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Pathways to Healthcare Professions

  • Need: Healthcare professionals and support staff are in high demand on tribal reservations in the Great Plains region.
  • Intervention: The Great Plains Tribal Chairmen's Health Board of South Dakota offer healthcare occupation courses for industry-recognized healthcare certifications and post-secondary degrees through the Health Profession Opportunity Grants program.
  • Results: Since the program's start, 241 participants have completed a healthcare training program, and 109 have found employment in healthcare occupations. Both participants and healthcare providers have expressed the value in local and cultural training for these healthcare professions.


Healthcare staff are in high demand on tribal reservations in the Great Plains region. For example, long-term care facilities are in need of licensed practical nurses and medical aides to help meet patients' medical needs while certified emergency medical technicians can help fill emergency medical service call schedules.

HPOG Logo In 2015, the Great Plains Tribal Chairmen's Health Board of South Dakota (GPTCHB) received a 5-year grant to conduct trainings in remote settings for Native Americans to advance in healthcare professions. Their program, Pathways to Healthcare Professions (PHP), is supported by the Health Profession Opportunity Grants (HPOG) and administered by the U.S. Department of Health and Human Services' Administration for Children and Families. Since 2010, HPOG has supported more than 32 healthcare professional training programs, including 8 through Tribal Organizations and Colleges.

PHP is the only HPOG program to offer a flexible training format on reservations for residents who would otherwise not have these opportunities. Training takes place in a classroom setting and at clinical sites for practical application. The program values cultural sensitivity and ties Native American cultural practices and traditions into their training.

PHP has been especially beneficial for American Indian Temporary Assistance for Needy Families (TANF) recipients and other low-income individuals. The program covers supplemental tuition and materials, as well as some support services like transportation and childcare. PHP trains students in various supportive healthcare professions, filling healthcare workforce needs and preparing students for future employment.

Pathways to Healthcare Professions Logo

PHP is a collaboration of academic institutions, human service, and workforce agencies in South Dakota and Nebraska.

Academic Partners:

Human Service and Workforce Agency Partners:

PHP has built additional relationships with the following healthcare facilities and nursing homes in Rapid City, Eagle Butte, and northwestern Nebraska to serve as clinical training sites and future employers of PHP graduates:

Services offered

Participants choose a career path that will train them in the following healthcare professions. Upon completion, they have the opportunity to earn an industry-recognized healthcare certification or a post-secondary degree.


  • Certified Nursing Assistant (CNA)
  • Medication Aide (MA)
  • Medical Insurance Coding and Billing

Post-Secondary Degrees:

  • Emergency Medical Technicians (EMT)
  • Licensed Practical Nurse (LPN)
  • Registered Nurse (RN)
  • Paramedic

PHP core staff includes a project director, program manager, program coordinator, student coach, career advisor, and a health educator. Staff help students stay on track with their courses and provide additional services, such as:

Administrative Support (in partnership with academic institutions)

  • Project management and coordination
  • Curriculum building
  • Case management
  • Recruitment and enrollment

Academic Success

  • Cover the cost of training supplies, supplemental tuition, books, study materials, and testing fees
  • Facilitate tutoring and exam preparation with academic partners
  • Provide materials needed to complete the training, including Wi-Fi access, laptops, scrubs, stethoscopes, and transportation to testing sites

Job Readiness

  • Provide assistance building resumes, cover letters, and job applications
  • Mock interviewing and professional attire advice
  • Professionalism, ethics, and etiquette taught as part of each course
  • Regular follow up with students once a job is secured

Financial Assistance

  • Assistance or vouchers in emergency situations such as utility disconnection, vehicle repairs, childcare, or fuel assistance


PHP's goal over 5 years of the grant-funded program is to enroll 350 participants and see 225 of them complete their training. In the first 2 years of the program, PHP has increased their reach, formed new partnership, and improved their recruitment and referral processes. The following results cover their recent efforts as of November, 2018:

  • 300 participants have enrolled in the PHP program
    • 241 participants have completed a healthcare training program
    • 59 are currently in the program
  • 33 participants have enrolled in a 2- or 4-year nursing program to earn their associate or BSN degree
  • 109 participants have been employed in healthcare occupations
    • 32 participants who were already employed by a healthcare facility when starting the PHP program earned a promotion or a raise

Participants noted:

  • The additional services related to job readiness and social supports were valuable aspects of the program.
  • Others in their communities took notice of students' success and were encouraged to pursue their own educational attainment.
  • Having healthcare staff trained in Native American cultural values brought a sense of comfort to Native American patients.

Healthcare employers have expressed the benefit of hiring Native American professionals, especially because of their impact on the fellow Native American patients they serve.

For more information about the evaluation of this program: Tribal Evaluation of the 2nd Generation of Health Profession Opportunity Grants.

For an overview of the second round of HPOG Grantees: An Introduction to the Tribal Health Profession Opportunity Grants (HPOG) 2.0 Program and Evaluation.


  • When PHP didn't reach their target enrollment of TANF recipients, they began focusing their recruitment efforts, visiting the South Dakota Department of Labor and Regulation office on a biweekly basis and building relationships with staff to increase referrals.
  • Lack of housing on reservations served by PHP prevented out-of-town students from registering for classes and graduates from applying for jobs. Those who had reliable means of transportation or money to pay for gas would sometimes travel up to 100 miles to attend classes.
  • Childcare was a need for many students enrolled in PHP, but childcare centers are rare on reservations and parents had a hard time securing consistent help to watch their children.
  • Getting access to a computer in order to complete coursework was difficult for some. Spotty internet service and broadband inconsistency prevented some students from being able to complete their coursework on time.
  • One factor that may prevent TANF recipients from enrolling in the PHP program is the background check required of healthcare facilities upon employment. Most healthcare employers will not hire an individual with a felony conviction on their record.
  • Because family is of high priority in Native American culture, students often dropped out of the program or missed classes if a family member needed extra care. PHP encouraged the involvement and interest of families in students' education by inviting them to events, social gatherings, or ceremonies offered by the program.
  • Maintaining current contact information for student records is sometimes challenging for PHP staff. When students have to choose between paying their electric bill versus their phone bill, many choose to go without phone service until funds become available. Therefore, phone numbers change frequently.
  • Program staff experienced glitches with the computer program that stored students' information. Some information that was previously entered was not visible and program updates sometimes interfered with the information recorded.
  • While they believed they were adequately trained in their area of study, participants also believed that the rapid pace at which the information was taught was overwhelming at times.


  • PHP staff utilized many different avenues to promote their program, including social media; television commercials; flyers; email; billboards; word-of-mouth; and regular visits to high schools, local businesses, and TANF offices.
  • Having a traveling trainer to educate program participants locally has contributed to the high rate of participant completion. Educational partners who have provided assistance in curriculum planning and hosted health career training programs have also played a key role in the program's success.
  • Before the program launched, one of the first steps was asking healthcare providers what type of healthcare positions they needed filled. They also contacted key leaders and potential partners to get a better understanding of resources that already existed for students and what was still needed. This helped PHP narrow their selection of healthcare occupations they offer.

Contact Information

Patty Eagle Bull, Director of Training & Education
Pathways to Healthcare Professions

American Indian or Alaska Native
Emergency medical technicians and paramedics
Health aides and assistants
Health occupations
Health workforce education and training
Health workforce supply and demand

States served
Nebraska, South Dakota

Date added
December 3, 2018

Suggested citation: Rural Health Information Hub, 2018. Pathways to Healthcare Professions [online]. Rural Health Information Hub. Available at: [Accessed 14 June 2021]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.