Background of Health Services
The Pascua Yaqui Health Services Division (PYHSD) is pursuing national accreditation from the Public Health Accreditation Board (PHAB). A major aspect of PHAB Accreditation includes conducting a Community Health Assessment (CHA). The outcomes of the CHA are used to prioritize program efforts and make informed decisions which can be used to create organizational plans such as a Strategic Plan and Community Health Improvement Plan, both of which are also required for PHAB Accreditation.
The 2016 Pascua Yaqui Pueblo CHA analyzes the health information available in existing databases within the PYHSD, other Tribal divisions, private providers, and state agencies. The CHA process involves determining what content to include, collecting data reflective of the desired content, and analyzing the meaning of those data. The CHA was completed in partnership with other organizations in the community and outside organizations such as Red Star International and The Inter Tribal Council of Arizona.
The PYHSD mission is to promote the highest possible standard for health and well-being within its communities. The PYHSD carries out this mission by managing over $30 million from federal, state, tribal, and private funds. As an Indian Self-Determination Act (ISDA) contract tribe, it negotiates two separate Annual Funding Agreements, one with Indian Health Service (IHS) Phoenix Area for member in Maricopa County, and the second with the Tucson Area.
After federal tribal recognition in 1978, the IHS established its first managed care plan on the Pascua Yaqui Pueblo by paying a monthly premium to El Rio Health Centers for each registered Tribal Member living in Pima County for medical and dental care as well as specialty services. The PYHSD supplemented these direct services by also running state programs such as WIC, ALTCS, and Tobacco Cessation. This managed care plan administered by IHS did not fully address community health needs, so the PYHSD assumed control of the managed care plan in fiscal year 2011. The PYHSD was then able to significantly increase its decision-making power by financially operating, expanding, and adding programs reflective of the community’s health needs. The effective and sustainable function of these services requires collaboration with the Arizona Health Care Cost Containment System (AHCCCS: Arizona’s Medicaid equivalent), the IHS Phoenix Indian Medical Center, Phoenix and Tucson IHS area offices, El Rio Health Centers, local hospitals, various private health care providers, and its more than 19,000 Tribal Members.
Even after the shift from IHS control to Tribal administration of the managed care plan, it remains challenging to interact with other Tribal departments, private health providers and government agencies. It is also difficult to maintain control of the Tribal health care system while securing intergovernmental and private partners. Limited infrastructure and jurisdictional authorities impede the ability to deliver health care consistently. Through activities required for public health department accreditation, the Pascua Yaqui Tribe will gain greater control over and maintain Tribal values within its health care practices.
Community Description and Challenges
Primary data, or data from PYHSD’s own programs and departments, is oftentimes the most accurate account of the health status of Pascua Yaqui community members. However, many factors such as lack of funding and expertise inhibit the gathering and analysis of useable data from all PYHSD programs. To bolster the content of this CHA, we included secondary data, or data gathered by outside sources, to tell the story of the community’s health.
The primary data collected within this CHA is representative of enrolled Pascua Yaqui Tribal members eligible for health services. This may include both enrolled members living on the Pascua Yaqui Pueblo Reservation and those living elsewhere who travel for their health services. Also, the data gathered from the Gathering Hiaki Voices for Wellness survey includes responses from individuals present in the Pascua Yaqui communities in Arizona where the surveyors were collecting responses.
The specific community represented by the secondary data, however, is more difficult to pinpoint. Depending on the source, the secondary data is representative of Tribal members who self-identify as Pascua Yaqui and may or may not live on the Pascua Yaqui Pueblo, or those who self-identify as living in Pascua Yaqui Pueblo.
Throughout this CHA, comparisons to Pima County and Arizona’s data is provided to show relative rates of indicators and to better understand the specific burden of disease felt by the Pascua Yaqui community overall. It is important to keep in mind that the true burden of disease of Pascua Yaqui community members may be higher because of the above described uncertainties of the data.
American Association of American Indian Physicians
Arizona State Health Department
Centers for Disease Control
El Rio Community Health Center
Indian Health Services
Inter Tribal Council of Arizona
Maricopa County Health Department
National Indian Health Board
Phoenix Area Indian Health Service
Pima County Health Department
U.S. Department of Health & Human Services: