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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Community health representative: The first tribally contracted program, since 1968 - American indian paraprofessional healthcare providers

CHR - Program Goal and Objectives

General CHR Information

Program Goal and Objectives


The CHR Program was implemented to improve the health knowledge, attitudes and practices of Indian people by promoting, supporting, and assisting the IHS in delivering a total health care program. The efforts of CHR program staff have produced an American Indian and Alaska Native health service delivery system, which provides for follow-up and continued contact with the health care delivery system at the community level, thereby meeting the most basic needs of the American Indian and Alaska Native population.

The goal of the CHR Program is to address health care needs through the provision of community-oriented primary care services, including traditional Native concepts in multiple’ settings, utilizing community-based, well-trained, medically-guided health care workers.


  • Provide curative, preventive, and rehabilitative services in those areas of health care in which services would not otherwise be available to the American Indian and Alaska Native people.
  • Provide home health care services.
  • Provide transportation within the local community to/from an IHS or tribal hospital or clinic for routine, non-emergency problems, to a patient without other means of transportation, when necessary.
  • Act as a liaison/advocate for the communities served by Federal, State, and local agencies. The liaison/advocate motivates and assists the agencies by clarifying the role of Native traditions, value systems, and cultural beliefs, to meet the health care needs of the communities, thereby reducing the potential for conflict and misunderstanding regarding the health conditions of American Indian and Alaska native people.
  • Interpret languages, if necessary, when the community-based language and the language used by other health care providers differ.
  • Facilitate communications between community members and health care’ providers, thereby enhancing accessibility and acceptability of health care facilities. The CHRs assist IHS and non-IHS health agencies to design and/or redesign services to ensure greater responsiveness to the needs of American and Alaska Native communities.
  • Provide and retain community-based health care providers to meet reservation and community health care needs as part of their community's health care system and to ensure that program training and performance meet established national standards, as specified in the Indian Health Manual, Indian Self-Determination Memorandum (ISDM), 81-4, and Section 107 of P.L. 100-713, dated November 23, 1988.
  • Develop annual program plans which address specific community health care needs.
  • Assess community health care resources, both IHS and non-IHS, and to facilitate appropriate utilization of those resources.
  • Ensure availability of appropriate IHS medical guidance to CHR Programs.
  • Ensure compliance with the requirements of a CHR data collection plan.
  • Provide and/or assist in demonstrations, conduct training sessions and community meetings in the areas of safety, nutrition/dietetics, environmental health, and in other areas of health concerns.
  • Provide health care education and facilitate understanding by using the Native language when appropriate, thereby fostering greater cross-cultural understanding.
  • Provide extensive health promotion/disease prevention information and instruction in self-help services that address chronic health problems.

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