Tribal Self-Governance Study Workgroup Meeting
January 5, 20001
MEETING SUMMARY
HISTORY AND CONCEPT OF TRIBAL SELF-GOVERNANCE:
Self-governance is a concept that has been advancing during the past 25 years. The purpose of self-governance is to empower the approximately 560 Federally recognized tribes in the United States. The experiment with self-governance began in the late ?80's through the Bureau of Indian Affairs of the Department of Interior with moving functions to the Tribes that had historically been operated by the Federal department to serve Indians and Tribes. Tribes succeeded in obtaining the right to operate these programs themselves. This concept implied treating tribes as governments. The success of the early experiments with self-governance has led the Congress to expand the concept. The Indian Health Services was the next set of major Department programs to be subjected to self-governance. The transition to self-governance is not an all or nothing approach but rather involves identifying eligible and appropriate programs and introducing a negotiation process by which tribes apply for a role of greater independence. Self-governance by Tribes necessarily involves limiting some of the ordinary controls exercised by Federal agencies in programs over which they have had, by statute, administrative responsibility.
A key objective of self-governance is to identify how to be more efficient with limited dollars and better serve the needs that exist. Another objective is greater tribal discretion, enabling tribes to select programs and combine funds to more effectively serve the tribal community. The expectation is that the advance of self-governance within the context of Department of Health and Human Services (DHHS) programs will be incremental and subject to testing and validation through experience by the Tribes and the Department. Sophistication that the leaders and tribal members now have has grown through their experience in managing programs formerly operated by the Bureau of Indian Affairs, DOI and by the Indian Health Service, DHHS, enabling a partnership between Indians and Federal program managers to evolve. It is important to approach the substantive problems and objections in an open minded fashion and to alleviate fears that waste or mismanagement of public funds might result.
“Inherent Federal functions” stay with an agency; the remaining areas represent potential shares for tribes to take over as far as both functions and resources (direct and administrative overhead). Tribes seek flexibility that allows them, at the local level to: redesign and coordinate programs to seek to achieve greater effectiveness. Although there are only about 30 self-governance agreements currently, over 200 tribes, over 40%, are currently involved in varying degrees of self-governance. An example is the Jamestown S’Klallum Tribe which took over and remade a managed health care program which it now runs which includes operating the health clinics.
At BIA, self-governance began as a demonstration; when reauthorized, it was made mandatory for the entire Department and made permanent. Federal DOI, non-BIA staff were reluctant to move forward because of concern about the impact. Title IV, regulations, applying to DOI go into effect January 16, 2001. There are some provisions that are inconsistent with Title V that are going to have to be worked out.
For DHHS, the tribes would have preferred to go directly to a demonstration rather than engage in a feasibility study during this first year, but they consider the study will be a positive step that will move the process along. The Jamestown S’Klallum Tribe provided copies of a paper: “Self- Governance: A Tribally-Driven Congressional Initiative” which more fully describes their perspective on this subject.
The reason that the current self-governance statutes state unequivocally that the “trust” relationship between the Federal government and the Tribes is guaranteed, even if a Tribe is electing self-governance is that the Tribes have historically had a fear of termination (actually threatened in earlier negotiations with DOI/BIA), in which the Federal government might drop its constitutional, treaty, and judicial responsibilities to tribes on the argument that self-governance replaces these obligations. The current law provides that this not occur.
The Department’s Tribal Self-Governance Advisory Committee (TSGAC) was initially set up to advise IHS as it proceeded with implementing self-governance and provide a liaison function between Indians and the Department. Now recasting itself as having a broader mission to address DHHS-wide self-governance applications, the TSGAC seeks to serve as a problem solving forum to aid agencies in addressing issues that arise. Tribal representatives on the TSGAC seek to foster a greater comfort level with this new initiative so that everyone can engage in identifying how to make self-governance work and move ahead as an initiative.
INDIAN HEALTH SERVICE EXPERIENCE:
A significant factual reality that strengthened efforts to experiment with self governance was (and is) the high disparities of health that remain (e.g., diabetes, TB, etc.). Addressing these disparities need to be the focus of future efforts by tribes under self-governance. Self- Governance involves change by agencies. If the programs are not working for Indians, then adjustments are needed. Within IHS, the operational guide has been to “find ways to get things done.” Tribal leaders merely expect full disclosure, honesty, and to be included in the decision process. They deserve to be treated with respect.
Tribes are working around a different sense of community than agencies may be used to dealing with. Indians have a view of health and wellness that may not fit well with the allopathic reductionist mode that is imposed from the Federal level. A reductionist bias may be ineffective and unfair in application to Indian communities. Tribes are concerned with advancing wholistic approaches, especially with regard to health.
Federal employees need to be aware of some negative stereotypes they are perceived by Indians as falling into. Federal (health) agencies have the task of building capacity for communities to meet their health needs based on their policy development; and to build the programmatic, managerial, and technical competencies to address their real needs. Since this is what our mission is, regardless, the self-governance model simply provides us with a new means of addressing the objectives that we are charged to address.
The people best placed to bring together the disparate resources and program funding to address complex, multi factorial problems beyond just single mission issues are the Indians themselves. Broad issues include social, educational, economic, as well as health. IHS experience has shown that working with the Tribes as partners can lead to better ways to health objectives.
Thinking through what are “inherent Federal functions” is a challenging task both to understand theoretically and apply practically. During first few years, there were many discussions regarding accounting and legal requirements; only later did focus on program content and function emerge. Six years down the line, IHS is now struggling with identifying what baseline data it has and the need to evaluate outcomes rather than merely measure processes. Baseline measures have changed from process toward outcomes; the IHS outcome measures are developed in partnership with the Tribes.
DISCUSSION:
This exercise (to collect, analyze our programs, and make recommendations to the Congress regarding feasibility for inclusion in a Department self-governance demonstration project) is very much one of “thinking outside the box.” This is an unfamiliar undertaking both for many of the HHS agencies and for the Indians. Real innovation can take place not at the Federal level acting alone but at both at the State level and within the Tribes themselves. This effort represents a real opportunity. NIH indicated it sees the opportunity for there to be something that can be done now and more that may become possible later. There may be a role for tribal/Indian participation in the research activities relevant to the Indian/tribal communities. Indian Health Care Improvement Act is being worked on which includes a wide range of issues and initiatives including more items that would relate to the research areas, as well as others.
NEXT STEPS
Workgroup members were asked to provide comments on the January 9, 2001 drafts of the Consultation Protocol and the Data collection instrument