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Addressing health disparities in Indian Country during COVID-19

by Elizabeth Fowler, Acting Director, Indian Health Service

Today, I provided testimony to the Senate Appropriations Committee Subcommittee on Interior, Environment, and Related Agencies Exit Disclaimer: You Are Leaving  on addressing health disparities in Indian Country and to review the Indian Health Services’ resources and needs. This was my first time testifying to Congress since serving as the acting director of the IHS. The IHS appreciates this opportunity to testify on our COVID-19 efforts and funding needs.

As we come to the 100-day mark of the Biden Administration, I am proud of the considerable accomplishments we have made in such a short period of time. We have administered more than 1.2 million vaccine doses across the Indian health system, increased drive-through testing sites, invested in next-generation testing, including at home tests and instant tests, and collaborated with the University of Baltimore, Maryland and Native American Lifelines of Baltimore to provide COVID-19 vaccines for American Indians and Alaska Natives and their household members in the Baltimore and Washington, D.C., areas.

The administration recently announced the investment of more than $4 billion Exit Disclaimer: You Are Leaving  to combat COVID-19 in Indian Country. This major investment in our communities supports our ongoing efforts to address long-standing health inequities experienced by American Indians and Alaska Natives. The coronavirus pandemic has highlighted the need for comprehensive, culturally appropriate personal and public health services that are available and accessible to American Indian and Alaska Native people.

It has been more than a year now that IHS and our dedicated workforce have been responding to COVID-19. Over the past year, IHS has worked tirelessly to ensure the safety of our IHS patients and staff, as well as tribal community members. During my testimony, I highlighted some of our considerable achievements, which include developing a COVID-19 data surveillance system and the IHS COVID-19 website to share critical health information, as well as important COVID-19 vaccine information and updates.

I also highlighted our support to tribes by ensuring their communities have access to safe water, which has also been an important aspect of the IHS COVID-19 response. In 2020, the IHS partnered with the Navajo Nation and other local organizations on a project using $5.2 million from IHS-appropriated Coronavirus Aid, Relief, and Economic Security Act funding to support the installation of 59 transitional water points on the Navajo Nation. These efforts have increased water access for over 9,600 homes without piped water, which is critical to support public health measures necessary to prevent the spread of COVID-19, and will remain critical beyond the pandemic.

As the IHS has expanded its use of technology to provide telehealth services during COVID-19, the pandemic has highlighted the challenges and risks posed by our current health IT system. This experience has reinforced IHS’ commitment to the modernization of our health IT infrastructure . The funding for electronic health record modernization provided by Congress in the CARES Act, the Fiscal Year 2021 appropriation, and the American Rescue Plan Act will allow us to proceed with the foundational steps in this important multi-year effort.

COVID-19 has also highlighted the consequences of long-term underinvestment in the Indian Health Service. The President’s Fiscal Year 2022 discretionary funding request Exit Disclaimer: You Are Leaving  provides a historic increase of $2.2 billion, or 36 percent, above Fiscal Year 2021 funding to increase access to high quality health care in Indian Country, and to begin remediating the impacts of chronic underfunding of the IHS. The request proposes advance appropriations for the IHS to insulate health programs from the impact of government shutdowns, and the uncertainty of annual appropriations. It also commits to a robust consultative process with tribes and urban Indian organizations to evaluate options to provide adequate, stable, and predictable funding for the IHS in the future.

I also emphasized the importance of protecting our patients and our employees from sexual abuse in a supportive environment. We have implemented extensive measures to promote and enhance patient safety and accountability, with multi-faceted efforts that involve oversight through quality assurance reviews, policy development and education, compliance enforcement, mandatory annual training for staff on the identification and reporting of sexual abuse in health care settings, and stringent professional standards and credentialing practices for our health care providers. We also recently announced a new hotline and website dedicated to receiving reports of suspected child or sexual abuse within an IHS facility and/or by an IHS staff member. These efforts are helping to improve the culture of accountability in everything we do across the IHS.

As we work towards recovery from COVID-19, we remain committed to working closely with our stakeholders and understand the importance of everyone coming together during this difficult time. We strongly encourage everyone to continue to follow CDC guidelines and instructions from your local, state, and tribal governments to prevent the spread of COVID-19 and protect the health and safety of our communities.

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Elizabeth Fowler, Acting Director, Indian Health Service

Elizabeth A. Fowler, a member of the Comanche Nation with descendancy from the Eastern Band of Cherokee Indians, is the acting director of the Indian Health Service. As acting director, Ms. Fowler administers a nationwide health care delivery program that is responsible for providing preventive, curative, and community health care to approximately 2.6 million American Indians and Alaska Natives in hospitals, clinics, and other settings throughout the United States.