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IHS 2022 Year in Review

by Roselyn Tso, Indian Health Service Director

As we come to the end of 2022, I want to reflect on the achievements across the agency. We have expanded access to health care and taken aggressive action to protect our tribal communities. We acknowledge the working partnerships with tribal leaders and urban Indian organization leaders and the organizations that support our mission, and we thank the many dedicated employees and providers at the IHS.

This year we achieved, for the first time, advance appropriations for the Indian Health Service, providing the agency with timely and predictable funding necessary to provide high quality health care services to 2.7 million American Indians and Alaska Natives across the country. This historic change will largely protect health programs from government shutdowns and ease the administrative burden of operating hospitals and health clinics.

For nearly three years now, our dedicated IHS workforce has responded to the COVID-19 pandemic. This year, we launched the Test to Treat initiative to assist people with quick access to lifesaving treatments, which started with 34 pilot sites and since expanded to 223 sites. We have also increased access to health care across the agency by expanding telehealth services across IHS federal facilities and continued our focus on modernizing our electronic health record system.

Encouraging and Supporting Vaccination in Indian Country

The IHS recently announced the IHS E3 Vaccine Strategy as a critical public health prevention priority in our vulnerable service population. IHS advocates recommending vaccines to our patients. E3 focuses on 1) Every patient at 2) Every encounter should be offered 3) Every recommended vaccine when appropriate Exit Disclaimer: You Are Leaving .

We ensured the inclusion of urban Indian organizations in the agency's promotion and administration of vaccines in urban Indian communities. To date, $480 million of COVID-19 funding has been allocated to UIOs, and in September, the IHS announced that an additional $2.4 million of Coronavirus Response and Relief Supplemental Appropriations Act funding would be dispersed to UIOs.

Expanding Health Care Services

This year, the IHS expanded services in tribal communities celebrating the opening of a number of facilities across Indian Country including the Little Shell Tribal Health Clinic in Great Falls, Montana and the White Buffalo Health Center and re-opening of the Verne E. Gibbs Health Center in the Fort Peck Service Unit.

The IHS Mid-Atlantic Service Unit in Virginia opened three mobile units to offer primary services until the ongoing Mid-Atlantic Tribal Health Clinic and the Monacan Health Center projects are completed. In Oklahoma, we partnered with the Cheyenne and Arapaho Tribes to expand the El Reno Indian Health Center.

In October, the IHS opened the Sacred Oaks Healing Center, a youth regional treatment center in Davis, California, to provide culturally appropriate substance use disorder and behavioral health treatment to youth. And in June, the Yukon-Kuskokwim Primary Care Center opened in Bethel, Alaska, a project funding through the IHS Joint Venture Construction Program.

Investing in Tribal Communities

In support of public health preparedness, infrastructure improvement and disease prevention, we invested a total of $9 billion dollars to support IHS, tribal, and urban Indian health programs to expand vaccinations, testing, public health surveillance and health care services throughout the pandemic.

An additional $3.5 billion was received from the Bipartisan Infrastructure Law Exit Disclaimer: You Are Leaving  to improve tribal water and sanitation systems, including $700 million in fiscal year 2022 funding for 475 sanitation facilities construction projects serving 71,000 American Indian and Alaska Native homes. Through the American Rescue Plan, IHS received $210 million to support public health workforce activities to bolster the capacity of tribal communities to respond to COVID-19 and future emergencies.

We are confronting diseases that significantly impact American Indian and Alaska Native communities. The IHS distributed $5 million to address Alzheimer's disease to develop models incorporating comprehensive approaches to care and service for people living with dementia. This funding marks the first time IHS will allocate funds for this critical need. The IHS also distributed $5 million for Ending the HIV Epidemic in the U.S. to support work toward eliminating HIV and hepatitis C in Indian Country.

We announced decisions on the $147 million authorized for the Fiscal Year 2023 Indian Health Service Special Diabetes Program for Indians, expanding the program from 275 to 302 grantees for 2023. We invested $43.4 million in tribal communities Exit Disclaimer: You Are Leaving  to support behavioral and mental health programs that address several issues, including substance abuse, suicide, and domestic violence prevention.

Fostering Partnerships

We also updated our 2018 MOU with the Johns Hopkins University Center for American Indian Health Exit Disclaimer: You Are Leaving , focusing on designing sustainable interventions by community health workers.

We strengthened partnerships with national universities through fellowships, residencies and clinical rotations to bring talented new practitioners into our facilities. Some examples include our agreement with Dartmouth College Exit Disclaimer: You Are Leaving  to support activities Exit Disclaimer: You Are Leaving  focused on generating positive change in Indigenous communities, and in the Great Plains Area, pediatric residents at Eagle Butte Hospital work under the direction of pediatricians from Boston Children’s Hospital.

Supporting Indian-owned Businesses

We aligned processes with the Bureau of Indian Affairs Exit Disclaimer: You Are Leaving  to facilitate more contracting opportunities for eligible entities under the Buy Indian Act Exit Disclaimer: You Are Leaving . In fiscal year 2022, IHS obligated $323.9 million to Native owned and controlled businesses. This is a significant increase from the previous year in which IHS obligated $55.9 million.

Engaging Tribal and Urban Indian Organization Leaders

In November, IHS initiated tribal consultation and urban confer to seek additional input on the final draft of the 2023-2027 IHS Office of Urban Indian Health Programs Strategic Plan and Implementation Plan to grow and expand support of UIOs to meet their communities' unique needs. Additionally, the IHS Directors Advisory Workgroup on Tribal Consultation continues its work with tribal leaders on updating the agency's Tribal Consultation Policy.

Quality Improvement Efforts

We identified and implemented processes to monitor and sustain quality improvement efforts due to hospital and health center accreditation and certification survey findings. In 2022, certification and accreditation organizations conducted 42 accreditation and certification surveys at IHS facilities. Many of these facilities completed these surveys through the added challenges of responding to COVID-19. Decision letters from the accreditation and certification entities resulted in full certification or accreditation for all surveyed IHS facilities.

As we move into the new year, the IHS draws from the faith, traditions and resilience of our American Indian and Alaska Native communities. Throughout these efforts our priority will remain the same, which is the safety of our patients, staff and tribal community members.

I wish you and your family happiness, peace and good health in the new year!

Roselyn Tso, Indian Health Service Director

Roselyn Tso, an enrolled member of the Navajo Nation, is the director of the Indian Health Service. As director, Ms. Tso administers a nationwide health care delivery program that is responsible for providing preventive, curative, and community health care to approximately 2.7 million American Indians and Alaska Natives in hospitals, clinics, and other settings throughout the United States. She previously served as the director of the IHS Navajo Area, where she was responsible for providing leadership in the administration of a comprehensive federal, tribal, and urban Indian health care system for over 244,000 American Indians and Alaska Natives throughout Arizona, New Mexico, and Utah.