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Community Health Representative (CHR)

The Community Health Representative (CHR) Program emphasizes Indian involvement in community health issues. It is generally accepted that the CHR program began in 1968, but the CHR program was not a creation of the Indian Health Service. The Office of Economic Opportunity (OEO) initially funded the Community Health Aide Program in 1967. In 1969, IHS requested funds to train 250 Community Health Aides in Alaska. By 1972, the last OEO-CHR program was transferred to IHS, which increased its support and training of CHRs to 1,003 in FY '74. IHS has held that the CHR program was created to meet four needs:

  • The need for greater involvement of American Indians/Alaskan Indians in their own health programs, and greater
  • participation by Native Americans in the identification and solving of their health problems.
  • The need for greater understanding between the Indian people and the Indian Health Service Staff.
  • The need to improve cross-cultural communication between the Indian community and the providers of health service.
  • The need to increased basic health care and instruction in Indian homes and communities.


The CHRs are paraprofessional indigenous community based trained health care staff contracted by the IHS with Tribal governments. Tribes have the flexibility to hire and design health care programs to meet Tribal members health needs through coordinated care for community members in their homes.

CHRs attend a 2 week basic course emphasizing Public Health and home health care concepts and vital sign and other patient handling skills using the Zucker Home Health Aide textbook. Completion of pre-course training modules and current certification in basic Cardiopulmonary Resuscitation (CPR) from AHA, ASHI, ARC or NSC is required prior to attending the two-week on site training. CHRs are encouraged to attend a 1 week refresher training every 3 years thereafter to update their health care skills. The OCA-IHS-CHR Consultant encourages all Tribal CHR Programs to work closely with their local IHS and Tribal clinics and hospitals to update and document their proficiency in taking vital signs, and other general screening assessments. On an annual basis Basic, Refresher, First Responder and CHR PCC training are offered at no cost to Tribal Programs who have left their CHR Program shares. Tribes who have taken their shares can buy back into these training opportunities.

The CHR Program documents its services utilizing the IHS RPMS CHR PCC (BCH) package. This reporting system is the only method available to IHS-HQ to respond to timely congressional inquiries on the Tribal CHR Programs and helps justify annual appropriations and support budget justification/increases. CHR PCC allows CHRs to document workload and direct patient care services and activities.

Benefits of using the CHR PCC package. [DOC - 36 KB]

To get set up and obtain access to the RPMS CHR PCC Package contact your local IT Site Manager at your local facility and contact the Area CHR Consultant for training.

The Area CHR Consultant provides program technical assistance. This includes training, proposal development, periodic site visits, transportation issues, developing program plans and meeting with the Oklahoma Area Association of CHRs. The CHR Program is guided by the Indian Health Manual, Part 3, Chapter 16. For more information regarding the CHR Program aspects, contact Debra Isham, Area Community Health Representative Consultant, Oklahoma City Area Indian Health Service. For CHR Contract information contact your Project Officer. For Oklahoma Area that is Jennifer Lamere.