DEPARTMENT

OF HEALTH

Ms. Ramona Antone-Nez, Acting Executive Director

Telephone #: 928-871-6350
Email: ramona.nez@nndoh.org
FY 2016 Second Quarterly Report
(January, February, March 2016)

TABLE OF CONTENTS

Page No.

I.

EXECUTIVE SUMMARY

II.

CRITICAL ISSUES

III.

PROJECT STATUS

IV.

BUDGET STATUS

V.

OPERATIONAL & PROCESS IMPROVEMENT INITIATIVE STATUS

DEPARTMENT OF HEALTH| FY 2016 2nd Quarter Report Page 1

I.

Executive Summary

The Navajo Department of Health (NDOH) provides health care delivery and preventive community
based services throughout the Navajo Nation. With the new Navajo Nation Council approved
legislation as a Department of Health, NDOH is authorized to carry out goals and objectives to meet
the comprehensive health care and public health needs of the Navajo Nation and its population. Health
related services are provided across the Navajo Nation with offices in most of the Agencies and some
in border towns to provide greater access to services. Also, the NDOH plays a crucial role in supporting
and advocating for plans or projects initiated by the Navajo Nation or local communities. This
important role continues to be coordinated with the Health, Education and Human Services Committee
(HEHSC) of the Navajo Nation Council, as the oversight committee for NDOH and other subcommittees
of the Council as considered necessary.

Currently, several tasks have been identified while others continue to be addressed in order to become
fully operational as a Department of Health, including the development of policies and the complete
revision of the existing Master Plan of Operation.

The second quarterly report covers January - March, 2016, which features the activities of 15 programs
including the Executive Administration.

The Executive Administration of the Navajo Department of Health reports the following:
A. The Kayenta Health Center is now complete. This new State-of-the-Art health care facility will be
dedicated on April 27, 2016. The Kayenta Health Center Planner in coordination with the Kayenta
Steering Committee is planning activities to commemorate the completion of the new clinic. A
draft agenda for this event has been developed subjected to finalization upon confirmations. The
President of the Navajo Nation along with other high-ranking federal officials are invited to speak
at this momentous event.
B. In addition, in Fiscal Year 2016 the United States Congress appropriated $105 million for the Indian
Health Service Health Care Facilities Construction line item. This amount includes funds for the
Dilkon Health Center in the amount of $12 million to be used to develop the utilities, water, and
other infrastructure for the new health center. However, the Indian Health Service has not yet
allocated the funds to the Navajo Area Indian Health Service. Once the funds have been allocated
to the Navajo Area IHS, a Notice of Funding Availability will be sent to the Navajo Nation Office of
the President and Vice President for further action.
C. The Dilkon Health Centers Program Justification Document (PJD) is presently going through an
amendment process. This is necessary as the original PJD was approved in 2006; so it is essential
that the PJD be updated to reflect current information such as workload, programs, services, etc.,
as it relates to the planning of the new Dilkon Health Center.
D. The issue of water to serve the new Health Clinic continues to be addressed, the assigned planner
for the Dilkon project has been attending water planning meetings that include the Sihasin

DEPARTMENT OF HEALTH| FY 2016 2nd Quarter Report Page 2

E.

F.

G.

H.

I.
J.

K.

Committee meetings, TAG meetings and meetings with the Office of the Navajo Nation Speaker to
promote the concept of having viable water sources available to serve the proposed Dilkon Health
Center. An alternate water source being considered for the project is the Lower Greasewood
Water Supply Project which is in development and construction. However, a more permanent
water source will have to be determined soon.
During this quarter, the NDOH helped sponsor the Annual CMS Outreach and Education Training
which was held in Gallup, NM on March 15 & 16, 2016. The target audience was primarily patient
benefits coordinators, IHS/638 facilities business office staff, patient registration staff, health
information management staff, Purchased/Referred Care staff, and Navajo Nation Department of
Health direct service providers. Staff from the Navajo Epidemiology Center provided a
presentation on the Hantavirus and the Zika Virus and its impact on the Navajo Nation.
The Navajo Breast and Cervical Cancer Prevention Program developed a plan to provide
mammogram screening to clients in the New Mexico portion of the Navajo Nation. The first official
mobile mammogram screening in New Mexico with partner Dzilth-Na-O-Dith-Hle Health Center is
set for April 5, 2016. This as a major accomplishment because prior to this; no services were
provided to the New Mexico side of the Navajo Nation.
The Department of Behavioral Health Services is working to assess the Dual Diagnosis Capability in
Addiction Treatment (DDCAT) and Tribal Core (Traditional Practitioners and Faith-Based), DBHS has
commenced assessments for FY2016. Based on assessments completed in 2015, a compilation of
data was obtained to determine a benchmark that DBHS can utilize to improve on dual diagnosing
capabilities. Training was held on March 7, 2016 in Tuba City to introduce new participants to the
assessment process. Thereafter assessments were completed on March 8 for Tuba City and March
9 for Kayenta.
The Community Health Representatives and Outreach Program is working with Indian Health
Service and/or their 638 facilities through the Public Health Nursing program to assist them with
referrals, case management, particularly for high risk populations, and coordination of meetings,
and jointly sponsoring Health Promotion presentations/activities such as the Just Move It, and
Fitness Gram in the schools. Health screenings and fairs have increased to provide education on
priority health issues such as HIV, Hantavirus, Rocky Mountain Spotted Fever (RMSF) and the flu.
The Food Distribution Program (FDP) through its seven distribution warehouse sites provides
eligible households with service. During the second quarter, there were 340 tailgate food
deliveries completed and a total of 22,906 participants were served.
The Health Education Program staff was apprised of the Zika Virus, causative agent, environment,
signs and symptoms, mode of transmission, occurrence, reservoir, incubation period, risk groups,
and prevention measures. It is important that staff have this knowledge in order to provide quality
health and disease prevention education.
Coordinated partnership is the key to public health nursing provision by the Kayenta Public Health
Nursing program. This office coordinates with various internal and external programs to provide
quality public health nursing services to the patients/clients of the Kayenta Service Unit. During the
second quarter reporting period, a total of twenty-two public health education events were held
with a total of 1,351 participants.

DEPARTMENT OF HEALTH| FY 2016 2nd Quarter Report Page 3

L. The Navajo Area Agency on Aging has reestablished the Navajo Area Council on Aging (NACOA)
with elected officers. A Plan of Operation and a guiding set of By-Laws will be developed to help
govern the affairs of the NACOA.
M. The Navajo Epidemiology Center/Navajo Suicide Surveillance Project: To address high rates of
suicide among Navajo youths, the NEC, Navajo Department of Behavioral Health Services, and
Navajo Area Indian Health Service are working toward the development of a community-based
suicide surveillance system that has evolved to include community-based reporting of suicidal and
related behavior, engagement and referral of affected individuals, and the development of
prevention strategies reflecting patterns of suicidal behavior on the Navajo Nation.
N. The Navajo Special Diabetes Program submitted an amended budget to Indian Health Service
Grants Management in the amount of $6.4 million for the SDPI Program however the program was
approved for only $2.4 million; this amount will enable the program to continue until FY2017; at
which time the NSDP will have to reapply for new funding. The Program wants to highlight the fact
that there remains a standing shortfall of $4 million.
O. The New Dawn Program New Dawn Program has rendered direct services to 198 people including 3
youths and 5 veterans. The Program will soon begin distributing vegetable seeds, fruit trees, and
vegetable seedlings to communities and services will increase in number.
P. The Office of Environmental Health /Code Enforcements purpose is to reduce environmentally
related disease and injury among the Navajo Nation population through the enforcement of health
and safety codes, regulations and standards. It also provides food service facility/establishment
surveys, monitoring and surveillance, permit issuances, food handlers training, flea market
surveys, monitoring and surveillance, technical assistance, and adverse actions, if warranted.
During this quarter, there were several food establishment and service facilities that were closed
after assessment. Most of these facilities were re-opened after corrective actions were taken to
address concerns.
Q. The Office of Navajo Uranium Workers reports during this quarter 19 clients received
compensation from the Federal Radiation Compensation Network totaling in the amount of an
overall $1.2 million dollars. The ONUW continues to do case management to ensure eligible
former uranium workers and/or their dependents receive consideration for compensation.
R. The Public Health Emergency Preparedness Program reports the completion and submittal of the
Navajo Nation-Wide Threat, Hazard Identification and Risk Assessment Report (THIRA) to FEMA for
review and approval. The document must be shared at all levels of government to build defense,
prevention, response and recovery capabilities to protect the communities.
S. The Navajo Women, Infants and Children (WIC) Program reports that the Acting Principal
Nutritionist is conducting a comprehensive review of the current policies and procedures for the
purpose of updating and amending the policies/procedures as determined appropriate.
T. Food Access Navigation Demonstration Project USDA Cooperative Agreement for the amount of
$2.4 million. A Program Director has been hired.




DEPARTMENT OF HEALTH| FY 2016 2nd Quarter Report Page 4

II.

Critical Issues

A. The Department of Behavioral Health Services (DBHS): The Thoreau Outpatient Treatment Center
was reported to have termite infestation, causing interior and exterior damage to the building.
Repairs are needed between the walls of the womens and mens restrooms. The Office of
Environmental Health inspected the building on March 14, 2016; a written report will be prepared.
Navajo Nation OSHA also inspected the building. An Action Plan was developed to address the
problem. Closure of the building is not feasible due to the demanding case load at this site
however; the safety of clients and staff takes precedence. Therefore, a contract with Carter Pest
Services was completed and they will monitor the facility on a monthly basis. DBHS will also review
and proceed with Action Plan from NNOSHA and continue to collaborate with Thoreau Chapter to
plan for land site acquisition for a new facility. DBHS will review a cost analysis of current repairs;
future projections based on severity of problem and will outline next steps.
B. The BCCPP Program reports that there is a continual problem with requesting carryover funds after
the program completes and submits the Final Financial Report. This is largely due to requests by
Contract Accounting to have the program make changes/adjustments to the report. This creates
delays in the submittal of the Final Financial Report to the funding source. The most recent report
was submitted 3 months late, thus it impeded the Programs effort to request carryover funds.
Because the request for carryover funds was submitted late, any available carryover funds will not
be available for program to expend until next quarter (the final quarter of the fiscal year).
C. The CHR Outreach program reports that the Patient Records Information Services Manager (PRISM)
which is a STD/HIV Data Base needs to be installed and fully operational at the Social Hygiene Field
Offices in partnership with the States of New Mexico and of Arizona STD Health Departments. The
installation and operation of this Data Base will allow the field staff to input data into the system
for reporting purposes.
D. The Food Distribution Program is working with the USDA on the Management Evaluation, this
effort will continue until it is completed with USDAs approval.
E. The Health Education Program reports that the Youth Risk Behavior Surveillance Survey (YRBSS) did
not meet the required threshold of 60% participation rate, from both middle school (50%) and high
school (47%). Therefore, no report will be generated for the year 2014, which is a first interruption
of the tri-ennial report. Another factor that contributed to this is that Schools Boards voted down
their schools participation in the YRBSS.
F. The Kayenta Public Health Nursing is still without a full-time Program Director; currently there is a
delegated Acting Director overseeing the program. The Program desires to have the position
advertised to ensure a full-time Director is recruited and selected to fill the position.
G. The Navajo Area Agency on Aging reports that the Office of Environmental Health under the Navajo
Area Indian Health Service and the Navajo Nation OEH have closed four Senior Centers in several
communities as follows: Shiprock, NM due mouse infestation; Huerfano, NM due to unsafe Butane
bottle; Ganado, AZ due to unsafe and health hazard infrastructure; and Coyote Canyon, NM due to
an unsafe obsolete building. Corrective Action Plans are being implemented by the Supervisors of
the affected Senior Centers.

DEPARTMENT OF HEALTH| FY 2016 2nd Quarter Report Page 5

H. The Navajo Epidemiology Center continues to have need for sufficient resources to support staff
positions and infrastructure for NEC to operate at its full capacity, especially now that the Navajo
Department of Health has been approved.
I. The Navajo Special Diabetes Program is concerned about the $4 million shortfall to the SDPI
Competitive Grant and how the reduced funding will ultimately impact operations in 2016.
J. The New Dawn Program have issues with availability of office space for the field staff stationed in
the Crownpoint Agency; field staff have had been occupying space in the Navajo Area Agency on
Aging office however the staff were asked to move out because NAAA intended to hire additional
staff. Consequently, the New Dawn field staff must find an alternate office space. There is a small
mobile trailer home located near the Crownpoint Chapter House that is available however; it will
require the Program to develop an MOU to be entered into with the Crownpoint Chapter.
K. The Office of Navajo Uranium Workers reports that there has been no action regarding the 2015
RECA Amendments. To help resolve this matter, the ONUW has established a network system with
various uranium organizations and OPVP to strategize on a plan of action that would allow the
RECA Amendments can begin to move through the appropriate legislative processes for a decision.
L. The Public Health Emergency Preparedness Program NN (NDOH) continues to experience
challenges with separate funding allocations to the Navajo Nation which encompasses three states.
For this reason, the program is working on a tri-state agreement with the three state health
officials and the three federal regional offices to allow the Navajo Nation to receive direct funding
in 2017 on behalf of the Program.
M. The WIC Program is in the initial stages of developing an Electronic Benefits Transfer (EBT) system.
The national target date for transitioning WIC to EBT is 2020. Navajo WIC is targeting January 2017
as the first phase rollout. NNWIC will be soliciting a card design from the program field staff. NDOH
Program Directors will have an opportunity to participate in three card designs.

III.

Project(s) Status

A. The Breast and Cervical Cancer Prevention Program submitted Year 5 Grant budget and work plan
to CDC in February 2016. The grant was sent through the grants.gov website 8 days before the due
date.
B. The Department of Behavioral Health Services DBHS is working with NetSmart, Inc., to design and
implement a new Electronic Health Record system for DBHS. The current EHR system, AccuCare
will be utilized to the end of year 2016. The new EHR will be implemented by January 01, 2017.
Trainings will be completed within the year for employees so transition can be achieved efficiently.
DBHS is also exploring the concept of incorporating and enhancing billing capabilities with the new
system for effective third party billing.
C. The Health Education Program staff previously assisted the Arizona Department of Health Services
in creating a school curriculum on Rocky Mountain Spotted Fever (RMSF); in February 2016 staff
received training which included Public Health Nurses and CHRs. The curriculum is aimed at
prevention, intervention (tick removal), and information regarding when to seek medical attention.
D. The Navajo Area Agency on Aging has accomplished 98% of its 100% goal to achieve Employees
Annual Certification for CPR, First Aid, Fire Safety, Food Handling Permit and Safe Driving.

DEPARTMENT OF HEALTH| FY 2016 2nd Quarter Report Page 6

E. The Navajo Epidemiology Center (NEC): Navajo Infectious Disease Surveillance System Project:
MOA established between the NEC and New Mexico Department of Health (NMDOH) to conduct
public health related epidemiological investigation, disease surveillance and response, and to
integrate both entities in response to acute events. The MOA will assure: (a) complete and timely
acute public health event and disease surveillance activities to include appropriate documentation,
case management, training, and collaboration with NMDOH personnel, healthcare providers, other
agencies, and key identified partners as needed; (b) responses to infectious disease and other
acute disease cases, clusters and outbreaks; (c) special projects, data analysis, and related
initiatives; and (d) supervision and communication as it relates to central/regional/local
coordination with NMDOH.
F. The Navajo Special Diabetes Program sponsored 25 public service announcements on Healthy
Eating since February 2016 to the present date. The radio stations ran sixty-second
announcements to highlight healthy eating. To date, there have been a total of 75 announcements
completed.
G. The New Dawn Programs field staff have provided a number of presentations in the communities,
schools and senior centers to provide education on horticulture and food preservation.
H. The Office of Navajo Uranium workers reports their buildings HVAC system was repaired in January
2016. The office identified funds within the program budget and contracted with an independent
contractor to complete the job.
I. The Public Health Emergency Preparedness Program has completed an application for Arizona
Ebola Funds in the amount of $15,000 for FY 2015-FY 2017. The documents are in the 164 Review
Process and the packet is currently with OMB/OCG section.
J. Navajo WIC reports that an asbestos assessment is being performed by the Navajo Nation Risk
Management office for the WIC Tsaile building replacement project. This assessment is required
before existing building are moved off the land on which they are currently situated. Upon removal
of the two trailers, the Navajo Nation Design and Engineering will conduct an assessment of utilities
and soil. Procurement of proposed Navajo WIC building will follow the comprehensive asbestos
assessment and abatement, if necessary.

IV.

Budget Status

2nd Quarterly Budget Information

Funding Source

Number of
Personnel

FY 2016
Personnel

General Funds etc

$ amt

Department of Health

Funding Source
External Funds

Department of Health

% Used

251

$ amt

Used

$4,249,970

Number of
Personnel

FY 2016 /15
Personnel

$ amt

1,328

FY 2016
Operating

$8,453,324

33%

1,562,548

% Used
35%

12%

FY 2016/15
Operating

$ amt

Used

9,866,277

41%

DEPARTMENT OF HEALTH| FY 2016 2nd Quarter Report Page 7

V. Operational and Process Improvement Initiative Status

A. The NDOH Executive Administration is pleased to report that programs under the NDOH are
working to complete their FMIS training modules to ensure they meet the 6B Rollout as mandated
by the Office of the Controller. Some staff including the Acting Executive Director have completed
the modules and have passed all the requesting testing, however the rest of the staff are still
working on completing the training modules.
B. The CHR-Outreach Program reports that the Navajo Nation through auditors KPMG conducted an
Annual Calendar Year 2015 Single Audit of the CHR Program with preliminary results being positive.
C. The DBHS is working to standardize all clinical forms in lieu of revisions being completed with the
DBHS Policies and Procedures. This will help with service delivery and to ensure that all levels of
service at all DBHS sites are concurrent and effective.
D. The Health Education Program staff participated in the Public Health Emergency Preparedness
exercise through meetings and online training; ICS 100, 700 and 300 in class instruction was
attended by staff as well as the Medical Countermeasure (MCM) Communications meetings.
E. The Navajo Area Agency on Aging reports that there is a review of policies and procedures
underway to work toward program performance improvement. The review will allow for update
(s) to the policies and procedures.
F. The Navajo Special Diabetes Program participated in mandatory SDPI Webinars on SDPI Outcomes
System (SOS) which is being implemented this year by IHS SDPI Program; the intent is to record
data on a specific target group. NSDP addressed data fields for the target group. Data from the
Web-based Data Collection and Management System with Real Time Solutions may provide the
necessary data for the SOS.
G. The Office of Navajo Uranium Workers plans to work with the State Legislators and the Navajo
Nation to secure funds for a new building.
H. The Public Health Emergency Preparedness Program continually strives to improve the NDOH
Incident Management Team capacity with review of the emergency response after action reports,
in addition to reviewing and updating the emergency operational plans; and offering NIMS-ICS
training to personnel.
I. The Navajo WIC Program is working toward complying with the FY2016 Condition of Appropriations
# 8 (developing the programmatic Plan of Operation). As a unit under the Navajo Department of
Health, NWIC is exploring alternatives to organize its service delivery methodologies utilizing the
Public Health Accreditation Boards model for Standards and Measures.

DEPARTMENT OF HEALTH| FY 2016 2nd Quarter Report Page 8