Alaska Rural Community Health Economic Strategies (ARCHES)

Location and Context
Alaska is truly a rural state. Its vast geography coupled with a minimal infrastructure contributes to many problems not experienced by other parts of America. Twenty-five percent of all Alaskans, and 46 percent of Alaska Natives (Eskimos, Aleuts, Indians), live in communities of fewer than 1,000 people. Nearly one-quarter of Alaskans live in communities accessible only by boat or aircraft. Given the great distances between the smallest rural communities and either sub-regional or regional centers, the future of rural Alaska depends largely upon how well the health and economic infrastructure connects rural people to services and jobs. The Alaska Native Health System functions at three distinct levels - statewide, regional and village. Statewide health services are operated by the Alaska Native Tribal Health Consortium (ANTHC), and include the Alaska Native Medical Center and numerous other specialized functions. Regional health organizations are responsible for service delivery within geographic areas containing six to 50 small communities. The beneficiary populations served by the regional health organizations vary between 2,000 and 20,000. Some regional health organizations operate hospitals and all operate a variety of health programs, including the Community Health Aide Program (CHAP). The regional Native health organizations have for many years employed Community Health Aides/Practitioners to provide basic primary care services in rural communities under standing orders from physicians at regional hospital facilities. These individuals are locally recruited and complete a series of training sessions at one of four training centers around the state. There are approximately 500 Community Health Aides working in 180 villages, providing high quality, culturally sensitive health care to fellow village residents. Within this system of care, the Village-Based Health Provider Training project will provide significantly increased access to training and training resources at the regional and village levels of service.

Collaborative Structure and Strategy
The Alaska Rural Community Health Economic Strategies (ARCHES) has designed the Village-Based Health Provider Training Project as its first collaborative endeavor involving the full partnership. The purpose of this three-year project is to support the development of up to 100 new health care related jobs throughout rural Alaska in service areas with the greatest need. This goal will be accomplished by providing the means for existing Alaska Native regional health organizations, who are already responsible for health care in the communities of their geographic region, to access training for paraprofessional provider staff in the three critical areas of dental health, behavioral health and personal/elder care. This collaborative venture will capitalize on linkages established among funders and community organizations committed to improving the health of rural Alaskans. The lead program agent of the partnership is the Alaska Native Tribal Health Consortium. Through the Village Based Health Provider Training initiative, ARCHES supports the development of rural employment opportunities, advancement of village-based skills and expansion of capacity to meet critical health care needs in the most rural parts of Alaska.

Leverage and Impact
Initial commitments and leverage from the Rasmuson Foundation and the Denali Commission resulted in the National Rural Funders Collaborative commitment of $300,000 over three years. The Denali Commission has committed $100,000 annually for three years. The Rasmuson Foundation recently awarded its largest grant ever to the ANTHC, at $1,000,000 over five years, to support the development and implementation of the statewide dental health aide component to the initiative. The Rasmuson grant matches both the larger Village Based Health Provider Training Project and the Dental Health Aide Program Development initiative, funded with a $1,325,000 Indian Health Service grant. The Alaska Mental Health Trust Authority awarded $76,500 to the initiative for project staffing, and will consider ongoing support at this level for each subsequent project year. Supplemental requests to the Robert Wood Johnson and Ford Foundations, totaling 1,200,000 over three years, are pending.

	Main Contact
	Paul Sherry Chief Executive Officer Alaska Native Tribal Health Consortium Phone: (907) 729-1905 psherry@anthc.org