Resilience and adaptability of traditional healthcare systems: a case study of communities in two regions of Brazil

The traditional healthcare systems (THS) of communities in two different regions of Brazil were investigated through the lens of social-ecological resilience, assuming that the resilience of THS and of the communities influence each other. We analyzed what has sustained and changed in the trajectory of THS of different rural and coastal communities in Brazil during the last seven decades, focusing on the domains of social biodiversity (especially on plant diversity for medicinal use), health practices learning, and social organization. The THS analyzed refer to three rural communities in northeastern Brazil, and three Quilombola communities on the southern coast of Brazil. Data were obtained through participatory methods, interviews, and secondary sources. The main drivers affecting the THS were the (1) development of national and regional infrastructure, (2) access to public healthcare, (3) implementation of protected areas, and (4) recognition of Quilombola territories (Quilombos). The components of social biodiversity, learning, and social organization contributed to the adaptive capacity and resilience of the systems through the continuity of knowledge transmission, use of local biodiversity for healthcare, request for local specialists, recovery of cultural practices, and institutional development of local organizations and partnerships. Challenges concerning the resilience of the THS are explained by the urbanization processes, restriction of access and use of some native plants, decrease in economic dependence on local biodiversity resources, and the need to improve social capital. After assessing the factors affecting the resilience of THS, we recommend actions that could enhance social-ecological resilience in different communities and under different situations.