This is How We Build the Tribal Health Workforce

Navajo Nation President Russell Begaye and Dr. Glorinda Segay, director of Navajo Department of Health and co-chair for the Community Health Aide Program Tribal Advisory Group.

Published March 24, 2018

PHOENIX— Navajo Nation President Russell Begaye attended the first meeting for the Community Health Aide Program (CHAP) Tribal Advisory Group (TAG) on Mar. 21-22 to build the tribal health workforce and increase access to health care for Native Americans across the country.

“There are gaps in the healthcare workforce that need to be filled,” President Russell Begaye said. “And the group here is responsible for developing the policy allowing community members to fill those gaps. What this means is shorter patient wait times, more preventative care and better health outcomes overall. At the head of this effort, empowering tribal nations stands Navajo.”

CHAP TAG is a newly created group charged with providing input and feedback to Indian Health Service (IHS) to expand the use of community health aides, which are mid-level health care providers. Specifically, there are two primary positions under examination for the federal expansion of CHAP: dental health aides and behavioral health aides.

Dr. Glorinda Segay, director of the Navajo Department of Health, was nominated and selected as the tribal co-chair for CHAP TAG and she will serve with Dr. Beverly Cotton who is the federal co-chair.

“This is a great opportunity for Native Americans,” Segay said. “Navajo’s community health representatives have been successful in improving health outcomes largely because they have a cultural and traditional basis. We see the opportunity for community health aides to do the same.”

On the Navajo Nation, there are currently 99 community health representatives that provide health outreach, health promotion and disease prevention services under the tribe’s Community Health Representative and Outreach Program. These individuals are frontline public health workers. They are from the communities they serve and, as a result, are culturally competent and have a low turnover rate.

There are key differences between community health representatives and community health aides. However, as one of the group members put it, both are bound by the concept of community health. Essential differences discussed at the meeting focused on how aides have a broader scope of practice than representatives, the different funding sources and how each is shaped by separate legislative authorities.

Objectives of CHAP TAG that were discussed included building a training curriculum, establishing and maintaining a certification board, creating a supervision and evaluation process and more to ensure that community health aides are highly qualified and receive accreditation, certification or both.

President Begaye called attention to the Navajo Nation’s managed care organization (MCO) and his desire to incorporate its requirements in the development of CHAP.

“Community health aides should be required to meet the standards of an MCO. We are creating our own to have greater self-determination over our own health care system,” President Begaye said. “Every patient, every tribal community—we need to make sure their health needs are taken care of.”

CHAP TAG will continue meeting to develop its recommendations for the IHS policy to expand the federal program. The date and location for next meeting have not yet been determined.

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