Alaskans want to know why Village Built Clinics are underfunded

Alaska Natives in rural communities often depend on local clinics as their only source for primary health care. However, many of these clinics are in trouble or already closed, and Alaskans want an answer as to why.

Village Built Clinics are health facilities available to rural Alaska communities. They provide primary health care services and are usually staffed by mid-level providers or community health aides.

“They are the only provider of care for remote communities,” said Carolyn Crowder, health department director for the Aleutian Pribilof Islands Association. “They are part of the essential infrastructure.”

The Village Built Clinic program is a big part of this rural health care. Alaska has about 166 VBCs, which are typically leased by the Indian Health Service, a division of U.S. Department of Health and Human Services.

Most of the clinics are owned by tribes, tribal health organizations, local governments or private entities, however.

These clinics are part of the Community Health Aide Program, or CHAP, which depends on these clinics being built and maintained to stay active.

The problem is these clinics have fallen on hard times. The funding, which is contracted through HIS, isn’t enough to keep up with renovations or staffing. She said some examples include cases of clinics running out of fuel or losing pipes and even medicine from freezing conditions. As a result, many have been deemed unsafe, and others have closed due to health and safety issues. Alaskans are pointing the finger at IHS.

Crowder said underfunding has put these clinics in tough spot. She pointed out that, under the Indian Health Care Improvement Act, IHS is responsible for the CHAP program in Alaska and obligated to properly maintain the clinics and pay full costs for their leases.

“Having a safe facility for people to work in is essential. Not having safe facilities hurts abilities to recruit and retain providers and staff,” she said.

In March, Crowder testified on the matter before the House Natural Resources Subcommittee on Indian and Alaska Native Affairs and said stated that IHS is underfunding them by an estimated $6.6 million annually. She told the Journal this does not include major operations or repairs but only day-to-day operations.

Crowder said that by fiscal year 2006, the lease payments to the villages covered only 55 percent of operating costs on average statewide and has shifted the financial responsibility to the villages. She said IHS has sufficient funds to meet the clinics’ needs.

The Alaska Native Tribal Health Consortium reported in 2005 that a June 2000 study showed that 33 percent needed improvement or replacing.

Alaska Sens. Lisa Murkowski and Mark Begich wrote to IHS Director Yvette Roubideaux asking for an explanation on the funding problems. An excerpt from the letter reads, “It has come to our attention that funding provided by the IHS through leases for the VBC has failed to keep pace with the costs of operating and maintaining the VBCs, and that such funding has also been insufficient to maintain the VBCs in a safe condition.”

The senators ask for a written response why available appropriations have not been made for VBCs and why IHS has not entered into direct leases with these villages using IHS’s authority under the Indian Health Care Improvement Act.

In a Facebook post dated March 16, Murkowski wrote, “Village Built Clinics are critical to healthcare of Alaska natives in villages, yet the facilities are in poor condition or have had to close due to health hazards, leaving some communities without a clinic at all. I want to know why the Indian Health Services hasn’t fully funded the program.”

IHS did not respond to repeated attempts for comment by press time. The Journal inquired about the letter, a summary of the program, which communities it applies to and program costs. IHS spokeswoman Constance James could not provide any information.

President Barack Obama has announced a proposed 2.7 percent increase for the IHS’s fiscal year 2013 budget, bringing to proposed budget authority to $4.42 billion. This budget proposes funds for essential health care services, administrative costs and construction for tribes unable to provide such health care services in their communities.


Jonathan Grass can be reached at [email protected].

04/12/2012 - 8:53am