Indian Health Service Program
The Indian Health Service of the United States, an agency within the Department of Health and Human Services, is responsible for providing health services in the national area to Native American and Alaska Native populations. The health care delivery to members of federally recognized American Indians is based on a special relationship between the federal government of the United States and the governments of each indigenous populations. This relationship was established in 1787, based on Article 1, Section 8 of the Constitution, through decisions of the Supreme Court, laws from the Legislative Branch and Executive Orders. The Indian Health program became a primary responsibility of the DHHS under P.L. 83-568, the Transfer Act, on August 5, 1954. The Act provides “that all functions, responsibilities, authorities, and duties…relating to the maintenance and operation of hospital and health facilities for Indians, and the conservation of Indian Health…shall be administered by the Surgeon General of the United States Public Health Service.”
The Indian Health Service is an advocate for Indian people with a goal to elevate their health status to the highest possible level. The objective is to have maximum Tribal involvement in the development and management of Indian health programs to meet their communities' needs. Indian Health Service works with the people involved in the health delivery programs so that they can be “cognizant of entitlements of Indian people, as American citizens, to all federal, State, and local health programs, in addition to Indian Health Service and Tribal services.” A WHO collaborating center on Indigenous Peoples Health would allow Indian Health Service to share their expertise in the area of maintaining indigenous leadership and getting non-indigenous health providers to understand indigenous expectations and health needs .
The Indian Health Service also acts as the principal federal health advocate for American Indian and Alaska Native people in the building of health coalitions, networks, and partnerships with Tribal nations and other government agencies as well as with non-federal organizations, e.g., academic medical centers and private foundations. The WHO collaboration center on Indigenous Peoples Health would access the strength in Indian Health Service to network with other organizations. The collaboration center would enable linkage between interested parties working on indigenous health issues, such as member countries, universities, experts, foundations or centers.
The Indian Health Service functions through developing and operating health services delivery system that is designed to provide a broad-spectrum program of preventive, curative, rehabilitative, and environmental services. This system integrates health services delivered directly through Indian Health Service facilities, purchased through contractual arrangements with providers in the private sector, and delivered through tribally operated programs and urban Indian programs. A priority of the WHO collaboration center would be to share what Indian Health Services knows about health service delivery to indigenous people and to indigenous environments to vastly improve the health status of indigenous people.
One of the two laws that has critical influence on the relationship between Native Americans, Alaska Natives and the government of the United States is the 1976 Indian Health Care Improvement Act, P.L. 94-437 which defines goals in health that should be targeted by different programs and agencies to elevate health status. The other critical law is the 1975 Indian Self-determination Act, P.L. 93-638 that builds upon Indian Health Service policy by authorizing the governments of Native Americans and Alaska Natives to assume control and responsibility of health programs, technical and financial resources. The joint policy effort among the Native Americans, Alaska Natives and the United States government has been identified as a critical element in the present and future success in the actions of American Indian and Alaska Native peoples. Many other international indigenous communities would be better off if they had a working relationship with their federal government. Native Americans and Indian Health Service have valuable information on negotiations with federal governments that could be available through a WHO collaboration center on Indigenous Peoples Health.
The Indian Health Service currently works to help 1.5 million Native Americans and Alaska Natives, who belong to 557 different recognized communities in 34 states. Until October 1995, it directed 38 hospitals, 61 health centers, 4 school-health centers and 47 health posts. In that same year, of the 144 basic administrative units of Indian Health Service, Native people operated 76 and 70% of the workers at the different levels of the institution were Natives. Indian Health Service’s implemented health model is community-based and it is oriented toward primary care. This model incorporates environmental sanitation, public health, medical care, mental health services and contains cultural and spiritual components. Approximately, 10 million dollars per year is invested in the supply of safe water, sewerage, and environmental protection. The success of this model is based on the Indian Health Service which has put an emphasis on the strengthening and capacity building of local human resources. This capacity building includes technical, programmatic, managerial, fiscal and political competence. The political proposal in the United States is that Self-determination should be worked on with the Native American and Alaska Native populations as real allies with the federal government.
The Native Americans and Alaska Natives in the United States have developed competencies demonstrating great sophistication and capacity in the management of the health programs. The success has been documented and measured through the use of an integrated information system. This system shows results on Native Trends with regard to the different population groups in the country. Over the years there has been a marked increase in involvement of Native Americans, Alaska Native peoples and the generation of alliances with the Indian Health Service. For example, there is the exchange of technical and managerial assistance among the different Native peoples and established advice with indigenous representation which has played an important role in policy development, establishment of priorities, goals and allocation of resources. The National Indian Health Council, together with other institutions such as the National Indian Association of Education and the American Indian National Congress have been major players in policy development.
Text of related legislation can be obtained at Thomas.
