health care access

Harvard Project: COVID-19 Resources for Indian Country Toolbox

Year

As the country responds to the coronavirus (COVID-19) pandemic, the task before tribal nations is complicated by many unknowns. The Harvard Project recognizes the challenges you're up against and we want to help. We are not experts in the health consequences of the pandemic, but we are monitoring tribal governments' response to the crisis. Across Indian Country, we are witnessing tribal leaders and national Native organizations taking action to protect and position Native nations to see a better tomorrow. These examples and many more make up the contents of this COVID-19 Resources for Indian Country toolbox. We've pulled together resources that demonstrate ways to build governance capacity, illustrate best practices by tribes, provide trusted information about the virus itself, and supply tribal health ordinances intended to meet your immediate needs. Native nation building begins with strong governance, and we hope the examples in this toolbox spark ideas for action that strengthens your community.

Native Nations
Resource Type
Citation

The Harvard Kennedy School Project on Indigenous Governance and Development. "COVID-19 Resources for Indian Country." November 2021. Online Toolkit. (https://sites.google.com/g.harvard.edu/covid-19-resources/..., accessed May 31, 2023.)

Native Nation Building and the CARES Act

Producer
Native Nations Institute
Year

On June 10, 2020 the Native Nations Institute hosted an a online panel discussion with Chairman Bryan Newland of the Bay Mills Indian Community, Councilwoman Herminia Frias of the Pascua Yaqui Tribe, and hosted by Karen Diver the former Chair of the Fond du Lac Band of Lake Superior Chippewa and the Director of Business Development for the Native American Advancement Initiatives for the Native Nations Institute. These distinguished tribal leaders brought their wealth of knowledge and first-hand experience in making Indigenous Governance address the needs of their Native communities in response to the crisis surrounding COVID-19. Across Indian Country the pandemic has brought a rise in new challenges and bringing old ones to more prominence when dealing with the Federal Government for appropriate resources. The CARES Act was passed to address some of these needs but does not deal with the root of the issue many Native Nations face in asserting the methods of self-governance. The panelists provide insights on ways they are working to help the citizens of their Native Nations be resilient under constraints of emergency response. 

Transcript available upon request. Please email: nni@email.arizona.edu

Puyallup's Institutionalized Quality Improvement Program

Year

Following a major tribally-initiated restructuring in the early 1980s that created a quality improvement committee and a flatter organizational structure, the PTHA has increased patient access for urgent care visits, reduced "no show" rates, created clinical objectives, increased dental treatments, and incorporated the use of traditional healers into health care delivery. The Puyallup Tribe's Quality Improvement Program has enabled the PTHA to effectively address many of the health care needs of the community that were previously unmet under the Indian Health Service's management. With six full time physicians and a staff of 210, the PTHA has become a model for other Indian nations seeking to create and sustain health systems that meet the highest standard of excellence.

Native Nations
Resource Type
Citation

 "Institutionalized Quality Improvement Program". Honoring Nations: 1999 Honoree. The Harvard Project on American Indian Economic Development, John F. Kennedy School of Government, Harvard University. Cambridge, Massachusetts. 2000. Report.

Permissions

This Honoring Nations report is featured on the Indigenous Governance Database with the permission of the Harvard Project on American Indian Economic Development. 

Does more equitable governance lead to more equitable health care? A case study based on the implementation of health reform in Aboriginal health Australia

Year

There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments.

The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. The study included data on the uptake of Aboriginal health assessments from July 2008 to December 2012. The study population was 83190 in 2008/9, 856986 in 2009/10, 88256 in 2010/11 and 90903 in 2011/12. Logistic regression was used to examine the relationships between organisations within forums and the regional uptake of Aboriginal health assessments. The independent variables included before and after the AHNPA, state, remoteness, level of representation from Aboriginal organisations and links between Aboriginal and mainstream organisations.

The introduction of the AHNPA was associated with a shift in power from central government to regional forums. This shift has enabled Aboriginal people a much greater voice in governance. The results of the analyses show that improvements in the uptake of health assessments were associated with stronger links between Aboriginal organisations and between mainstream organisations working with Aboriginal organisations. Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity.

Resource Type
Citation

Kelaher, M.,Sabanovic, H., La Brooy, C., Lock, M., Lusher, D., Brown, L. "Does more equitable governance lead to more equitable health care? A case study based on the implementation of health reform in Aboriginal health Australia." Social Science & Medicine. Volume 123. December 2014. Paper. (http://www.sciencedirect.com/science/article/pii/S0277953614004614, accessed April 5, 2023)