Document Type



The purpose of the study was to review and analyze the Tribal involvement process and mechanisms established by the Indian Health Service Phoenix Area Office to enable the Tribes to manage their own health affairs. Specifically, the report evaluates the effectiveness of Tribal involvement processes and activities pertaining to IHS policy, development, planning, and evaluation. A major portion of the study centers on review and analysis of the Service Units'Advisory Boards and the Phoenix Area Health Board that was established by the Phoenix Area Office. The involvement and processes engaged in by the Indian Tribes, aside from the advisory boards, were also examined. Using exploratory research methods to evaluate Tribal involvement, the two main sources of data were documents and discussions. Documents were employed to identify the basic IHS policy statements on Tribal involvement policies including: those statements from IHS Headquarters and Area levels; Congressional Acts and regulations germane to IHS, and previous reports regarding Tribal involvement in IHS. Discussions included preliminary discussions, in-depth field discussions, project Advisory Board meetings, and the Phoenix and Reno Forums on Tribal Involvement in IHS. Data was presented in the form of plans, policy development, and the construction of models. The findings are comprehensive and detailed. Results cover several lengthy areas. IHS Phoenix Area plans, policy development, and evaluation were covered thoroughly. Other areas which were evaluated include Tribal involvement in the IHS Advisory Board System and IHS Tribal involvement policies, evolution of the IHS Health Boards policies, the Area Board, and the Service Unit Boards. Other areas considered in the study were, Tribal structures and functions for Tribal participation in IHS decision making, Tribal health structures, Tribal involvement in health planning, direct tribal contacts with IHS officials, Tribal program management and contracting, Inter-Tribal organizations, and governmental and legislative liaisons. Additionally, four models for tribal health participation have been developed. IHS has made a conscientious effort to establish Tribal involvement policies, but IHS needs to work cooperatively with tribes to establish Tribal involvement policies that reflect present day Tribal government capabilities and expanded Tribal health activities. There is a need to recognize a dialectical relationship between Tribal governments and IHS based on the concept of Tribal participation in health matters. IHS should use its Operational Planning System to educate Tribal leaders, tribal health staff, and individual Indian consumers about IHS planning and budget development procedures. Tribal involvement in IHS policy should not occur in isolation from other sectors of operation. Evaluation needs to be made an integral part of the process of Tribal participation in IHS planning and program development.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-26).