FEDERAL-TRIBAL RELATIONSHIP
    Federally recognized American Indian tribes and Alaska Native corporations enjoy a government-to-government relationship with the United States of America. This unique relationship has been given substance through numerous Supreme Court decisions, treaties, legislative acts, and Executive Orders.
    The provision of health services grew out of this government-to-government relationship. The IHS is the principal Federal health care provider and health advocate for Indian people.
    The principal legislation authorizing Federal funds for health services to recognized Indian tribes is the Snyder Act of 1921. It authorized funds "for the relief of distress and conservation of health . . . [and] . . . for the employment of . . . physicians . . . for Indians tribes throughout the United States."
    Congress passed the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended) to provide tribes the option of either assuming from the IHS the administration and operation of health services and programs in their communities, or to remain within the IHS administered direct health system. Congress subsequently passed the Indian Health Care Improvement Act (P.L. 94-437), which is a health-specific law that supports the options of P.L. 93-638. The goal of P.L. 94-437 is to provide the quantity and quality of health services necessary to elevate the health status of American Indians and Alaska Natives to the highest possible level and to encourage the maximum participation of tribes in the planning and management of those services.

MISSION, GOAL, AND FOUNDATION
    The IHS provides a comprehensive health services delivery system for American Indians and Alaska Natives with opportunity for maximum tribal involvement in developing and managing programs to meet their health needs. The mission of the IHS, in partnership with American Indian and Alaska Native people, is to raise their physical, mental, social, and spiritual health to the highest level. The goal of the IHS is to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to all American Indian and Alaska Native people. The foundation of the IHS is to uphold the Federal Government obligation to promote healthy American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of tribes.
    In order to carry out its mission, uphold its foundation, and attain its goal, the IHS:
    1. Assists Indian tribes in developing their health programs through activities such as health management training, technical assistance, and human resource development;
    2. Facilitates and assists Indian tribes in coordinating health planning, in obtaining and using health resources available through Federal, State, and local programs, and in operating comprehensive health care services and health programs.
    3. Provides comprehensive health care services, including hospital and ambulatory medical care, preventive and rehabilitative services, and development of community sanitation facilities.
    4. Serves as the principal Federal advocate in the health field for Indians to ensure comprehensive health services for American Indian and Alaska Native people.

HEALTH CARE DELIVERY
    Preventive measures involving environmental, educational, and outreach activities are combined with therapeutic measures into a single national health system. Within these broad categories are special initiatives in traditional medicine, elder care, women's health, children and adolescents, injury prevention, domestic violence and child abuse, health care financing, state health care, sanitation facilities, and oral health. Most IHS funds are appropriated for American Indians who live on or near reservations. Congress also has authorized programs that provide some access to care for Indians who live in urban areas.
    IHS services are provided directly and through tribally contracted and operated health programs. Health services also include health care purchased from more than 9,000 private providers annually. The Federal system consists of 36 hospitals, 61 health centers, 49 health stations, and 5 residential treatment centers. In addition, 34 urban Indian health projects provide a variety of health and referral services.
    The IHS clinical staff consists of approximately 2,700 nurses, 900 physicians, 350 engineers, 450 pharmacists, 300 dentists, 150 sanitarians, and 83 physician assistants. The IHS also employs various allied health professionals, such as nutritionists, health administrators, engineers, and medical records administrators. The IHS has a vacancy rate of about 12% for health professional positions, ranging from a vacancy rate of 5% for sanitarians to 23% for dentists.
    Through P.L. 93-638 self-determination contracts, American Indian tribes and Alaska Native corporations administer 13 hospitals, 158 health centers, 28 residential treatment centers, 76 health stations, and 170 Alaska village clinics.

FACILITIES CONSTRUCTION AND MAINTENANCE
    Since 1960, more than 230,000 Indian homes have benefited from IHS funding of water and sewerage facilities, solid waste disposal systems, and technical assistance for operation and maintenance organizations. The age-adjusted death rate from gastrointestinal disease for American Indians and Alaska Natives has decreased by more than 91% since 1955, the year the IHS was established.
    Approximately 93% of American Indian and Alaska Native homes have been provided sanitation facilities since the inception of the IHS sanitation construction program. The IHS also funds construction of new and replacement hospitals and ambulatory care facilities and staff quarters.

CAREER OPPORTUNITIES
    The IHS employs approximately 15,000 people, including members of virtually every discipline involved in providing health care, social, and environmental health services. Fully 100% of the IHS senior executive service staff are of American Indian or Alaska Native descent. Excluding medical professionals, approximately 88% of all IHS staff are of American Indian or Alaska Native descent. Individuals who have health related degrees have the option of joining the IHS as civil servants or as commissioned officers in the Public Health Service (PHS).
    The Indian Health Care Improvement Act, P.L. 94-437, authorized the IHS to administer three interrelated scholarship programs to meet the health professional staffing needs of IHS and other health programs serving Indian people. In addition, the IHS administers a Loan Repayment Program for the purpose of recruiting and retaining highly qualified health professionals to meet staffing needs.
    The PHS Commissioned Officer Student Training and Extern Program provides students of the health professions the opportunity to gain experience in a health service environment during free periods of the academic year. The Indian Health Professions Program provides scholarships, loans, and summer employment in return for agreements by students to serve in IHS, tribal, or urban Indian programs. As a matter of law and policy, the IHS gives preference to qualified Indians in applicant selection and career development training. The PHS National Health Service Corps program offers scholarships and stipends to medical students who agree to enter primary care specialties and to sign on for a minimum 2-year tour of duty in PHS programs, including IHS direct and tribal programs.

IHS HEADQUARTERS AND AREA OFFICES
    IHS Headquarters is located in Rockville, MD. There are 12 IHS administrative units, called Area Offices, which are located in: