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Safe Water and Waste Disposal Facilities


Adequate sanitation facilities are lacking in approximately 52,000 American Indian and Alaska Native homes (or 12.5 percent). Of these homes approximately 6,600 (or 1.6 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. A recent cost benefit analysis indicated that for every dollar IHS spends on sanitation facilities to serve eligible existing homes, at least a twentyfold return in health benefits is achieved. The IHS Sanitation Facilities Construction Program has been the primary provider of these services since 1960.


There is a backlog of 1,563 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 $2.6 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 2020

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