Tribal executive committee enhances communication, collaboration, and representation during emergency preparedness planning while acknowledging tribal sovereignty

Background

The United States has a unique legal relationship with Indian tribal governments as set forth in the US constitution, treaties, statutes, executive orders, and court decisions. Since the formation of the union, the US has recognized Indian tribes as domestic dependent nations under its protection. The US continues to work with Indian tribes on a government-to-government basis, recognizes the right of Indian tribes to self-government, and supports tribal sovereignty and self-determination.

Although tribes have nation-to-nation status with the US federal government, and not with state governments, emergency preparedness planning and response at the local level still requires communication and collaboration between tribal and state governments.

Arizona has 21 Indian tribes residing within its borders, 12 of which contract with the Arizona Department of Health Services (AZDHS) to receive Public Health Emergency Preparedness (PHEP) funds. This funding engages tribal leadership through an integrated all-hazards approach to improve the health of tribal people on their lands.

Specific issues

• Clarity regarding tribal sovereignty. Tribal council members and state officials have not always had a shared understanding about tribal sovereignty during a public health emergency.
• Federal mandate for tribal consultation. Federal guidelines and mandates for federal agencies include having tribal consultation policies. The State of Arizona did not previously have a tribal consultation policy or structure, a requirement for some future funding opportunities.
• Tribal advocacy. Arizona tribes lacked a way to coordinate and advocate for public health emergency preparedness and response resources with the state health department.
• Emergency decision-making ability. Arizona’s 36 independent governments (15 counties and 21 tribes) posed a challenge to authority, communications, logistics, and coordination during an emergency. An efficient emergency decision-making process was needed.

The practice

The State of Arizona created an executive body representing the state’s 21 tribes to facilitate local input in state decisions and to establish an emergency decision-making process.

AZDHS formed two organizations—the Arizona Local Health Organization Agency (ALHOA) and Tribal Collaborative Team—in 2006 to (1) represent the state’s 15 local counties and 21 tribes, respectively, (2) address emergency preparedness planning, and (3) establish an avenue for rapid decision-making. Initial work was funded with federal pandemic influenza funding passed through the state health department.

Though initially slow to gel, the Tribal Collaborative Team ultimately followed the example of the ALHOA and, over the course of a year, developed a strategic plan that was signed in January 2010. The six goals of the strategic plan are to:

1. Foster government-to-government relationships to enhance tribal preparedness
2. Create effective community awareness, preparedness, training, and education programs for the health of native people
3. Establish a process to review and have input into the requirements of Public Health Emergency Preparedness cooperative agreement(s)
4. Enhance the integrated all-hazards approach to public health emergency preparedness
5. Enhance the recognition of the Tribal Collaborative Team as the executive body for Arizona Tribal Public Health Emergency Preparedness Coordinators
6. Identify alternative funding and contracting mechanisms for tribes to participate in Public Health Emergency Preparedness activities to include the Arizona Department of Health Services Public Health Emergency Preparedness contracting program

The executive body, referenced in goal five, was renamed the Arizona Tribal Executive Committee (AzTEC) and officially formed with bylaws in October 2010. The goal of AzTEC, as stated in the bylaws, is to “[represent] the tribes in negotiations and in providing consultation and recommendations on behalf of tribes to promote and protect the health, education, and general welfare of Arizona’s tribal members to facilitate tribal input into the decision-making process by AZDHS.”

AzTEC membership is open to all Arizona Tribal Public Health Emergency Preparedness Coordinators, up to nine members total. Committee members represent the Central Region (2), Southeastern Region (2), Western Region (1), Northern Region (3), and Arizona Department of Health Services (1). All members have one vote, except the state representative who is not allowed to vote, serve 2-year terms, and are eligible for reelection.

There is no budget for committee members, meeting expenses, or activities. Any necessary funding is provided for within existing PHEP cooperative agreements at the tribal level. Although AzTEC has managed without official funding, the group most likely will not be able to continue to meet on a monthly basis in the future due to pending funding cuts to PHEP programs at the tribal level.

What made this practice possible?

• Funding. Although there is no direct funding for AzTEC, 12 tribes receive PHEP funds through the state health department from CDC. Tribal PHEP funds cover basic travel and meeting costs.
• Inclusive process. The process of building support for AzTEC, discussing tribal sovereignty with tribal councils, and engaging representatives from all regions in Arizona created a stronger commitment to AzTEC.
• Tabletop exercises and drills. There was confusion at the local level about why the governor has authority on tribal lands during a public health emergency. A school-closing tabletop exercise and drill helped raise awareness about tribal sovereignty and the role of the state during an emergency.

Results

• Increased understanding of tribal and state government roles during a public health emergency.
• Created a better consultative process. AzTEC members reported that the committee has enabled tribes to have a better consultative process with the state health department. For example, when budget cuts were being considered, conference calls were arranged to talk about how the cuts were going to be structured. These conversations did not happen in the past.
• Established a process for emergency decision-making. AzTEC bylaws give members emergency decision-making authority on behalf of the tribes in Arizona.
• Developed a strategic plan. AzTEC members developed a 3-year strategic plan (2010-2013) for the tribal PHEP programs. The plan has been reviewed and is supported at the state level. It also defines responsibilities and expectations for all participating AzTEC members.