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About Us

The Indian Health Service (IHS) Community Health Representative (CHR) Program is an IHS-funded, tribally contracted program of well-trained and medically-guided community-based health workers. The CHR Program was established by Congress in 1968 in response to the expressed needs of American Indian and Alaska Native (AI/AN) governments, organizations, and the IHS, for a healthcare program that would provide an outreach component to meet specific tribal healthcare needs.

Clinic CHR staff sitting on a bench

Today, the CHR program serves as the largest tribally contracted and compacted program with more than 95% of CHR programs being directly operated by Tribes under P.L. 93-638 of the Indian Self-Determination and Education Assistance Act, as amended. There are more than 1,600 CHRs representing over 250 tribes in all 12 IHS Areas. The authority for the CHR program can be found in the Indian Health Care Improvement Act, Section 107 of P.L. 100-713, dated November 23, 1988. IHS-operated CHR programs

CHRs are trained in the skills of health care provision, disease control, and prevention and help to eliminate health disparities by removing barriers to care in their communities. CHRs are the frontline workforce focusing on improving Social Determinants of Health (SDOH) for underserved populations to decrease health inequities across the country using a community-based approach. CHR activities impact SDOH by increasing:

  • access to care and coverage,
  • social/cultural cohesion, transportation,
  • food access,
  • environmental quality,
  • social justice,
  • housing, and
  • educational training opportunities


Relationship and Trust-Building: to identify the specific needs of clients

Communication: especially continuity and clarity, between provider and patient, and traditional knowledge and language

Social Determinants of Health: conditions in which people are born, grow, work, live, and age, including social connectedness, traditional knowledge, spirituality, relationship to the environment, and a shared history


  • Raising awareness about numerous health issues like colorectal cancer, suicide, and more.
  • Conducting trainings.
  • Increasing screenings and community health improvements.