Document Type



The Oklahoma City Area Indian Health Service (IHS) Advisory Board, Inc. required a self-evaluation system for reviewing the performance of Tribally managed health care programs including the Community Health Representatives (CHR) Program. The Advisory Board concerned with the effectiveness of the CHR program, set the following objectives: 1) develop appropriate criteria and evaluation methods for program review; 2) conduct field evaluations in each CHR program area; 3) summarize findings and make recommendations; and 4) demonstrate the importance of consumer evaluation in regard to program effectiveness. A comparative research method utilizing a consumer evaluation of delivery services was the basis of the study. Data on the CHR program impact concerning the health of the Indian person was collected through personal statements of Service Unit personnel. Each contract Service Unit employed a varied number of personnel who serviced designated areas of differing population size. A pilot evaluation on one CHR Program resulted in modifications and a standard procedure implemented on an area-wide basis. The criteria analyzed included: 1) development of criteria and evaluation methods; 2) number of CHR program field evaluations; 3) results of field evaluations in terms of increasing program effectiveness and direction; and 4) level of Indian involvement in terms of magnitude, timeliness and program understanding. Each contract Service Unit program received initial findings based upon personnel statements. The unfamiliarity of the CHR proposal and the policies of IHS, the need for effective communication between relevant personnel, unfulfilled personnel needs and the need for more positive interactions among personnel were significant concerns. Budget allowances for mileage, tires, miscellaneous medical items, telephone bills, and insurance were lacking. CHRs needed uniforms, insignias, and car emblems for identification. Extended training, permanent meeting places, working relationships with tribal enforcement officials, positive public relations and merit raises were also expressed concerns.The IHS and the contract Service Units need to establish a more cohesive relationship. Recommendations included: 1) Implement CHR Program policies area-wide; 2) Service Unit Directors should attend quarterly Area Board meetings and present a 15 minute report of the Service Unit's program plan and current progress; 3) Health professionals need to be familiar with CHR contracts, representatives and Tribal contacts; 4) Service Unit Directors need to assume responsibility for availability of information, i.e., emergency room policy, dental program and priorities, eye glass program, hospital admitting policy, contract health program, Service Unit personnel, Program Plans of Service Unit and outpatient clinic hours; 5) Service Unit Directors should assume responsibility for improving staff attitudes; 6) Service Unit Directors need to assume responsibility for fulfilling the Contract Health Program; 7) Area Offices should allows public relations to prevail; 8) As soon as reconunendation # 1 is implemented, the IHS will print copies to be distributed to the CHR offices; 9) Implement uniform State and Federal withholdings of taxes, social security (matching), and unemployment compensation; 10) Provide funding for full-time Project Officers; and 11)After election year, tribal leaders need an orientation and update of programs and organizational structure by the IHS.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-64).