Tribal Self-Governance Health Care and Social Services Delivery Effectiveness Evaluation Feasibility Study: Draft Literature Review - Revised Report. IV.2 Studies of Tribal Self-Governance/Tribal Management of Health Programs


There has been limited quantitative research on Tribal contracting and compacting for IHS health programs or health service delivery. The Indian Health Service Baseline Measures Workgroup, composed of representatives from Tribes and from IHS, addressed the issue of evaluation of Self-Governance of IHS programs and recommended that a two-part evaluation be conducted (Indian Health Service, September 1996). One component of the evaluation would focus on evaluation of the process and outcomes of Self-Governance; the second component would focus on the impact of Self-Governance on non-Self-Governance Tribes. However, no formal evaluation based on these recommendations was subsequently conducted.

Three studies that have examined the impact of Tribal contracting for health services on administration and operations of health programs were identified in our literature search. Each of these studies relied on key informant interviews, site visits, or surveys of Tribal authorities or IHS staff to gather information on the success of Tribal management. Evidence on the effectiveness of self-governance of health programs available from this small number of studies is consistent and positive, but is based on qualitative measures, rather than quantitative measures.