This chapter examines the implementation of Ecuador’s intercultural health policy in Napo Province, Upper Amazonia. Based on two years of qualitative research, it focuses on Kichwa midwives and Primary Health Care Technicians (PHCTs) as mediators between communities and the Ministry of Public Health. PHCTs improved access by reducing linguistic barriers and promoting prevention, but their work was largely shaped by biomedical priorities. Midwives played a crucial role in maternal care and referrals, yet their knowledge was undervalued, financial recognition absent, and legitimacy often tied to biomedical validation. Sustainability was undermined by weak institutional support, limited intercultural training, staff turnover, budget cuts and persistent gender inequalities. The study highlights both the potential of community actors to strengthen health systems and the risk that interculturality remains a bureaucratic formality rather than a transformative political project.