Cultural care accountability for tribal health.
ICHAS, the Indigenous Cultural Healthcare Accountability Standards, is the first accountability framework written from inside Indian Country for the cultural dimension of healthcare. Sixty-six standards. Two hundred eight elements. Ten domains. Grounded in Lakota teaching. Designed to be adapted by each tribal nation.
No one is holding IHS Direct Service accountable for cultural care.
The healthcare system serving roughly 2.6 million American Indian and Alaska Native people operates under accreditation and review frameworks written from a Western clinical lens. Those frameworks measure ambulatory operations, credentialing, quality, and safety in great detail. None of them measures whether a clinic is culturally accountable to the tribal community it serves.
That is not an oversight. It is structural. The result is that Tribes, urban Indian health programs, and IHS Direct Service facilities are evaluated against standards that have no enforceable language for ceremony, traditional healing, language preservation, or whole-person care across mind, body, spirit, and behavior.
AAAHC has 347 standards. Four words cover culture.
A systematic review of the AAAHC Accreditation Handbook for Ambulatory Health Care v43, the standard against which most tribal ambulatory clinics are surveyed, reveals the following:
The full text of AAAHC's cultural language reads, in its entirety: “Culturally sensitive care, when applicable.” Patient Rights, PRR.100 EOC 9.
IHS Program Review carries one passing line.
The IHS Program Review checklists span 25 instruments covering every clinical and administrative domain in an Indian Health Service facility. The Patient Rights checklist contains a single passing reference: staff “respect patients’ cultural and personal values, beliefs, and preferences.”
No definition of what cultural values mean in Indian Country. No measurement criteria. No enforcement mechanism. One sentence carries the entire weight of cultural accountability across an agency that serves 2.6 million Native people.
The first accountability framework for cultural care, written from inside Indian Country.
ICHAS is grounded in the teachings of Richard Moves Camp, traditional Lakota medicine man. The architecture is universal. The cultural content is sovereign: each tribal nation adapts the framework to its own ceremonies, language, and traditions.
The framework is organized into ten domains, summarized below. The standards themselves, scoring methodology, ceremonial protocols, and tribal adaptation guide are available only under engagement, in respect of Richard's authorship and tribal sovereignty over the cultural content.
Richard Moves Camp.
Richard Moves Camp is a traditional Lakota medicine man of the Oglala Sioux Tribe. His ceremonial lineage extends through five generations to his great-great-grandfather Chips, born in 1823.
In 1978, Richard testified before the United States Senate Select Committee on Indian Affairs, contributing to the passage of the American Indian Religious Freedom Act. His teachings, accumulated and recorded over five decades, supply the cultural foundation for ICHAS: the Four Spiritual Laws, the Seven Laws of Unci Maka, the Medicine Wheel, the Buffalo Model, and the rights and protocols that govern care for women, men, children, and elders.
ICHAS does not publish Richard's teachings. ICHAS translates the structural implications of those teachings into accountability language a tribal program and an accreditation surveyor can both work with.
What we created is different. It will become the standard.
Cultural competence checklists bolted onto Western accreditation frameworks are not equivalent to a framework written from inside the culture being measured. They cannot be. A framework that asks a clinic to be “culturally sensitive, when applicable” is doing different work than a framework that asks a clinic to demonstrate Cultural Governance, Spiritual and Ceremonial Care, Sacred Rights Protection, and Whole Person Care to a measurable standard.
The current gap will not last. As tribal sovereignty in healthcare deepens, the expectation that programs are accountable to the cultural dimension of care will move from optional to required. Accreditation bodies, federal program offices, and tribal councils will need a framework to point at. ICHAS is built to be that framework.
Three ways tribal programs use ICHAS.
Self-assessment
Tribal programs use the framework internally to identify strengths, gaps, and priorities for cultural care investment. No external review. Lowest-friction entry point.
Facilitated review
IHA walks a program through the framework with the clinical and cultural leadership team. Produces a written assessment, scored against the 208 elements, with prioritized recommendations.
Accreditation pathway
For programs seeking formal ICHAS designation. Includes facilitated review, remediation, site visit, and cultural advisory board engagement. Longer timeline, deeper commitment.
Who ICHAS is built for.
- Tribally-owned clinics and FQHCs serving federally recognized tribes
- Urban Indian health programs operating under Title V
- 638 contracted and compacted programs wanting a cultural accountability measure alongside federal performance metrics
- IHS Direct Service facilities seeking a cultural accountability supplement
- Non-tribal health systems with tribal patient populations, as a structured way to assess and improve cultural responsiveness
- Foundations, federal program offices, and academic partners evaluating cultural care frameworks for funding or policy purposes
ICHAS is not a substitute for tribal consultation, tribal governance, or Indian preference hiring. It sits alongside those structural commitments as one measurement tool among many.
Evaluating cultural accountability?
Whether you are a tribal program scoping self-assessment or a non-tribal system trying to measure cultural responsiveness, start with a scoped conversation.
Book a discovery callWant to understand the grounding?
ICHAS is grounded in specific Indigenous teaching relationships. The cultural foundation page describes how that grounding threads through IHA's work.
See our cultural foundation