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
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
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
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
Organization(s): Johns Hopkins Bloomberg School of Public Health