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Community Health Representatives (CHR)

Tree drawing

In 1968, under the 1921 Snyder Act (25 U.S.C. 13), Congress established the Community Health Representatives (CHR) program within Indian Health Service (IHS). The CHR Program is an IHS funded, primarily tribally contracted and directed program. It is comprised of well-trained, community-based health paraprofessionals, who provide health care, and health promotion and disease prevention (HP/DP) services in their tribal communities to American Indian/Alaska Native (AI/AN) peoples, as mandated by the Indian Health Care Improvement Act [IHCIA] as amended in 2010. The CHR Program services and activities shall beare managed and carried out by IHS as necessary or by AI/AN governments under Public Law 93-638 the Indian Self Determination and Education Assistance Act (ISDEAA), Public Law 93-638 as amended.

The CHR Program is based on the concept that indigenous community members, trained in the basic skills of health care provision, disease control and prevention, would be able to achieve the most success in effecting change in community acceptance and utilization of limited health care resources.

The IHS recognizes that the CHR Program has made basic and important contributions to Indian health in its efforts to provide paraprofessional community-oriented health care services, and that the CHR Program should maintain its unique capabilities to provide community-based health care, HP/DP services.

The mission of the CHR program is to assist in raising the physical, mental, social, environmental and spiritual health of AI/ANs to the highest level. The CHR program’s goal is to provide quality health care and HP/DP services to AI/ANs through the use of well-trained CHRs, who are integrated into and partner with the patient’s health care team. The guiding principles are:

  • Committed to helping Tribal community members reach the highest attainable standard of health by addressing physical, mental, social, environmental and spiritual health through advocacy and education.
  • Honor and respect the customs and traditions of Tribal communities to build purposeful relationships that promote cultural awareness and understanding and facilitate access to essential health and human services.
  • Relentless pursuit of excellence and self-improvement to increase skills and ability to provide quality health services and promote wellness in Tribal communities.


Each CHR is responsible for providing services in accordance with his/her own level of education, experience, knowledge, skills, abilities, and competencies as defined within the individual’s position description and federal program policies under which he/she works. CHRs are health paraprofessionals as determined by Congress in the permanent authorization of the Indian Health Care Improvement Act (IHCIA). Preparation at the Basic CHR level is required for providing services to the community in the capacity of a CHR.

AI/ANs face multiple challenges in accessing care, including lack of fiscal resources, transportation and remoteness of communities. AI/AN communities and IHS are working to meet these challenges in ways such as telemedicine and mobile mammography. Even so, the personal, “high-talk, low-tech” approach that CHRs provide to patients is just as important to ensure that outreach, case-finding, monitoring, and follow-up outside the four walls of the clinic are done to facilitate patients’ access to health care services and resources across the spectrum of service settings.

Learn more about the IHS CHR Program.