Document Type



This report is an evaluation of the Indian Health Service (IHS) in the Pacific Northwest Region. The purpose of the study was to evaluate the health care planning process of the IHS. This primary goal was expanded through the articulation of three objectives. The first was to assess evidence of real and on-going planning within IHS. The second was to identify the actual or expressed purposes of the plans. The third was to identify the discrepancies between actual IHS plans and a standardized comprehensive model. The methodology used in completing this evaluation comprised three major procedural steps. The first was the formulation of a standardized and comprehensive model for health care planning. The second was an analysis of the existing system of health care planning used at the three administrative units of IHS. The third was a definition and evaluation of the IHS planning process. For the first step, a generic model was developed to provide a baseline for evaluating the wide variety of planning strategies employed by the IHS. The second step required field work and on-site visits at all Portland Area Service Units. The interviews with local Service Unit administrators aided the evaluators in their assessment of the process of defining and implementing specific health care goals and objectives. The third step involved an evaluation of the actual IHS planning process by comparing the ideal model and the realities of implementation.This report finds that: 1) the IHS planning process is directly linked to predetermined funding levels, which severely limits planing objectivity; 2) the IHS planning process is ill-defined and fails to demonstrate whether or not the health status of the Northwest Indians is being upgraded; 3) IHS planning is oriented to identify symptoms rather that causes, and is based on treatment rather than prevention at the level of the individual or total population; 4) the existing data system is geared to providing top level monitoring and provides little useful data for Tribal long-range planning; and 5) consumer input into the planning process is limited due to a lack of consumer knowledge and ability to fully and actively participate in the process.The study recommendations were presented in five parts: 1) IHS should structure their planning process to reflect a problem solving approach; 2) there should be a concerted effort to establish a standard pattern for demographic enumeration; 3) IHS should develop a system and open lines of communication for active consumer participation in the health care planning process; 4) IHS must begin to address structural flaws in the total organization including manpower levels and expertise, and control over lines of communication; and 5) IHS should initiate a major policy review to address the weaknesses inherent in short-range resource allocations.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-06).