Health Advisory Committees

A Tribal health program serves a community, and the community needs a meaningful way to be heard.

A health advisory committee can provide that connection. When properly structured, it gives Tribal members and other community representatives an opportunity to advise Tribal leadership and health-program management about health needs, priorities, concerns, and how the program is experienced by the people it serves.

An advisory committee, however, is not a substitute for Tribal Council and it is not a substitute for the Health Director.

The purpose of an advisory committee

The most useful role of a health advisory committee is to provide advice and community perspective.

Identify health concerns and priorities in the community.
Provide feedback about how services are working.
Help identify barriers to accessing care.
Bring community perspectives to planning and priority setting.
Improve communication between the health program and the community.
Help Tribal leadership understand how health policies and services are experienced by Tribal members.
Review proposed changes to services and provide recommendations.
Serve as a continuing source of community input rather than relying only on occasional complaints or individual contacts.

An advisory committee can see things that management may not see from inside the health program.

The committee does not run the health program

One of the most important management issues is establishing clear boundaries.

Tribal Council has the authority to govern the Tribal health program. The Health Director is responsible for managing the program within the authority and resources provided by Tribal leadership.

An advisory committee advises.

Unless Tribal law or policy specifically gives it additional authority, the committee should not:

Direct health-program employees.
Make individual personnel decisions.
Direct clinical decisions.
Decide individual patient eligibility or PRC cases.
Bypass the Health Director to manage the program.
Act as a substitute for Tribal Council.

These boundaries protect both the committee and the health program.

Without clear boundaries, an advisory committee can unintentionally become a second management structure. That can create confusion for employees, weaken accountability, and make it difficult for the Health Director to know who is responsible for a decision.

Who should serve?

The composition of an advisory committee matters.

Membership should reflect the community the program serves. Depending on the Tribe and the purpose of the committee, members might include Tribal elders, patients, parents, youth representatives, Tribal members with particular health concerns, and people with experience in health, education, social services, or other relevant areas.

The committee should not become simply another group of Tribal government employees.

Community representation is one of its greatest strengths.

At the same time, members need enough information to provide useful advice. Orientation about the health program, its financing, eligibility requirements, PRC, staffing, and limitations can make the committee substantially more effective.

A clear charter is important

A good advisory committee should have a written purpose.

The charter or governing policy should address:

The purpose of the committee.
Who appoints members.
Terms of membership.
Responsibilities of members.
How meetings are conducted.
What information the committee receives.
Who receives the committee’s recommendations.
How recommendations are communicated to Tribal Council and health-program management.
Confidentiality and privacy requirements.
What authority the committee does—and does not—have.

The clearer these expectations are, the more useful the committee can be.

Information and confidentiality

Advisory committees need information to provide meaningful advice, but health information is not simply another form of government information.

Patient confidentiality must be protected.

The committee generally does not need access to individual patient records to understand community health needs. Aggregate information, trends, program reports, patient experience information, and other appropriately protected information can often provide what the committee needs without exposing individual patients.

The Health Director should establish clear rules about what information can be shared and how it can be used.

The most important part: closing the loop

An advisory committee becomes frustrated when it makes recommendations and never hears what happened.

Management should acknowledge recommendations and, when appropriate, explain what action was taken—or why a recommendation could not be implemented.

That does not mean management must agree with every recommendation.

It means the community should know that its advice was heard and considered.

A simple process can help:

Community concern → Advisory Committee → Recommendation → Management/Tribal Council response → Community feedback

That feedback loop is often more important than the number of meetings held.

Questions for Tribal leadership

Does the health program have a meaningful mechanism for community input?
Is the advisory committee’s role clearly defined?
Does the committee understand the difference between advising and managing?
Does the Health Director receive and respond to its recommendations?
Does Tribal Council receive important recommendations when appropriate?
Are members representative of the community?
Are members given enough information to provide informed advice?
Are confidentiality and patient privacy protected?
Does the community know what happens to the recommendations it makes?

A practical management principle

A health advisory committee works best when everyone understands their role.

Tribal Council governs.
The Health Director manages.
The health professionals provide care.
The advisory committee provides community advice.

Those roles can—and should—work together.

The objective is not to create another layer of government. It is to make sure that the people a Tribal health program exists to serve have a meaningful voice in how that program develops.