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NIHB Recognized by the Public Health Accreditation Board
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Strengthening Tribal Public Health Systems
(Formally Tribal ASI)


Historically, Tribes ensured their communities’ health by integrating systems of health and well-being. As with most if not all indigenous people, prior to European contact, Native Americans had complex traditions, cultural practices, social organizations, economies, forms of government, education, and spirituality that interrelatedly worked together to ensure the health and survival of the people.

Contemporary Tribal public health systems, shaped by a history of colonialism, epidemics, government policy, and a lack of funding evolved along a different trajectory than their local and state counterparts and hence they are often overlooked or underrepresented in the US public health system. “Tribal nations have an inherent right to promote and protect the health and welfare of their citizens, using the methods most relevant for their communities.”1 As such, the National Indian Health Board supports Tribal nations as they rebuild and define their current systems.

Since 2008, the (NIHB) has partnered with Tribal nations and national partners in an effort to advance public health practice in Indian Country. With the support of the Centers for Disease Control and Prevention, NIHB has provided funding and technical assistance to Tribes pursuing performance improvement and public health accreditation projects and initiatives.

Strong Systems, Stronger Communities

Strong Systems, Stronger Communities (SSSC), (created in 2018), is a funding opportunity provided by the National Indian Health Board (NIHB) and supported by the CDC. This opportunity builds on a former project - NIHB’s Tribal Accreditation Support Initiative (ASI) and continues NIHB’s commitment to strengthening Tribal public health systems by offering support and technical assistance specifically to Tribes as they complete projects to improve their performance, meet national public health accreditation standards, and/or promote interconnection across the public health system to improve population health.

The intended outcomes of SSSC include;

  • Increased performance improvement practice
  • Increased innovation in response to system integration challenges, and
  • Progress toward national public health standards.

While performance improvement focuses on internal changes to improve services, system improvement focuses on incorporating health equity and interconnection of various systems that can impact the public health of a community. Interconnection is defined as "the linkage of programs, activities, and/or stakeholders to promote overall efficiency and effectiveness and achieve gains in population health."

Request for Applications: Strong Systems, Stronger Communities: Strengthening Tribal Public Health Systems

Applications due Friday, September 20, 2019

Download the Request for Applications Announcement

The National Indian Health Board (NIHB) and the Centers for Disease Control and Prevention are pleased to announce the second cycle of funding for Strong Systems, Stronger Communities (SSSC) for Tribes.

There are 2 separate funding opportunities available:

Self-Assessment Award

The Self-Assessment Award is intended for Tribal entities new to performance improvement who wish to conduct a self-assessment of their current ability and departmental needs to meet public health accreditation standards, as defined by the Public Health Accreditation Board (PHAB). The Self-Assessment awardees will receive training, form a team, and complete a self-assessment.

Download the Request For Applications (RFA) and Application Package for the Self-Assessment Award

Performance Improvement / System Improvement Award

The PI/SI award will support projects through two paths: performance improvement (PI) projects to build public health capacity, and system improvement (SI) projects, which focus on incorporating health equity and interconnection of various systems that can impact the public health of the community. Tribes will have the opportunity to perform work by choosing project categories in either the PI path, SI path, or both. Support for public health accreditation activities is offered, but seeking accreditation is not required.

Download the Request For Applications (RFA) and Application Package for the PI/SI Award

TO APPLY: The request for applications (RFA) can be downloaded, completed as a Word document, and then submitted. Completed applications are due to NIHB via email by Friday, September 20, 2019, by 11:59pm Eastern Time.

NIHB and CDC staff hosted a

PI/SI Award Pre-Application Webinar
View the Slides HERE
View the Recording HERE

Self-Assessment Award Pre-Application Webinar
View the Slides HERE
View the Recording HERE

Additional questions about this RFA may be directed to Sarah Price, [email protected].

NIHB and CDC staff will not answer any questions or provide any information that may provide an unfair advantage to any applicants.

Current SSSC Awardees 2018-2019

Awardees are divided into two cohorts for this grant cycle.

The Self-Assessment Cohort awardees are receiving training in performance improvement, creating a performance-improvement team, and engaging in a self-assessment of their current public health capacities. These awardees include:

  • Lummi Nation
  • Taos Pueblo
  • Fort Berthold Diabetes Program (Three Affiliated Tribes- Mandan, Hidatsa, and Arikara Nation)

The Performance/System Improvement Cohort awardees are each pursuing their own performance/system improvement projects based on need identified in their community and health system. These awardees and projects include:

  • Eastern Band of Cherokee Indians: Develop their performance management policy and provide training to staff.
  • Forest County Potawatomi Community: Update the community health department strategic plan, and continue workforce development initiatives.
  • Lower Sioux Indian Community: Develop a Community Health Assessment (CHA)
  • San Carlos Apache Tribe: Perform a quality improvement project to reduce incidence and improve treatment adherence for Rocky Mountain Spotted Fever.
  • Sonoma County Indian Health Project: Build staff’s public health capacity at a newly created public health department, and create a community resource guide.
  • Winnebago Tribe of Nebraska: Use information collected from their CHA to develop a Community Health Improvement Plan (CHIP). Finalize a Workforce Development Plan.

Tribal Accreditation Support Initiative

From 2014-2018, NIHB supported Tribal efforts to increase their readiness for public health accreditation through the Tribal Accreditation Support Initiative (ASI). Over the course of four years, twenty Tribal awardees performed performance improvement tasks such as Community/Tribal Health Assessments and Improvement Plans, strategic planning, workforce development, and quality improvement projects. As a measure of readiness, NIHB adapted the evidence-based Community Readiness Model to an Accreditation Readiness Model, and used this to track progress and assist awardees in charting their course for systems improvement.

View Tribal ASI Awardees 2014-2108


View Past Awardees Project Presentations


1.Reference: Tribes maintain “inherent powers of limited sovereignty which has never been extinguished.” United States v. Wheeler, 435 U.S. 313, 322–3 (1978) (quoting F. Cohen, HANDBOOK OF FEDERAL INDIAN LAW 122 (1945)). Wheeler further explains that “Indian tribes still possess those aspects of sovereignty not withdrawn by treaty or statute, or by implication as a necessary result of their dependent status.” Wheeler, 435 U.S. at 323. See also, Lawrence O. Gostin, PUBLIC HEALTH LAW: POWER, DUTY, RESTRAINT 5, 8–9 (2nd ed. 2008), which describes governments as not only having the power to promote the health and welfare of its citizens but also the duty and obligation to do so.


A collection of guides, templates, self-assessments, worksheets and other resources.
TALC is free webinar series designed for sharing and learning about public health accreditations in Tribal communities. Upcoming webinars and past recordings are available.
Tribal examples of the six major documents required for public health accreditation: community health assessment, community health improvement plan, strategic plan, quality improvement plan, workforce development plan, emergency preparedness plan.
General information, costs and benefits, the steps to accreditation, positions papers, etc.
News, case studies, videos and presentations featuring the Tribal experience with public health accreditation.
Tribal Public Health Accreditation Advisory Board


NIHB Contact:

Carolyn Angus-Hornbuckle, JD
Director of Public Health Policy and Programs

National Indian Health Board
910 Pennsylvania Ave, SE
Washington, DC 20003
Phone: 202-507-4089
[email protected]


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