Review of Indian Health Service's Tribal Management Grants Program

EXECUTIVE SUMMARY:

This report provides the results of our review of the Indian Health Service's (IHS) Tribal Management Grants Program (program). We performed this review at the request of IHS management. The program, authorized by the Indian Self-Determination and Education Assistance Act, Public Law 93-638, as amended, is intended to be a source of funds to assist American Indian and Alaska Native tribes and tribal organizations (tribes) assess whether they want to provide health care services under contracts with IHS (this is in contrast to tribes receiving direct health care from IHS facilities). The grants, which average about $81,000 are used mainly to improve the management capacity of the tribes or tribal organizations, and to aid in planning and evaluation. In Fiscal Year (FY) 1995, about one-third of IHS' $1.36 billion budget was awarded in contracts to tribes so they could provide their own health care services.

Our overall objective was to evaluate the success of the Tribal Management Grants Program. Our specific sub-objectives were to determine whether (1) the application review process was effective in finding those projects consistent with the program objectives; (2) IHS project officers provided needed program support to the tribes; and (3) IHS evaluated those projects funded to ascertain the overall success of the program.

Our review identified areas where improvements could be made to the Tribal Management Grants Program, specifically regarding the effectiveness of the application review process and the project officers' support provided to the tribes. However, because there were no agreed-upon measurement criteria, we found that the overall performance of the program could not be objectively measured.

Regarding our specific sub-objectives, we determined:

Finding 1: The application review process needs to be improved. Although IHS had established review criteria, reviewers did not apply criteria consistently. A consistent evaluation would ensure, for example, that all reviewers applied the same criteria in judging the applications.

Finding 2: Many project officers did not provide tribes support in applying for or carrying out their grants because they did not view their role in this program as important.

Finding 3: The IHS did not make an adequate evaluation of the program's performance. Because IHS did not have agreed upon criteria for the program, nor established goals to measure program success, IHS has not been able to evaluate the program's performance.

We also found differing interpretations of the program among and between the three groups we surveyed--tribes, reviewers, and project officers. Such variance appeared to be linked to IHS not clearly defining and communicating the purpose of the program to all affected parties.

Our findings led us to conclude that there is no assurance that the most qualified projects were selected for funding; or that the funded projects received sufficient program support to succeed. Further, because a system has not been developed to measure project and program achievements, there is no assurance that the program is accomplishing what was intended under the law.

To ensure that the program is administered fairly and provides the maximum benefit to the tribes, we suggest that IHS: (1) revise its application review process to ensure that all applications are reviewed consistently; (2) emphasize to project officers the importance of providing needed support to the tribes and delineate relevant tasks in their performance plans; (3) develop program performance criteria; (4) implement a system to measure program accomplishments; and (5) clearly define and communicate to the tribes, reviewers, and project officers the purpose of the program.

In its October 3, 1996 comments to our draft report, IHS indicated agreement with our findings and suggested several technical changes which we have incorporated.