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North Carolina North COHARIE INTRA-TRIBAL COUNCIL, INC. NORTHCAROLINA Project Title: Coharie Health Access, Improvement, and Awareness Project Award Amount: $264,863 Type of Grant: Social and Economic Development Strategies Project Period: Sept. 2008 – Sept. 2010 Grantee Type: Tribal Nonprofit PROJECT SNAPSHOT and health problems on behalf of tribal members. • 3 jobs created Major barriers to health care for tribal • 25 elders involved members include an inability to pay for • 30 youth involved health services, apprehension toward Western medicines due to lack of cultural • $63,059 in resources leveraged sensitivity in service delivery, unavailable • 32 individuals trained prevention programs, and insufficient access • 10 partnerships formed to care in rural areas. As a result of these barriers, the Coharie Tribe has a BACKGROUND disproportionately high percentage of The Coharie Indian Tribe consists of 2,791 members suffering from diabetes, obesity, enrolled members and was recognized by high cholesterol, and a number of other the State of North Carolina in 1971. maladies and disabilities. Approximately 80 percent of its members PURPOSE AND OBJECTIVES reside in the tribe’s service area, Harnett and Sampson counties, which consistently rank The purpose of this project was to increase below state levels along numerous critical access to health care and to enhance health indicators. Although recognized by awareness and knowledge of health care the state, the tribe is not federally issues and resources among members of the recognized, so its members do not receive tribe. The project’s single objective was health care from the Indian Health Service. comprised of three core components to be completed over a two-year duration. The tribe currently is governed by the Coharie Intra-Tribal Council, Inc., which The first project component was to provide consists of seven members elected by the in-home medical services to tribal members, tribal membership and seeks to address a with a target figure of 112 individuals and/or broad scope of interrelated social, economic, families to be served over two years. To accomplish this, project staff utilized a small __________________________________________________________________________ 90 team of registered nurses (RNs) to provide OUTCOMES AND COMMUNITY IMPACT in-home medical services to171 tribal Project staff stated that the project had a members. significant, positive impact on the Coharie The second project component was to Tribal community. First and foremost, free conduct quarterly health screening clinics, medical services provided to 171 tribal equaling a total of eight over the project’s members obviated many unnecessary and duration. To reach as many tribal members costly emergency room visits; free medical as possible, the clinics were advertised well treatment was provided to all recipients, the in advance and held in several different vast majority of whom did not have health locations. The primary aim of the clinics insurance or other financial resources to pay was to provide health education and for these services. Moreover, home visits preventative care. Numerous screenings resulted in critical references to physicians were offered, including blood pressure, for eight cases in which recipients had NORTHCAROLINA glucose levels, cholesterol, flu shots, and serious health conditions requiring vision exams. The project staff aimed to additional care. In these cases, recipients serve a minimum of 180 individuals at these stated that they were not aware of the clinics, and the target was exceeded, with severity of their conditions and that if not for 254 tribal members receiving screenings. the home visit they likely would not have received any form of treatment. The third project component was to design health-related pamphlets and brochures and Additionally, according to project staff, the disseminate them at tribal community health screening clinics, mobile units, and meetings. Project staff originally had dissemination of health education materials planned to design and customize the were highly effective in raising awareness of educational materials to make them behavioral determinants of health, culturally appropriate, but they later decided promoting health literacy, and that using existing health education communicating the importance of materials would be more pragmatic and preventative care for all tribal members, cost-effective. To disseminate the materials, particularly elders and youth. the project team attended community meetings, providing the materials to 357 tribal members. This significantly exceeded the pre-project goal of 200 tribal members receiving health education resources. Lastly, project staff created a health advisory committee for the tribe, consisting of three RNs, an outreach coordinator, and a health care consultant. This committee conducted an ongoing evaluation of community health needs, exchanged contact information, and coordinated the deployment of a mobile health unit staffed with a physician and an RN to provide additional screenings, treatment, and prescriptions for community members. __________________________________________________________________________ 91 EASTERN BAND OF CHEROKEE INDIANS NORTHCAROLINA Project Title: Fisheries and Wildlife Digital Permitting System Award Amount: $213,000 Type of Grant: Social and Economic Development Strategies Project Period: Sept. 2009 – Sept. 2010 Grantee Type: Tribe PROJECT SNAPSHOT PURPOSE AND OBJECTIVES • $73,530 in resources leveraged The purpose of this project was to develop • 32 individuals trained and implement an electronic fishing permitting system and website in order to • 33 partnerships formed collect tribal revenue more efficiently. BACKGROUND The first objective was to obtain, install, and The Eastern Band of Cherokee Indians implement use of 30 electronic permitting (EBCI) is a federally recognized tribe with units and associated equipment at existing approximately 14,000 members. EBCI vendor sites. Several tribal departments operates a trout fishing program in its waters collaborated in the development of a through the tribe’s Fisheries and Wildlife Request for Proposal (RFP) to find a Management Program. This program offers contractor to install the units, train vendors residents and visitors opportunities to fish on how to use the permitting system, and to mountain streams that are stocked regularly build the accompanying website. The with trout from the tribe’s hatchery. Millennium Group won the bid process to Prior to this project, the Fisheries and perform these tasks and, according to the Wildlife Management Program had been project director, has a strong track record utilizing a paper permitting process to sell working with state and private contractors in fishing licenses. These paper permits were developing and managing electronic fishing sold by authorized vendors (local business permit systems. partners, such as tackle shops and gas The project team purchased 38 total units stations) and the revenue earned was (which included computers, monitors, and submitted to EBCI. However, considerable accessories) for use in the following ways: deficiencies in this system, such as lost 30 units were designated for vendors to sell paperwork and inconsistent tracking, often fishing permits, two units were assigned to have delayed or prevented collections. This the contractor to provide technical support, has resulted in significant uncollected one unit was used by the Fisheries and revenue for the tribe. Wildlife Management Program, and five __________________________________________________________________________ 92 spares were to be used as back-up units in software was issued by the project’s case of technical problems. Training on the contractor to EBCI. A 10-year contract has new computer systems and software was been signed between the Millennium Group given to vendors in groups, followed by and EBCI that entails system maintenance, individual sessions to reinforce proficiency. troubleshooting, and technical support, and Each vendor was given an incentive in the allows for a one-time upgrade of the entire form of an 8 percent commission for each permitting hardware system. permit sold. The new electronic permitting system The second objective was to establish a provides accountability and predictable website for the Fisheries and Wildlife income, as the tribe is guaranteed payment Program that would inform vendors and from vendors by the 10th day of each customers of opportunities within the month. Vendors are required to turn in program, fee schedules, and electronic revenue beyond the 8 percent that they keep NORTHCAROLINA permitting. The contractor developed the and will no longer be able to sell fishing website, which also was intended to function permits if they do not submit revenue. as an e-permitting portal. Lastly, the Fisheries and Wildlife Management Program has reduced time and OUTCOMES AND COMMUNITY IMPACT complications associated with issuing The project team was fully successful in permits manually, improved its management converting the paper permit system into an of customer and transaction data, and electronic one and creating an associated increased revenue for the tribe. Due to the website. Electronic permitting systems were 10-year contract between EBCI and the installed at the facilities of 29 vendors by the contractor, the capacity gained from this end of the project period. Each of these project will be sustainable for at least a vendors had been trained to proficiency in
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