The Tribal Health Care Delivery System:
There are 229 federally recognized tribes in Alaska. The state is divided into 9 health care delivery areas (or service units) – each area is as large as a state in the lower 48 with a low population density, no road systems, extreme weather conditions, and a very high cost of living. In each service unit, the tribes have selected an entity to provide the health care services for the region, although some tribes have chosen to retain provision of local health care services.
The tribal health care delivery system is operated under a statewide compact with the federal government authorized under PL 93-638. There are six rural hospitals operated by the tribes, with tertiary care services provided at the Alaska Native Medical Center in Anchorage, which is operated by the Alaska Native Tribal Health Consortium www.anthc.org representing all the tribes.
There are over 25 health centers with at least a mid-level practitioner providing health care services. Each small village has a local clinic staffed by Community Health Aides and Practitioners (CHA/P) www.anthc.org/cs/chs/chap/ These are local people chosen by the village council and trained under a a five-tiered career ladder curriculum. The tribal health care system developed training standards for the CHA/P program that includes certification by a board of directors. Mid-level clinics exist in many larger communities. Additional clinics are being developed with federal grant funds for the construction and some operational assistance in collaboration with the Denali Commission www.denali.gov
Most tribal health care programs include mental health and substance abuse programs and some level of home and community based services supporting the elderly and disabled within their community of residence. These may include Home and Community Based Waivers, and/or the Personal Care Attendant program through the Division of Senior and Disabilities Services and Home Health through the Division of Health Care Services.