30th Anniversary Self-governance-Employee Guide to Self-governance Part 1
EMPLOYEE GUIDE TO TRIBAL SELF-GOVERNANCE
PART 1
In 1995, Gila River Indian Community leadership made a transformative choice to take full control of their healthcare through tribal self-governance. It was a bold step toward reclaiming their right to decide how healthcare should be delivered to their people.
That decision allowed for the creation of Gila River Health Care a healthcare system that is rooted in the Community’s values, shaped by their traditions, and that is accountable to the Community.
Over the past 30 years, tribal Self-governance has empowered the Gila River Indian Community and its healthcare system, Gila River Health Care, to innovate with technology while protecting tradition and ensuring that healthcare remains guided by the needs and voices of their people.
Tribal Self-governance has created a path forward, and in 2025, we honor the past 30 years with gratitude. Our employees have and continue to strengthen Gila River Health Care. We thank you for stepping into the future sovereign, unified, and Gila River strong.
TRIBAL SELF-GOVERNANCE BENEFITS
Enhanced Sovereignty: By taking control of program administration, tribes exercise greater self-determination and autonomy over their communities.
Improved Service Delivery: Tribes are better positioned to understand and address the specific needs of their members, leading to more effective and culturally relevant programs.
Economic Development: Managing programs locally can create jobs, build capacity within tribal communities, and stimulate economic growth.
Reduced Federal Oversight: Self-determination contracts reduce the level of federal oversight, allowing tribes to operate programs with greater flexibility and efficiency.
Cost-Effectiveness: Tribes often find that managing programs under 638 contracts is more cost-effective than relying on federal agencies.
ERA: A Time of Limited Control
1940’S - 1995
BEFORE THE TRANSITION TO SELF-GOVERNANCE, INDIAN HEALTH SERVICE (IHS), A FEDERAL AGENCY, PROVIDED HEALTHCARE FOR THE GILA RIVER INDIAN COMMUNITY.
This system often lacked the funding, flexibility, and cultural understanding needed to fully meet the Community's needs.
Tribal members had little say in key parts of their healthcare, such as which services were offered, who was hired, how clinics were improved, and the long-term goals.
Clinics and programs operated with limited funding and space, often leading to overcrowded facilities, long wait times, and inconsistent access to specialty care.
These challenges made existing health problems in Native communities even worse, including higher rates of chronic illness, limited preventive care, and unmet mental and behavioral health needs.
This was a time of major limitations when care was given to the Community, but not guided by or created with the Community.
THE SHIFT: EMBRACING
SELF-GOVERNANCE
The Right To Govern Our Own Health Care System
1995 - PRESENT
IN 1995, THE GILA RIVER INDIAN COMMUNITY TOOK A HISTORIC STEP TOWARD SELF-DETERMINATION BY BEGINNING THE TRANSITION TO SELF-GOVERNANCE UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT (PUBLIC LAW 93-638).
This powerful legislation allowed tribes to take direct control of programs and services previously managed by the federal government. Through this shift, the Community established Gila River Health Care as a tribally chartered 638 non-profit organization, marking a bold and visionary move to govern its own health system.
Tribal leaders took complete control of healthcare operations deciding which services to offer, how to manage budgets, who to hire, and how to grow facilities. But this change was more than just paperwork; it was a powerful act of sovereignty. It gave the Community the right to build a healthcare system based on its values, priorities, and vision for the future.
By embracing Self-governance, the Gila River Indian Community chose to lead its own path forward to health and wellness—on its own terms, in its own voice.
WHAT SELF-GOVERNANCE
MEANS TO GRHC:
Self-governance = Self-Determination in Action
1995 - PRESENT
SELF-GOVERNANCE HAS ALLOWED GILA RIVER HEALTH CARE (GRHC) TO TURN A LIMITED FEDERAL SYSTEM INTO A STRONG, TRIBALLY LED HEALTHCARE MODEL THAT REFLECTS THE SPIRIT, STRENGTH, AND SOVEREIGNTY OF THE GILA RIVER INDIAN COMMUNITY.
What began as a small clinic has grown into a strong network of care including Hu Hu Kam Memorial Hospital, Komatke Health Center, Hau’pal Health Center, and mobile units, making healthcare more accessible across all districts.
This growth has allowed GRHC to provide more culturally relevant and complete care from prevention and chronic disease management to advanced specialty services that were once out of reach for the Community. GRHC has focused on growing its workforce by training and hiring Community members at all levels, from care teams to leadership, building a healthcare system created by the Community, for the Community.
Innovation is central to this progress, with GRHC integrating traditional healing with modern medicine, using technology, and relying on data to deliver smart, responsive care.
At its core, Self-governance has allowed GRHC to uphold and protect the cultural identity of the Akimel O’otham and Pee-Posh peoples while delivering high quality, healthcare.
It is not just an operational model, it is self-determination in action, and a daily expression of what it means to govern our own health.
THE LEGACY CONTINUES:
Building the Next Generation of Tribal Healthcare Providers 1995 - PRESENT
GILA RIVER HEALTH CARE IS RECOGNIZED AS A NATIONAL MODEL OF SUCCESSFUL TRIBAL HEALTHCARE. IT SHOWS HOW SELF-DETERMINATION CAN CREATE LASTING AND MEANINGFUL CHANGE.
Gila River Health Care is recognized as a national model of successful tribal healthcare. It shows how self-determination can create lasting and meaningful change.
As Gila River Health Care looks to the future, it continues to build on this legacy through strong collaborations with academic institutions, universities, and federal partners expanding opportunities and strengthening the foundation of care.
A key focus is empowering the next generation through initiatives like internships and The Elev8 Initiative, which prepare Community members to become future leaders of tribal healthcare.
Gila River Health Care is also expanding its services and reach, bringing care to more people through innovative telehealth options and Healthcare-On-The-Go mobile units.
Gila River Health Care leads boldly into the future—ensuring that the spirit of self-governance continues to grow for generations to come.
GILA R I VER PEOPL E FOU N DATIO N
The tools of Self-Governance have allowed for the establishment of the Gila River People Foundation.
GILA R I VER PEOPL E FOU N DATIO N
Gila River People Foundation’s mission is aligned and supports the guiding principals and healing initiatives of Gila River Health Care.
“Gila River Health Care’s Self-governance journey is rooted in trust, strengthened by Community, and guided by the belief that healing begins with sovereignty.
“Gila River Health Care’s Self-governance journey is rooted in trust, strengthened by Community, and guided by the belief that healing begins with sovereignty.
This 30-year legacy would not be possible without the commitment and contributions of many.”
This 30-year legacy would not be possible without the commitment and contributions of many.”
OUR DEEPEST GRATITUDE TO:
Patients and Visitors: For trusting us with your care and inspiring us to serve with compassion and respect.
Employees and Providers: For your unwavering dedication, resilience, and heart in delivering quality, culturally grounded care every day.
Gila River Health Care Leadership: For stewarding our mission and elevating our purpose with integrity, strategy, and heart.
Tribal Leaders Past and Present: For your vision, courage, and determination to reclaim and redefine our path through Self-Governance.
Partners and Collaborators: For walking alongside us to build healthier futures for all generations of the Gila River Indian Community.
Learn How Other Indigenous Communities Are Thriving Through Self-Governance
For Our People: Stories of Tribal Self-Governance & Sovereignty provides a platform for Tribal Nations to share their stories in their own voices.
See how other Indigenous communities are shifting the narrative and celebrating the success and innovation of tribal self-governance as they build healthy, sustainable, and prosperous Nations.
