Indian self-governance: going through the compacting process.

The self-governance process is one that can promote tribal sovereignty, improve health care, maximize tribal involvement in developing and managing programs, and enhance relationships between health care workers and the population served. This article focuses on the needs of Indian Health Service (IHS) personnel during the four phases of the compacting process. In the pre-negotiation phase, tribes debate the merits of compacting. The negotiation phase consists of meetings between the IHS and the compacting tribe, conferences designed to clarify employment options for health facility personnel, and the initiation of recruiting. The transfer of responsibilities takes place during the transition phase. During this phase, employees may be asked to assume extra duties; also, from the point of view of morale, it is important to recognize departing and incoming personnel during this time. Meetings between the tribe and IHS will continue into the post-transition phase. Communication, group effort, and the strong leadership and encouragement of the tribal government and the IHS can contribute to a smooth transition.