Community Health Workers in Tribal Communities

Community health workers (CHWs) serving tribal communities, referred to as community health representatives (CHRs), are considered the oldest CHW workforce program. Recognizing the unique work of CHRs within tribal communities, Congress established the Indian Health Service (IHS) CHR program in 1968. The CHR program is solely carried out by tribal governments through legal arrangements with IHS.

The CHR program was designed specifically to meet the need for greater involvement of tribal populations in their own health programs, including identifying and solving health problems. Multiple research studies have found evidence of CHR effectiveness within tribal communities, including reducing risk factors for kidney disease among Zuni Tribal members in rural New Mexico and helping patients change their lifestyles to manage health conditions in the Navajo Nation Tribe.

CHWs and specifically CHRs are particularly suited to working in tribal communities and other populations due to their shared history and culture with those they serve, an understanding of the challenges faced by community members, and deep connections with the community.

Resources to Learn More

Community Health Representative Program
Website
Provides outreach healthcare services including health promotion and disease prevention services to American Indians and Alaska Natives within their communities.
Organization(s): Indian Health Service

Family Spirit
Website
Offers an evidence-based culturally designed in-home parent training and support program delivered by community-based health educators for Indigenous caregivers during pregnancy and early childhood.
Organization(s): Johns Hopkins Center for Indigenous Health

National Association of Community Health Representatives
Website
Represents professionally trained community health representatives (CHRs) who provide outreach healthcare services to American Indians and Alaska Natives within their communities. Advocates for professional development of CHRs to increase their skills and knowledge in the provision of health services and expresses their concerns to the Indian Health Service.
Organization(s): National Association of Community Health Representatives