Like other communities across the United States, American Indians and Alaska Natives living in tribal areas anxiously awaited supplies of masks, gloves and other vital personal protective equipment during the early days of the COVID-19 pandemic. But unlike other U.S. states and municipalities, Indian Country did not have access to a stockpile of their own reserves, creating a shortage of much-needed PPE, greatly inhibiting their initial pandemic response.

For a community that was disproportionately impacted by COVID-19, access to critical medical supplies during emergencies is one of the major concerns for the new director of the federal Indian Health Service. Established in 1955, IHS is the main provider of health services for the nearly 2.6 million American Indian and Alaska Natives in 574 tribes across 37 states. IHS exists as an operating division within the Department of Health and Human Services, and many of its programs function as partnerships between the federal government and the tribes themselves.

IHS works to stay ahead of the health disparities that impact Indian Country. American Indian and Alaska Native life expectancy is 5.5 years less than the average American, in part due to significantly higher rates of cancer, heart disease, diabetes, stroke and immunological conditions like HIV. During the COVID-19 pandemic, infection rates were 1.6 times greater for American Indians compared to white Americans, while their rate of hospitalization was three times higher and their chance of death nearly double.

Last fall, IHS veteran Roselyn Tso became the agency’s new director — the first Navajo Nation citizen to assume the role. Since Tso’s appointment, historic progress has been made; in December, advance appropriations were awarded to IHS in the omnibus spending package approved by Congress. This provision ensures that the agency has basic certainty of funding, protecting IHS services from disruption and paving the way for future change. Tso now faces several key issues that, if resolved, would allow IHS to continue this momentum forward and improve health care for American Indians and Native Alaskans. There are three key areas of focus that could make a real difference in Native and Tribal care:

Health care staffing

Medical facilities across the nation are struggling to find enough health care professionals to meet demand, placing additional burden on already strained medical systems. But in Indian Country, like the rest of rural America, recruiting and keeping good health care talent is an even greater challenge. The Government Accountability Office found that IHS clinics had more than 1,400 vacancies for health professional positions in 2022, including physicians, nurses and other care providers. To combat this national shortage, talent pipeline programs are being established across the nation; IHS could launch its own version, investing long-term in a workforce for these critical positions across Indian Country.

Access to care

COVID-19 also shone a spotlight on the troubling lack of access to health care that these communities experience. In fact, in the early COVID months, there were only 222 hospital beds available to Navajo Nation’s 170,000 residents, along with another 74,000 American Indians who live off the reservation. Proportionally, the number of hospital beds available to these communities is far fewer than what is available to the general U.S. population. Overall, funding for facilities and needed beds hasn’t kept up with the growing number of patients in these areas. This extreme shortage is compounded by the remote locations of many reservations, which makes traveling to a health care facility challenging.

Mobile clinics offering a range of medical services can help reduce this health access gap by bringing the clinic to the patient, especially those in remote areas. IHS could consider modeling programs from states like Pennsylvania and establish its own mobile clinic program, and deliver medical care directly to communities that need it most.

Medical supplies

Getting needed PPE supplies into the hands of tribal communities has been an ongoing issue since the start of the pandemic. Even more than a year after COVID-19 hit, there were still problems delivering medical supplies to American Indians and Alaska Natives, often due to inadequate infrastructure and the rural location of many of these communities. Medically underserved communities like these are often the most vulnerable to COVID-19 infection — a stark reality exacerbated by the disproportionate access to PPE and other health supplies.

In addition to potential legislation currently in the works, public-private partnerships with experienced commercial leaders could increase federal capacity to deliver critical supplies to these underserved communities. Commercial medical distribution enterprises have experience forecasting product needs and developing community-specific product formularies so stock remains in constant supply; a critical function to fully support communities in more remote locations.

Ultimately, it’s clear that no one expects a new director to come equipped with a panacea and immediately solve all of the health issues facing IHS and Indian Country. However, by working with partners and other relevant agencies to develop shared solutions to the supply and access issues facing these communities, IHS can protect and improve the overall health of the tribal community for years to come.

Deborah Haywood is vice president of government solutions for McKesson Medical-Surgical.

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