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Rural Health Information Hub

Community Health Workers in Tribal Communities

Community health workers (CHWs) in American Indian/Alaska Native (AI/AN) communities, referred to as community health representatives (CHRs), are considered the oldest CHW workforce program. Congress established the program in 1968. CHRs were recognized for their unique work on their reservations and in their communities under the Indian Health Care Improvement Act of 1987. The CHR program is solely carried out by AI/AN governments through legal arrangements with Indian Health Services (IHS).

The CHR program in AI/AN communities was designed specifically to meet the need for greater involvement of AI/ANs in their own health programs, and greater participation by Native Americans in identifying and solving health problems. A recent study of a CHR program for Zuni Indians in rural New Mexico found CHRs to be effective in reducing risk factors for kidney disease. Another recent qualitative study of a CHR program in the Navajo Nation explored patients’ experiences with the program, noting that the CHR program helped patients to change their lifestyles and manage their conditions, patients felt that they and their families benefited from health education, and patients approved of CHRs’ respect of traditional practices.

CHWs and specifically CHRs are particularly suited to working in American Indian/Alaska Native communities 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.

See the Rural Tribal Health topic page for more information about the health of tribal communities in rural areas.

Resources to Learn More

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

Family Spirit
Provides information, research, and training with regard to an evidence-based home visiting program of paraprofessionals that has been culturally tailored for use in in American Indian/Alaskan Native communities.
Organization(s): Johns Hopkins Bloomberg School of Public Health

National Association of Community Health Representatives
Presents information about the National Association of Community Health Representatives, which represents 264 Community Health Representative (CHR) programs in the U.S.
Organization(s): National Association of Community Health Representatives