IHS Awards $32.7 Million toward Expansion

The Indian Health Services (IHS) is a division of the Department of Health and Human Services. This federal program provides healthcare to federally-recognized tribes in Alaska and the contiguous US, or Alaska Native and Native American tribes. In 2021, the IHS awarded $32.7 million to two programs.

In August 2021, IHS awarded $25 million to 14 tribes and tribal organizations, and in October 2021 it awarded another $7.7 million to expand the IHS Community Health Aid Program (CHAP). Both programs are integral to making sure Native Americans and Alaska Native tribe members have access to quality healthcare services, regardless of their location around the country.

The $25 million is being awarded to support the Small Ambulatory Program that will culminate in the construction, expansion, or modernization of small ambulatory health care centers. The IHS Small Ambulatory Program works toward making sure that these tribes have access to outpatient services. Since its inception in 2001, the program has funded over 60 projects involving upgrading facilities, expanding facilities, and offering new services for a total of $99 million.

The Small Ambulatory Program falls under the Division of Facilities and Planning Construction. This program works to facilitate engineering, planning, and construction support through developing relationships among tribes, service unit engineers, and related professionals.

The $7.7 million awarded to CHAP will go toward providing primary, dental, and behavioral healthcare to rural and remote Alaska Native and Native American communities. This awarded will be distributed among the following seven tribes, each receiving $669,000 over two years.

-Wichita and Affiliated Tribes

-Indian Health Council, Inc.

-California Rural Indian Health Board, Inc.

-Three Affiliated Tribes

-Southern Plains Tribal Health Board

-Navajo Nation, Division of Behavioral and Mental Health Services

-Kickapoo Tribal Health Center

This money is going to be used to determine the appropriateness of the CHAP workforce model for the existing tribal health care system and to determine whether the model is appropriate for the tribes' primary, oral, and behavioral healthcare needs.

This $7.7 million grant award will also provide $1 million over two years to the Northwest Portland Area Indian Health Board, the Fort Belknap Indian Community, and the Lummi Nation. This money will be used to support the CHAP planning and implementation program, which will fund establishing CHAPs that are uniquely tailored to meet community needs.

The national CHAP expansion will be similar to the expansion of the Alaska model. This model relied on building up the existing workforce with mid-level paraprofessionals, relying on culturally competent providers, and offering workforce development opportunities for staff.

IHS is important in that it performs a number of activities that facilitate healthcare for these Native Americans and Alaska Natives through CHAP. IHS designed the CHAP Tribal Assessment and Planning and Tribal Planning and Implementation programs to get feedback across the healthcare system on how to use Fiscal Year 2020 funding.

Through IHS, CHAP offers training and education to tribal community, dental, and behavioral health providers so that they can offer access to quality health care, disease prevention services, and health promotion. The program initially served rural areas in Alaska, but now has been expanded to include the 48 contiguous states.

Finally, IHS also created the CHAP Tribal Advisory Group in 2018, which was founded to make sure that the agency hears concerns and questions from tribes, tribal organizations, and urban Native American and Alaska Native communities across the US. This advisory heard community concerns and answered questions through events such as listening sessions, planning meetings, and focus groups.

These two projects are a part of the organization’s mission to increase health care access for Alaska Native and Native American communities. For more information on these projects and other IHS news, please visit https://www.ihs.gov/newsroom/pressreleases/.

High-Risk Newborn-Characteristics Risks

Research manuals in neonatal care, such as the Manual of Neonatal Care, tackle newborn conditions, the effects of maternal drugs on the fetus, and assessment and treatment in the immediate postnatal period. Worldwide, nearly half of the deaths in children under age 5 are newborns. Therefore, high-risk newborns must receive additional attention before, during, and immediately after birth.

High-risk newborns are typically associated with specific fetal, maternal, or placental conditions. When at least one of these conditions is present, nursery staff must be prepared for possible difficulties.

One of the associated risks for the fetus is the age of the mother at delivery. Newborns from mothers under 16 years have a higher risk of intrauterine growth retardation (IUGR) and prematurity. Neonates from mothers over 40 have a higher risk of blood loss, chromosomal abnormalities, IUGR, and macrosomia, meaning they are much larger than average. Additionally, mothers with certain medical conditions may present complications. If they have renal disease, heart disease, lung disease, hypertension, or anemia, they have a higher risk of giving birth to a premature or stillborn child.

Some fetal characteristics and associated risks for neonates are multiple gestations, which can result in birth trauma, twin-twin transfusion syndrome (when there is a disproportion in the blood exchange between twins or multiples), and prematurity; and abnormal fetal position or presentation, a factor that may result in hemorrhage, congenital anomalies, and birth trauma. Polyhydramnios, or the excessive accumulation of amniotic fluid, may also cause complications such as central nervous system disorders, neuromuscular disorders, diaphragmatic hernia, and swallowing problems.

If labor and delivery conditions are unnatural, the nursery staff must be prepared for possible risks. For instance, if the mother presents fever during childbirth, the neonate has a higher risk of sepsis, which affects the bloodstream and may cause death. In addition, issues may arise with preterm delivery and post-term delivery, or delivery occurring more than two weeks after the term. Post-term delivery has higher chances of asphyxia, stillbirth, and meconium aspiration (the baby breathing in its feces in the amniotic fluid).

Other labor and delivery conditions that present a higher risk of complication for fetuses and newborns include rapid or prolonged labor, prolapsed cord, cesarean section, and placental anomalies such as a torn placenta, one that is excessively small, or one that is excessively large. Immediately evident neonatal conditions and associated risks include prematurity, which may result in respiratory distress syndrome and other sequelae, or conditions that occur due to another condition; a foul smell of membranes or amniotic fluid, which may indicate infection; and small size for the gestational age.

As a rule, at least one healthcare provider trained in neonatal resuscitation must be physically available during birth, no matter the risk status. However, if a healthcare provider anticipates a high-risk delivery due to factors identified before birth, advanced neonatal resuscitation is crucial - at least two healthcare providers should be available to manage the baby. Furthermore, the nursery staff must have a resuscitation team for high-risk gestations, each member with a specific, predetermined role.

Finally, a healthcare provider should save the placenta after delivery. With the help of placental pathology, doctors can diagnose difficult conditions, such as toxoplasmosis, an infectious disease with flu-like symptoms caused by a parasite.