Managing a Tribal Health Program
What does a Tribal leader or community member need to know about the job of a Tribal Health Director?
Managing a Tribal health program is a demanding job. A health director is responsible for much more than the operation of a clinic or the supervision of health care staff. The director must manage people, programs, budgets, federal requirements, health care resources, and relationships with Tribal leadership and the community.
These pages provide a practical introduction to the major responsibilities and challenges involved in managing a Tribal health program.
The material draws on my experience in IHS facility administration, as health director for three Tribes in Washington State, and in executive leadership and policy at the Northwest Portland Area Indian Health Board.
Scope of experience. My direct management experience has primarily been with smaller Tribal health programs serving populations of fewer than 10,000 patients. I have also consulted on management issues for larger Tribes with IHS-operated programs, including the Confederated Tribes of the Colville Reservation in Washington. The material in this section should therefore be understood primarily as practical experience with smaller Tribal health programs, rather than as a comprehensive account of managing large IHS-operated systems.
For Tribal leaders and community members
The primary audience for these pages is Tribal leadership and community members who want to better understand what a Tribal health director is responsible for and how a Tribal health program operates.
Health directors and managers need more detailed professional training than these pages provide, and these pages are not intended to replace it.
They are intended to help Tribal leaders understand the health program they govern, ask better questions, establish realistic expectations, and support effective management. They may also be useful to health program staff who are unfamiliar with the full scope of the health director’s responsibilities.
What the job involves
A Tribal health director works at the intersection of Tribal government, health care, federal Indian health policy, financing, and the needs of the community.
The director must balance competing demands while working within available resources and the requirements governing the health program.
Select a topic below to explore its dedicated webpage and supporting materials.
Understanding the Job
- A Dangerous Position: The Health Director’s Job
- Managing the Health Program: From Problems to Decisions
- What Tribal Council Needs to Understand
- Health Advisory Committees
- Clinical Services and Staff
Managing Resources
- Financing a Tribal Health Program
- Eligibility
- Purchased/Referred Care
- Health Information Systems
- Grant Proposals and Grant Management
Managing Health Services
A practical resource
This material was originally developed for an earlier website, Management & Policy Analysis for Indian Health (2017–2023). Some Tribal health directors used those materials to help staff understand the roles of health directors, deputy directors, and other management and policy staff.
The materials have been revised and gathered here because the practical experience behind them remains useful.
They are offered freely and without restriction for Tribal leaders, health professionals, staff, students, and others interested in understanding Tribal health programs.
The basic principle
A Tribal health program is more than a clinic.
It is a complex Tribal government operation that must bring together governance, people, financing, clinical services, public health, and community needs.
Understanding how those pieces fit together is essential to managing the program effectively—and to governing it effectively.
For the financing behind these responsibilities, see the Papers and the Indian Health Finance course.