[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Family and community nursing](https://durgical.com/en/nursing/areas/community/) › The differential approach: ethnic peoples, gender, victims of the armed conflict and intercultural care # The differential approach: ethnic peoples, gender, victims of the armed conflict and intercultural care - Safe practice Colombian law asks services to adjust care to each group's age, gender, ethnicity, disability and history, including victims of the armed conflict. Updated Nov 13, 2026 ## Key points - Ley 1448 de 2011, art. 13: the differential approach covers age, gender, sexual diversity, disability, beliefs, national origin and ethnic, cultural and territorial diversity. - PAPSIVI (Ley 1448, art. 137) has two components: comprehensive health care and psychosocial care. - Psychosocial care can be individual, family or community, and the programme should seek out victims. - SISPI (Decreto 1953 de 2014) works in coordination and complementarity with the general health system (SGSSS). - Intercultural care: dialogue and respect between traditional knowledge and the health system, on equal terms. ## What it is The differential approach (enfoque diferencial) recognises that some populations have particular characteristics because of their age, sex, sexual orientation and gender identity, disability, beliefs, national origin, or ethnic, cultural and territorial diversity, and that care must be adjusted to them. Ley 1448 de 2011 (victims of the armed conflict, art. 13, modified by Ley 2421 de 2024) makes it a principle and asks for special guarantees for groups at higher risk. Its art. 137 created the Programme of Psychosocial Care and Comprehensive Health for Victims (PAPSIVI). For Indigenous peoples, Decreto 1953 de 2014 defines the Indigenous Own and Intercultural Health System (SISPI), which works with the general health system. For the nurse, the approach means asking who the person is, adapting the care and coordinating with the right programme. ## What it requires - Ley 1448 art. 13 names groups that need special guarantees: women, young people, children, older people, people with disabilities, peasant farmers, social leaders, ethnic groups and victims of forced displacement, among others. - PAPSIVI must be proactive, free of charge, interdisciplinary (including nurses and community health promoters) and must have a component for women victims of sexual violence. - Decreto 1953 art. 75 lists SISPI principles: accessibility, therapeutic complementarity, reciprocity and interculturality. - Under SISPI, health (salud propia) is harmony and balance according to each people's worldview: with oneself, the family, the community and the territory. ## Components - Life course: children, adolescents, adults and older people have different needs and rights. - Gender and sexual diversity: risks of violence and barriers that differ by gender. - Ethnicity: Indigenous, Afro-Colombian, Raizal, Palenquero and Rrom peoples, with their own authorities and knowledge. - Disability: physical, communicative and attitudinal barriers. - Victims of the armed conflict: psychosocial harm, displacement and distrust. ## How it is applied (and why) - Ask how the person identifies (people, language, gender) instead of assuming — the approach starts with recognising the person. - Ask whether the person or family is a victim of the conflict, in private and without pressure — it opens access to PAPSIVI and other measures. - Explain care in the person's language, with an interpreter or community link if needed — consent requires understanding. - Ask about traditional practices and agree how to combine them with the care plan — complementarity builds trust. - In Indigenous territories, coordinate with the people's own health authorities and structures — SISPI is built with them. - Refer victims to the psychosocial and health components available — the harm of the conflict is physical and emotional. - Adapt the setting: privacy, accessibility, times that fit rural work — the rule must not become a barrier. - Record the differential variables in the record — what is not recorded does not reach planning. ## In nursing practice - PAPSIVI care protocols are designed locally according to the type of violence and the victims' cultural background (Ley 1448, art. 137). - Take seriously signs of distress, grief, fear and distrust in victims; they are expected after violence and deserve care. - Until SISPI is in place in a territory, the general system guarantees Indigenous peoples' care through Indigenous and non-Indigenous institutions (Decreto 1953, art. 88). - The differential approach also applies inside the team: training, sensitivity and respect for diversity. ## Common mistakes - Thinking the differential approach is only for ethnic peoples. - Pressing a victim to tell what happened when the care does not need it. - Imposing the plan without dialogue with the community's own authorities or healers. - Not recording ethnicity, disability or victim status, so the group stays invisible. ## Test yourself Think of the answer, then tap the question to see it. ## Which law makes the differential approach a principle for victims of the armed conflict? Ley 1448 de 2011, art. 13 (modified by Ley 2421 de 2024). ## What are the two components of PAPSIVI? Comprehensive health care (physical and mental health) and psychosocial care, which can be individual, family or community. ## What is SISPI? The Indigenous Own and Intercultural Health System (Decreto 1953 de 2014), which works in coordination and complementarity with the general health system. ## What does interculturality mean in SISPI? Communication and coordination between the peoples' knowledge and practices and the health system's institutions, with recognition and respect on equal terms. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/the-differential-approach-ethnic-peoples-gender-victims-of-the-armed-conflict-an/) ## Elsewhere in DurgiPedia - [Culture, explanatory models and interpreters](https://durgical.com/en/behavioral-science/culture-explanatory-models-and-interpreters/) - [Justice: fair distribution and equal treatment](https://durgical.com/en/medical-ethics/justice-fair-distribution-and-equal-treatment/) ## Connections ## Related 3 - [Vulnerable populations and health equity: who, why and how the nurse works with them](https://durgical.com/en/nursing/vulnerable-populations-and-health-equity-who-why-and-how-the-nurse-works-with-th/) - [Culturally competent care in practice](https://durgical.com/en/nursing/culturally-competent-care-in-practice/) - [Madeleine Leininger's transcultural nursing and culturally congruent care](https://durgical.com/en/nursing/madeleine-leininger-s-transcultural-nursing-and-culturally-congruent-care/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Ley 1448 de 2011 (víctimas del conflicto armado), arts. 13 y 137, con las modificaciones de la Ley 2421 de 2024](https://www.secretariasenado.gov.co/senado/basedoc/ley_1448_2011.html) (Secretaría General del Senado de la República, Colombia, 2011); [Programa de Atención Psicosocial y Salud Integral a Víctimas (PAPSIVI)](https://www.minsalud.gov.co/Proteccion-Social/promocion-social/Victimas/Paginas/papsivi.aspx) (Ministerio de Salud y Protección Social, Colombia, 2024); [Decreto 1953 de 2014 (Sistema Indígena de Salud Propio Intercultural, arts. 74 a 88)](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=59636) (Función Pública, Gestor Normativo, Colombia, 2014). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. 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