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National Indian Health Board Exploring Tribal Public Health Accreditation. Aleena M. Hernandez, MPH Red Star Innovations, LLC January 21, 2010. Overview. Historical Basis of Indian Health Tribal Management of Health Programs NIHB’s Exploring Tribal Public Health Accreditation project

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National indian health board exploring tribal public health accreditation

National Indian Health BoardExploring Tribal Public Health Accreditation

Aleena M. Hernandez, MPH

Red Star Innovations, LLC

January 21, 2010


Overview

Overview

  • Historical Basis of Indian Health

  • Tribal Management of Health Programs

  • NIHB’s Exploring Tribal Public Health Accreditation project

  • PHAB/NIHB Tribal Think Tank

    • Recommendations

    • Next Steps


Promises to keep public health policy for american indians and alaska natives in the 21 st century

Promises to Keep: Public Health Policy for American Indians and Alaska Natives in the 21st Century

Dixon M, Roubideaux Y

American Public Health Association, 2001


American indians and alaska natives

American Indians and Alaska Natives

  • 564 Federally-recognized Tribes in 35 States1

  • Sovereign Nations

  • Distinct culture, language and traditions

  • Live on trust land and in urban areas

  • Economic Diversity

  • Tribal Membership

1 Indian Health Service Website www.ihs.gov


2000 census

AI/AN alone2.5 million (0.9%)

AI/AN in combination with 1.6 million

one or more other races

Total AI/AN 4.1 million (1.5%)

Reported a specific tribal affiliation74%

IHS Service Population1.5 million

2000 Census


Historical basis of indian health

Historical Basis of Indian Health

  • Pre-Contact/Tradition Medicine

  • Impact of European Settlement

  • Constitution/Supreme Court/Treaties/Legislation

    • Sovereignty

    • Federal Trust Responsibility

    • Government to Government Relationship


Significant policy legislation affecting indian health

Significant Policy/Legislation Affecting Indian Health

  • 1800’s – Responsibility of the War Department

  • Indian Removal

    • Indian Removal Act of 1830

    • 1836 – Medical services for land cessions

  • 1849 - BIA/Department of Interior

  • Dawes Act – General Allotment Act 1887

    • Reservation land divided into allotments

    • Ban on traditional practices

    • Introduction of boarding schools


Significant policy legislation affecting indian health1

Significant Policy/Legislation Affecting Indian Health

  • Indian Reorganization Act 1934

  • Termination Program of the 1950’s

  • The Transfer Act of 1954 – Transferred health services from the BIA to PHS

  • 1955 - Indian Health Service established


Indian health service

Indian Health Service

  • Under the US Department of Health and Human Services

  • Comprehensive, primary health care system and some public health services

    • Only agency to provide direct medical care

  • Trust Responsibility: Members of federally recognized tribes

  • Divided into 12 Service Areas


  • Per capita health expenditures

    Per Capita Health Expenditures

    • Indian Health Service (2005)$2,130

    • Bureau of Prisons (2005 estimate)$3,986

      • In California and New Mexico over $4000

  • Veterans Administration (2002)$4,653

  • US General Population (2003)$5,670

  • Department of Health and Human Services, www.dhhs.gov, Source published January 2006


    Tribal management of health programs

    Tribal Management of Health Programs

    The Indian Self-Determination and Educational Assistance Act 1975 P.L. 93-638

    • Tribes can manage their health programs

      • Title I: CONTRACT part or all of the services

      • Title V: COMPACT entire health programs

      • Funding issues: shares, contract support costs


    Putting tribal public health into context for accreditation

    Putting Tribal Public Health Into Context for Accreditation

    • Direct service and 638 (contract/compact) tribes

    • Geographic location (IHS Area, Rural/Urban)

    • Landbase versus non-landbase tribes, checkerboard

    • Single tribe applicant versus consortium of tribes

    • Tribe, Health Department Size

    • Public Health Activity

    • Multi-jurisdictional overlap and relations


    National indian health board

    National Indian Health Board

    Exploring Tribal

    Public Health Accreditation


    Exploring tribal public health accreditation

    Exploring Tribal Public Health Accreditation

    • National Indian Health Board involvement

    • Grant: Robert Wood Johnson Foundation 2008

    • Purpose: to assess the feasibility of the promotion of voluntary public health accreditation and public health standards in Indian Country


    Exploring tribal public health accreditation1

    Exploring Tribal Public Health Accreditation

    • Objectives of NIHB Project:

      • Establish an Advisory Panel

      • Review past accreditation efforts in Indian country

      • Explore/Discuss the potential for voluntary public health accreditation in Indian country

        • Benefits, challenges, barriers, ideas…

      • Gather recommendations from Indian country

        • Process, resources needed, potential partnerships

      • Produce a Strategic Plan


    Call for input results

    Call for Input Results

    • Positive response to concept of public health accreditation – broader than just health services

    • Interest in tribes having a leadership role

    • Opportunity to recognize the excellence in public health across Indian Country

    • Challenges include the diversity of public health delivery in Indian country, time, capacity and cost to seek accreditation, multiple entities involved


    Strategic plan recommendations

    Strategic Plan Recommendations

    • Provide ongoing education/awareness to Tribes

      • Provide training, Technical Assistance, preparation, and readiness assessments relevant to tribal context

    • Consider Tribal version of Standards and Measures

    • Explore PHAB’s role in strengthening relationships among tribal, local, and state HDs

      • Convene regional roundtables

      • Facilitate a “Tribal Think Tank” to address relations


    Public health accreditation board national indian health board

    Public Health Accreditation BoardNational Indian Health Board

    Tribal Think Tank

    December 16, 2009

    Tucson, Arizona


    Tribal think tank

    TRIBAL THINK TANK

    17 Participants Representing

    • Tribal Beta Test Sites

    • NIHB Tribal Public Health Accreditation Advisory Board Members

    • Tribal Health Directors/Administrators

    • PHAB Staff/Board Members

    • RWJF


    Tribal think tank objectives

    Tribal Think Tank Objectives

    Based on NIHB Advisory Board Recommendations:

    • Identify and discuss strategies to ensure ongoing Tribal input into the accreditation process

    • Identify strategies for PHAB to strengthen Tribal/State relations in accreditation

    • Explore the adaptation of the PHAB Public Health Accreditation Standards and Measures to create a Tribal version


    Strategies involving tribes

    Strategies: Involving Tribes

    • Convene local, regional and national meetings

    • Provide outreach and education to tribes

    • Hire/contract individuals with experience in tribal public health systems (culturally competence)

    • Identify opportunities for communication and collaboration among tribal, local and state health department


    Accreditation incentives

    Accreditation Incentives

    • Potential to identify model Tribal Public Health Systems

    • Opportunity to strengthen tribal public health infrastructure

      • Improve the quality of care

      • Build credibility and

      • Strengthens a tribe’s ability to advocate for health

        Cost Issues – funding is needed to support tribal infrastructure development, technical assistance, and capacity building.


    Tribe state relations

    Tribe/State Relations

    • Government to Government relationship

    • Overlapping Jurisdictions

    • Responsibility and Authority

    • Federal transfer of responsibility and funding for public health functions to states


    Tribal consultation

    Tribal Consultation

    • 1994 – Bill Clinton introduced Tribal Consultation Policy

      • Facilitates formal government to government relations

      • Requires federal executive departments and agencies to consult with tribes prior to making decisions that would affect them

    • November 2009, President Barack Obama convened all tribal leaders in Tribal Consultation


    Strategies tribe state relations

    Strategies: Tribe/State Relations

    • Conduct regional/national roundtables with tribal, local, and state health departments

    • Use the Beta Test to develop a “Model Partnership for Accreditation”

    • Provide education about tribal public health systems to local and state health departments

    • Utilize the accreditation process/documents to encourage coordination and collaboration among tribal, local and state health departments


    Key recommendations

    Key Recommendations

    • Ensure ongoing Tribal Input and Engagement

    • Involve key stakeholders within Tribal Public Health Systems

    • Adapt the standards, measures, and documentation for tribal health departments.

    • Provide opportunities for tribe, local and state health departments to convene, communicate and coordinate


    Next steps

    Next Steps

    • Formalize a process for adapting tribal versions of the Standards, Measures and documentation

    • Conduct outreach to tribes at the regional and national level

    • Convene tribal, local and state health departments to dialogue about partnership and accreditation

    • Utilize input from the Tribal Beta Test Sites to identify lessons learned and to inform future work


    Thank you

    Thank You

    Aimee Centivany, MPH

    National Indian Health Board

    [email protected]

    Aleena M. Hernandez, MPH

    Red Star Innovations, LLC

    [email protected]


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