HEALTH EDUCATION

+--------------+-------------+-------------+-------------+-------------+
|              | 2002        | 2003        | 2004        | Increase    |
|              |             |             |             |             |
|              | Actual      | President's | Estimate    | or Decrease |
|              |             |             |             |             |
|              |             | Budget      |             |             |
+--------------+-------------+-------------+-------------+-------------+
| BA           | \           | \           | \           | +\$877,000  |
|              | $10,628,000 | $11,063,000 | $11,940,000 |             |
+--------------+-------------+-------------+-------------+-------------+
| FTE          | 30          | 32          | 37          | +5          |
+--------------+-------------+-------------+-------------+-------------+
|              |             |             |             |             |
+--------------+-------------+-------------+-------------+-------------+
| HIV-AIDS     | (\$535,000) | (\$535,000) | (\$535,000) | \$0         |
| (\$)         |             |             |             |             |
+--------------+-------------+-------------+-------------+-------------+
| HIV-AIDS     | \(1\)       | \(1\)       | \(1\)       | 0           |
| (FTE)        |             |             |             |             |
+--------------+-------------+-------------+-------------+-------------+
|              |             |             |             |             |
+--------------+-------------+-------------+-------------+-------------+
| Health       | 600,000     | 600,000     | 600,000     | 0           |
| Education    |             |             |             |             |
| Services     |             |             |             |             |
| Provided     |             |             |             |             |
+--------------+-------------+-------------+-------------+-------------+

**[PURPOSE AND METHOD OF OPERATION]{.underline}**

##### Program Mission and Responsibilities

The Indian Health Service (IHS) Health Education program communicates
the importance and on-going need of health education and patient
education to improve health promotion and disease prevention among
American Indian and Alaska Native communities. This is accomplished by
increasing the collaboration between all IHS health disciplines and
programs. A mechanism for the delivery and tracking of health and
patient education has been developed and training is being provided to
all health programs and disciplines.

The IHS Health Education program is committed to a partnership with
American Indian and Alaska Native communities to raise the health status
of American Indians and Alaska Natives to the highest possible level.
This is accomplished through education, leadership and promoting
community capacity building that nurtures healthy lifestyles and
utilization of health services. In addition, the Health Education
program fosters participation of American Indian and Alaska Native
communities in developing and managing programs to meet their health
priorities.

The IHS Health Education provides technical assistance to Area Offices
(regional). The Area Offices provides resource distribution and
technical support to the Service Units (local level); whether federal or
tribal, in the delivery of comprehensive health care to over 1.6 million
American Indians and Alaska Natives.

The emphasis of the IHS Health Education is to strategically improve and
strengthen the practice of public health education, to take an active
role in community health planning as determined by sound epidemiological
data derived from a variety of sources such as RPMS, community surveys
and clinical and community evaluations. The IHS Health Education adheres
to proven intervention strategies that are driven by health priorities
identified by statistical analysis. The Health Education Program has
identified these priorities that encompass the core practices of public
health education - community health, school health, employee health
promotion, and patient education:

-   To provide leadership in developing safe and healthy Indian
    communities

-   To develop and strengthen a standardized, nationwide patient and
    health education program

-   To enhance the capacity of those schools that educate American
    Indian and Alaska Natives to respond to issues of youth health

-   To assist Head Start programs in the provision of health education
    activities

-   To support the IHS Director's youth, elderly and women's priorities

-   To support diabetes education:

    -   To accomplish these activities partnerships have been developed
        with health programs, tribes, schools, communities, educational
        institutions, and public and private foundations. The IHS Health
        Education program will assist our partners to engage in
        community-based prevention activities, such as smoking
        cessation, diabetes education, HIV/AIDS/STD risk behavior
        education, injury prevention, obesity and physical inactivity,
        and hearing loss

The Health Education Program has been active through the development and
completion of a Web site that includes health education recruitment
information, the IHS Patient Education Protocols/Codes, and a directory
of all I/T/U health education programs. In addition, the Health
Education Program has designed enhancements to the Health Education
Resource Management System (HERMS) management information system that
automatically translates raw monthly HERMS data into more user-friendly
forms, such as charts, graphs, etc.

The IHS Health Education Program has a long history of serving as a
benchmark and Federal model of health education services. It is one of
the few health education programs nationally that serves such diverse
health education needs working with over 561 tribal entities. Most
recently, the program has embarked on a model "Patient Education
Project" that allows outcome measurements to be obtained for health
education services to meet the new JCAHO standards for health/patient
education. New FY 2002 ORYX indicators have also been developed to track
health education in our hospitals, clinics and community programs on
breast self-exams, diabetes and exercise, smoking cessation, and
breast-feeding.

Health Education Program needs are as follows:

-   To increase training staff on the documentation and coding of
    patient and health education

-   To refine the GPRA+ and PCC+ software to track patient and health
    education

-   To provide technical assistance to more IHS Area Health Educators on
    the Health Education Resource Management System (HERMS)

-   The Health Education Resource Management System (HERMS) indicates
    that the number of health education encounters is declining:

    -   This is due to insufficient training on how to document and code
        patient and health education encounters among our clients.
        Documented evidence on the RPMS/PCC system indicates that
        documentation and coding is improving but falls far short of the
        actual encounters, which calls for better documenting and coding
        with appropriate training.

-   One Patient Education Documentation and Coding Training would be
    offered to the Billings, Nashville, Navajo, and Phoenix Areas in FY
    2003

-   A national meeting of health educators would re-focus attention to
    the need to complete the HERMS Reporting system on a daily basis

-   12 Health Education Projects would be funded in the amount of
    \$100,000 each to those sites employing a full-time health educator

-   A copy of the Health Education RRM (supported by the IHS HERMS
    Program) would support the need for additional funding

-   Productivity would be tracked through the IHS HERMS Reporting System
    as well as through the IHS Patient Education Protocols and Code use
    through RPMS/PCC, as well as GPRA

Based on preliminary analyses of FY 2002 health education workload data,
less than 40 percent of the eligible American Indian and Alaska Native
population had access to health education services. As health education
services decrease, the approach to wellness moves away from a preventive
and health and wellness model to one of acute and chronic care.

**[ACCOMPLISHMENTS]{.underline}**

-   During FY 2002, the IHS will continue collaboration with NIH to
    assist three American Indian and Alaska Native communities to
    implement culturally sensitive community-directed pilot
    cardiovascular disease prevention programs including implementation
    of primary prevention indicators and selection of behavioral and
    clinical measures for tracking baseline date by each Tribal site.

-   The IHS Patient Education Protocols and Code Manual is reviewed on
    an annual basis and will be included in the IHS Standard Book of
    Codes.

#### **PERFORMANCE MEASURES**

The Health Education budget contributes to the accomplishment of the
following FY 2004 performance measures:

[Indicator 7]{.underline}: During FY 2004, maintain the proportion of
eligible women who have had a Pap screen within the previous three years
at the FY 2003 levels.

[Indicator 8:]{.underline} During FY 2004, maintain mammography
screening at the FY 2003 rate.

[Indicator 24]{.underline}: During FY 2004:

a\. increase the rates for all recommended immunizations for American
Indian and Alaska Native children ages 3‑27 months by 2% over the FY
2003 rates

b\. establish baseline rates for recommended immunizations for American
Indian and Alaska Native children 19‑35 months.

[Indicator 25]{.underline}: In FY 2004, maintain the FY 2003 rate for
influenza vaccination levels among non-institutionalized adults age 55
years and older.

[Indicator 26]{.underline}: In FY 2004, maintain the FY 2003 rate for
pneumococcal vaccination levels among non-institutionalized adults age
65 years and older.

Following are the funding levels for the last 5 fiscal years:

+-------------------+-------------------------------+-------------------+
| # Year            | **[Funding]{.underline}**     | **[F              |
|                   |                               | TE]{.underline}** |
+-------------------+-------------------------------+-------------------+
| 1999              | \$9,430,000                   | 37                |
+-------------------+-------------------------------+-------------------+
| 2000              | \$9,625,000                   | 35                |
+-------------------+-------------------------------+-------------------+
| 2001              | \$10,236,000                  | 31                |
+-------------------+-------------------------------+-------------------+
| 2002              | \$10,628,000                  | 34                |
+-------------------+-------------------------------+-------------------+
| 2003              | \$11,063,000                  | 32                |
+-------------------+-------------------------------+-------------------+

**[RATIONALE FOR BUDGET REQUEST]{.underline}**

**[TOTAL REQUEST]{.underline}** \-- The request of \$11,940,000 and 37
FTE is an increase of \$877,000 and 5 FTE over the FY 2003 President's
Budget request of \$11,063,000 and 37 FTE. The increase includes the
following:

[Pay Cost Increase: +\$194,000]{.underline}

The request of \$194,000 will fund federal and tribal pay costs which
will assist the IHS in maintaining access to services for the IHS
patient population. Provision of these funds is necessary to maintain
the current I/T/U health system which works to eliminate disparities in
health status between the American Indian and Alaska Native population
and the rest of the U.S.

[Phasing-In of Staff for New Facilities: +\$683,000 and 5
FTE]{.underline}

This request provides for the phasing-in of staff and related costs for
new facilities allowing IHS to expand services in areas where existing
capacity is most over extended. The staffing of new facilities also
contributes to the recruitment and retention of medical staff and
promotes self-determination activities. The following table displays the
requested increase.

+---------------------------------+---------------+---------+---------+
| **[Facilities]{.underline}:**   | **[Dollars]{  | **[FTE] | **      |
|                                 | .underline}** | {.under | [Tribe] |
|                                 |               | line}** | {.under |
|                                 |               |         | line}** |
+---------------------------------+---------------+---------+---------+
| Ft. Defiance, AZ Hospital       | \$96,000      | 1       | 0       |
|                                 |               |         |         |
| Pawnee, OK Health Center        | 395,000       | 4       | 0       |
|                                 |               |         |         |
| #### Winnebago, NE Hospital     | [192,000      | [       | [       |
|                                 | ]{.underline} | 0]{.und | 2]{.und |
| Total                           |               | erline} | erline} |
|                                 | \$683,000     |         |         |
|                                 |               | 5       | 2       |
+---------------------------------+---------------+---------+---------+