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   Providers - The CHAP

For most rural areas of the state, village clinics managed by the Indian Health Service or tribal health corporations provide the only source of local medical care. These tribal village clinics are staffed primarily by Community Health Aides (CHAs) rather than physicians or mid-level practitioners. Most CHAs are nominated to the position by their village council and receive 16 weeks of basic medical training. Training includes advanced first aid, CPR, and a combination of didactic and clinical instruction in other areas of primary care. Once trained, CHAs act as the first-line for village primary health care and as the initial responder for emergency care. They are clinically supervised at a distance by a physician or mid-level provider, who is most commonly located at a regional medical center. Recognizing the importance of CHAs to the delivery of primary health services in rural Alaska, the state Medicaid office recently approved these providers as eligible for financial reimbursement under the state’s program. Approximately 579 CHAs in 200 villages now provide almost a half-million patient encounters a year. U.S. Coast Guard (USCG) beneficiaries face many of the same issues. Most USCG facilities are located in the same remote and rural locations shared by IHS beneficiaries. Furthermore, the Coast Guard has only small health clinics that provide quality care to patients, but lack inpatient and specialty services, and are completely reliant on other federal providers for support. 248 AFHCAN Sites – By provider Physician (MD) 13% PA / Nurse Practitioner 10% Public Health Nurse 10% Community Health Aide 66%