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Safe Water and Waste Disposal Facilities


Adequate sanitation facilities are lacking in approximately 38,000 American Indian and Alaska Native homes (or 9.5 percent). Of these homes approximately 7,100 (or 1.8 percent) lack access to a safe water supply and/or waste disposal facilities, compared to less than 1 percent of homes for the U.S. general population.


Sanitation engineers installing pipelines

Families with satisfactory environmental conditions in their homes, which include safe water and sewerage systems, require appreciably fewer medical services and place fewer demands on the Indian Health Service (IHS) and tribal primary health care delivery system. The Indian Sanitation Facilities Act, Public Law 86-121, authorizes the IHS to provide essential sanitation facilities, such as safe drinking water and adequate sewerage systems, to Indian homes and communities.

The IHS Sanitation Facilities Construction Program is a preventative health program that yields positive benefits and is a good investment. Access to water and waste water disposal facilities has been shown to reduce cases of respiratory, skin and soft tissue, and gastro enteric disease. It is estimated the water and waste water projects funded in FY 2020 will save over $259 M in cost due to a reduction in healthcare facility visits alone. Every $1 spent on water and sewer infrastructure will save $1.18 in avoided direct healthcare costs. The IHS Sanitation Facilities Construction Program has been the primary provider of these services since 1960.


There is a backlog of 1,580 needed sanitation facilities construction projects. The cost to provide all American Indians and Alaska Natives with safe drinking water and adequate sewerage systems in their homes is estimated to be $3.1 billion. With inflation, new environmental requirements, and population growth, the current sanitation appropriations are not reducing the backlog. In addition to providing safe sanitation facilities to existing homes, the IHS also provides sanitation facilities to new homes.


The IHS, in consultation with tribes, annually identifies sanitation facility needs. The IHS and tribes will continue to collaborate with other federal agencies, states, and organizations to provide needed resources for these essential facilities.


Please access the Division of Sanitation Facilities Construction website.

For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.

May 2021

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