Improving Federal Programs that Serve Tribes and Their Members - High Risk Issue
Concerns about ineffective federal administration of Indian education and healthcare programs and federal mismanagement of energy resources held in trust for tribes and their members has resulted in the designation of federal management of these programs as high risk.
The United States fulfills its responsibilities to Indian tribes and Indians, in part, by:
- administering education programs to approximately 41,000 Indian students and providing administrative support services to schools through the Department of the Interiorâ€™s Bureau of Indian Education (BIE) and Bureau of Indian Affairs (BIA),
- administering health care programs to approximately 2.2 million tribal members through the Department of Health and Human Servicesâ€™ Indian Health Service (IHS), and
- managing energy development that occurs on the 55 million surface acres or from the 57 million subsurface acres held in trust or restricted status for tribes and their membersâ€”conducted primarily through BIA.
However, there are concerns in each of these areas related to oversight, collaboration with stakeholders, workforce planning, equipment and infrastructure, and use of data. Specifically:
Federal agencies conduct limited and inconsistent oversight of federal activities:
- No actions have been taken to address key weaknesses in its oversight of BIE school expenditures, including implementing written oversight procedures and risk criteria for ensuring schools use Interior funds for their intended purpose of providing BIE students a quality education.
- IHS provides limited and inconsistent oversight of the quality of care provided in its federally operated facilities. As a result, the agency cannot ensure that patients receive quality care.
- Lengthy review and response times at BIA have hindered development of Indian energy resources in the past and BIA does not have a documented process or data needed to track agency review times. Without a process and data, BIA cannot ensure that its review process is transparent and efficient or that documents are moving forward in a timely manner.
Federal agencies lack effective collaboration and communication with stakeholders:
- IHS does not require its area offices to inform IHS headquarters if they distribute program increase funds to local Purchase Referred Care (PRC) programs using different criteria than the PRC allocation formula suggested by headquarters. As a result, IHS may be unaware of additional funding variation across areas.
- BIA has taken steps to form an Indian Energy Service Center that is intended to, among other things, help expedite the permitting process associated with Indian energy development. However, BIA did not coordinate with key regulatory agencies, such as Interiorâ€™s Fish and Wildlife Service and the Environmental Protection Agency. As a result, the Service Center is not the central point for collaborating with all federal regulatory partners generally involved in energy development, nor does it serve as a single point of contact for permitting requirements.
Federal agencies have conducted limited federal workforce planning activities:
- The capacity of BIA and BIE school staff to address school facility needs is limited due to gaps in expertise, steady declines in staffing levels, and limited institutional knowledge.
- An insufficient workforce has been the biggest impediment to ensuring patients could access timely primary care through the Indian health care system, according to IHS. Over 1,550 vacancies for health care professionals exist throughout the IHS health care system including: physicians, dentists, nurses, pharmacists, physician assistants, and nurse practitioners.
- BIA has not conducted key workforce planning activities, such as identifying the key workforce skills needed to achieve agency goals, and assessing any skill gaps, even though it has high vacancy rates at some of its agency offices. These workforce issues contribute to BIAâ€™s management shortcomings that have hindered Indian energy development.
Outdated and deteriorating equipment, technology, and infrastructure hinder federal efforts:
- Aging BIE school facilities and equipment contribute to degraded and unsafe conditions for students and staff.
- Access to timely primary care at some health care facilities serving Indian communities is hindered by outdated medical and telecommunications equipment.
- BIA does not have the necessary geographic information system (GIS) mapping data to identify ownership and use of resources, such as existing leases. Without GIS data, the process to identify transactions, such as leases and access agreements for Indian land and resources, can take significant time and staff resources because the process involves searching paper records stored in multiple locations.
Federal agencies lack complete and accurate data:
- Sound information on safety and health conditions of all BIE schools does not exist. Specifically, its nationwide information on safety and health deficiencies at schools is not complete and accurate because of key weaknesses in its inspection program. Without inspection information that is complete and accurate, BIA and BIE cannot effectively determine the magnitude and severity of safety and health deficiencies at schools and cannot ensure their facilities are safe for students and staff and currently meet safety and health requirements.
- IHS does not have complete and consistent PRC program data.
BIA does not have the data it needs to verify who owns some Indian oil and gas resources or identify where leases are in effect. In some cases, BIA cannot verify ownership because federal cadastral surveysâ€”the means by which land is defined, divided, traced, and recordedâ€”cannot be found or are outdated. The ability to account for Indian resources would assist BIA in fulfilling its federal trust responsibility, and determining ownership is a necessary step for BIA to approve leases and other energy-related documents.
GAO-18-580: Published: Aug 15, 2018. Publicly Released: Aug 15, 2018.
Indian Health Service clinics donâ€™t have enough doctors or nurses to provide quality and timely health care to American Indian and Alaska Native people. IHS data show an average vacancy rate for physicians, nurses, and other care providers of 25%. IHS uses multiple strategies to recruit and retain providers, including offering financial incentives and housing. However, IHS has trouble matching...
GAO-17-421: Published: May 24, 2017. Publicly Released: May 24, 2017.
The Department of the Interior (Interior) and its Office of the Assistant Secretary-Indian Affairs (Indian Affairs) have not taken actions to address identified weaknesses in the Bureau of Indian Affairs' (BIA) safety program, despite internal evaluations that have consistently found it to be failing. Specifically, Interior's internal evaluations conducted since 2011 identified major deficiencies...
GAO-17-447: Published: May 24, 2017. Publicly Released: May 24, 2017.
The Department of the Interior's (Interior) Office of the Assistant Secretary-Indian Affairs (Indian Affairs) does not have a comprehensive capital asset plan to guide the allocation of funding for school construction projects across its 185 Bureau of Indian Education (BIE) schools. Indian Affairs is in the process of replacing 3 schools and plans to replace 10 additional schools from a list of 54...
GAO-17-181: Published: Jan 9, 2017. Publicly Released: Jan 9, 2017.
American Indians and Alaska Natives die at higher rates than other Americans from preventable causesâ€”such as diabetes and influenza. The Indian Health Service is charged with providing health care to these populations, but we found it had limited, inconsistent oversight over the quality of care at its facilities. Among other things, a lack of agency-wide performance standards and significant le...
GAO-17-43: Published: Nov 10, 2016. Publicly Released: Nov 17, 2016.
Tribal nations hold considerable energy resources thatâ€”when developedâ€”can improve tribal well-being and long-term economic success. However, a number of factorsâ€”including a complex federal regulatory framework that involves multiple agenciesâ€”have hampered development. A collaborative federal approach to helping tribes achieve their energy goals is important. But we found that federal init...
GAO-16-333: Published: Mar 29, 2016. Publicly Released: Apr 28, 2016.
The Indian Health Service (IHS) has not conducted any systematic, agency-wide oversight of the timeliness of primary care provided in its federally operated facilities. IHS has delegated primary responsibility for the oversight of care provided in its facilities to its area offices and has not set any agency-wide standards for patient wait timesâ€”including both how long it should take to schedule...
GAO-16-313: Published: Mar 10, 2016. Publicly Released: Mar 10, 2016.
The Department of the Interior's (Interior) Office of the Assistant Secretary-Indian Affairs (Indian Affairs) lacks sound information on safety and health conditions of all Bureau of Indian Education (BIE) school facilities. Specifically, GAO found that Indian Affairs' national information on safety and health deficiencies at schools is not complete and accurate because of key weaknesses in its in...