The Community Health Representatives (CHR) Program was established in 1968, under the 1921 Snyder Act (25 U.S.C. 13). CHRs are frontline public health workers who are trusted members of the community with a close understanding of the community, language, and traditions. CHRs serve as a link between the clinical setting and the community to facilitate access to services and improve the quality and cultural competence of service delivery. They assist by increasing health knowledge of patients and communities through a broad range of activities such as transportation to health visits, outreach, community education, informal counseling, social support, and advocacy. The National IHS CHR Program provides funding, training, and technical assistance to tribal CHR programs to address the health care needs through the provision of community-oriented health services.
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