Tribal Self-Governance Health Care and Social Services Delivery Effectiveness Evaluation Feasibility Study: Draft Literature Review. 6. Implications for the Tribal Self-governance Evaluation Feasibility Study


A comprehensive and rigorous evaluation of processes, structure, and outcomes associated with Tribal management of health and social services programs would use both qualitative and quantitative analyses to address the issues of importance to understanding the benefits of Tribal management and the factors that contribute to the success of Tribal self-governance/management.

Qualitative methods – key informant interviews, site visits, surveys of perceptions – can provide useful insights and understanding of research questions such as: [4]

·        What are the goals of Tribes that manage health and social services programs?

·        How are programs structured differently under Tribal management?

·        What changes are made in the programs, and why were these changes made?

·        What problems were encountered in establishing Tribally managed programs?  How were these problems resolved?

·        How are community members involved in defining priorities and providing input to guide programs?

·        What are the recommendations of Tribal leaders, Tribal program managers, and Tribal program staff that could help them improve services and manage more effectively?

Quantitative methods are necessary to evaluate the outcomes associated with Tribal management of health and social services programs and to understand the factors to contribute to successful programs.  Consistent, reliable, and comparable data are necessary to examine research questions on the impact of Tribal management on measurable performance outcomes, such as:

·        How do the numbers and types of services offered change?

·        How many people use services, by type?  Are services routinely available or is there a significant delay in access or a waiting list?

·        What are the outcomes achieved by the program (e.g., percentage of clients receiving preventive health services, increased employment rates)?

·        Is the program able to recruit and retain appropriate professional staff to avoid vacancies?

·        Is the financial management of the program stable and adequate?  Are additional sources of revenues obtained to supplement the base allocation from the federal agency?  What are these additional sources of revenue and how much additional funding comes from each?

The evidence drawn from the review of the literature suggests that qualitative research has been the primary approach to evaluating Tribal management of health and social services programs to date.  Quantitative research, however, has been very limited in past studies, due to lack of reliable and comparable data for Tribally managed programs.  A primary focus of the Tribal Self-Governance Evaluation Feasibility Study, therefore, will be to review and identify potential sources of data that would be adequate to permit a quantitative evaluation of relevant issues.

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