering awareness-raising and training services, for example, to traditional midwives and doctors concerning health issues linked to their work in indigenous areas. Authorization for the creation of the National Commission on Traditional Indigenous Medicine58 was issued in 2003. The Commission was given the mandate to promote traditional indigenous medicine, in cooperation with the traditional indigenous authorities. To date, however, this body has not been established. V. Conclusions and recommendations 72. The legislative framework of Panama is highly developed in terms of the rights of indigenous peoples. In particular, the comarca system provides a significant level of protection for the rights of indigenous peoples in Panama, especially with regard to lands and territories, participation and self-governance, and health and education. 73. The country’s laws and programmes on indigenous issues provide a vital foundation for further work to build upon and strengthen the rights of the indigenous peoples of Panama. However, the Special Rapporteur observes that this foundation is fragile and unstable in many regards. 74. As pointed out earlier in this report, Panama is faced with a series of issues related to the enforcement and protection of the rights of indigenous peoples, particularly in connection with their lands and natural resources, the implementation of large-scale investment projects, self-governance and participation, and social and economic rights, including their rights to economic development, education and health. 75. In the light of the observations made in this report, the Special Rapporteur makes the following specific recommendations to the Government: (a) Seek out way of engaging in an ongoing dialogue with indigenous representatives in order to address existing concerns in a peaceful and constructive manner (para. 28); (b) Ensure that indigenous peoples play an appropriate role in the formulation of a bill on the prior consultation of indigenous peoples. This bill should provide for consultation with the indigenous authorities in the comarcas and collective lands (para. 21); (c) Proceed with the ratification of the ILO Indigenous and Tribal Peoples Convention, 1989 (No. 169) (para. 25); (d) Redouble efforts to protect the lands and natural resources located within the comarcas and to resolve the pending issue of the titling of the areas adjacent to the Ngobe-Bugle comarca (para. 29); (e) Move forward with the processing of the pending applications filed by the Bribri, Emberá and Wounaan peoples under Act No. 72 of 2008 and assist them in 57 58 18 Resolution No. 706 of 22 July 2011. Executive Decree No. 117 of 2003. GE.14-07234