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361 Additionally, politics had started to play a larger role in the health care arena. Today those pressures have not changed, but have been joined by other, more complex external influences: an environment of unparalleled Federal budget reductions, the transfer of many Federal programs and resources to States, decreases in discretionary programs in the Federal budget, the overall erosion of resources, and a strong antigovernment sentiment. Another significant additional pressure is the influence by competitive and economic based driven managed health care programs on the public health focus of health care. . . . . . . Collaboration with tribes and Indian leaders has increased. Tribes and Indian organizations are now involved in the development of the Indian Health Service budget and the setting of health priorities. An open style of management is taking hold; selections for key Indian leadership positions within the Agency are made with the direct involvement of tribal and Indian organization representatives within that Federal process; and the redesigning of the Indian Health Service is guided by a team of tribal and Indian leaders with Agency employees. We have made strides toward inclusion and involvement. In addition, tribal governments are identifying ways the Agency can be included in or supportive of their health delivery programs. I continue to believe that the Indian health system, comprising the Indian Health Service , tribal, and urban Indian programs, will improve the health of Indian people. . . . . . . Major decisions involve all tribes: those that contract with the Indian Health Service to provide their own health services, those that compact to assume administrative and operational control over their health programs, and those tribes that choose to stay within the Federal system of health care delivery. A new Indian Health Service budget structure and a business plan are being developed to reflect the commitment to self-determination and to provide for participation . At present, almost one-third of American Indian and Alaska Native people receive health services through tribal programs that were once administered and operated by the Indian Health Service. The trend of providing services through selfdetermination contracts and compacts is expected to continue and to increase within five years to where at least half of the American Indian and Alaska Native population, if not more, receive health services through tribal programs. . . . . . . I am particularly interested in the initiative to incorporate traditional healing as part of our health care program. I believe it is very important to the health of Indian people that traditional healing be respected and made a part of the policy and operations of our programs. I recognize that traditional healing methods are tribal- and culture-specific, therefore, our goal is to allow for maximum flexibility so that local communities can work with the service units to integrate traditional healing practices into Indian Health Service programs. I have just approved an Initiative on Domestic Violence and Child Abuse. Initiatives for the future include one on Disabilities, another on Veterans Health, and one on Men’s Wellness. The Indian Health Service has a proud history of success. The combined efforts of tribal, urban Indian, and Indian Health Service health programs will enable us to expand that success and lead us into the new era of Indian health care. . . . [The IHS Primary Care Provider: A Journal for Health Professionals Working with American Indians and Alaska Natives 21 (December 1996): 157–60.] 234. Bureau of Indian Affairs Strategic Plan September 30, 1997 In response to the Government Performance and Results Act of 1993, the Bureau of Indian Affairs, like other federal departments and agencies, drew up a Strategic Plan for the years 1997–2003. The plan, among other things, provided a mission statement and a list of general and specific goals, which give an indication of what the Bureau thought were its present duties and the directions it should pursue. 362 . . . . OUR MISSION The Bureau of Indian Affairs’ mission is to fulfill its trust responsibilities and promote selfdetermination on behalf of Tribal Governments, American Indians and Alaska Natives. The Bureau of Indian Affairs is the primary agency of the Federal Government charged with the responsibility to administer federal Indian policy and to discharge the federal trust responsibility for American Indian tribes, Alaska native villages and tribal organizations. Federal Indian policy and the trust responsibility are derived from the special legal and political relationship between the tribes and the federal government. . . . Today, the BIA provides services directly, or through Self-Determination contract, grant and compact agreements with tribes, to over 1.2 million...


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