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U.S. Department of Health and Human Services
Indian Health Manual

Chapter 11 - Environmental Health

Part 3 - Professional Services

Title Section
INTRODUCTION 3-11.1
    Purpose 3-11.1A
    Scope 3-11.1B
    Background 3-11.1C
    Policy 3-11.1D
Priorities 3-11.2
    Environmental Health Services Priorities 3-11.2A
    Sanitation Facilities Construction Priorities 3-11.2B
Authorities 3-11.3
Organization 3-11.4
    National Level 3-11.4A
    Area Level 3-11.4B
Responsibilities 3-11.5
    Directors, EHS and SFC 3-11.5A
    Area Division Directors, EHS and SFC 3-11.5B
    Field Staff 3-11.5C
    Licensing 3-11.5D
    Planning Environmental Health Priorities 3-11.5E
    Tribes 3-11.5F
Program Elements 3-11.6
    Program Elements' Common Services 3-11.6A
    Air Quality Program 3-11.6B
    Community Facilities and Institutions 3-11.6C
    Community Injury Prevention 3-11.6D
    Drinking Water Quality 3-11.6E
    Emergency Management 3-11.6F
    Environmental Sustainability 3-11.6G
    Food Safety 3-11.6H
    Health Care Institutions 3-11.6I
    Healthy Housing 3-11.6J
    Mass Gatherings and Recreational Sites 3-11.6K
    Operation and Maintenance of Sanitation Facilities 3-11.6L
    Project Management 3-11.6M
    Recreational Water and Water Features 3-11.6N
    Safety Management 3-11.6O
    Vectorborne and Communicable Disease Control 3-11.6P
    Waste Management 3-11.6Q

Exhibit Description
Exhibit 3-11.A "Ten Essential Public Health Services"
Exhibit 3-11.B "Resource and Materials Lists"

3-11.1  INTRODUCTION

  1. Purpose.  This revised and updated chapter replaces an Indian Health Manual chapter that has been in effect for almost 30 years.  This chapter incorporates nationally recognized best practices into the Indian Health Service (IHS) Environmental Health Program to protect the health and prevent diseases in the eligible American Indian and Alaska Native (AI/AN) population that we serve.  The use of this updated chapter will help to reduce environmentally related morbidity and mortality in Tribal communities.
  2. Scope.  The three core functions of governmental public health were defined as assessment, policy development, and assurance.  The Public Health Functions Steering Committee developed the "Ten Essential Public Health Services," as an explanation of the three core functions.  The Office of Environmental Health and Engineering (OEHE) operates within the framework of the "Ten Essential Public Health Services" (Manual Exhibit 3-11-A).  This chapter addresses the activities of two Divisions within the OEHE:
    1. Environmental Health Services (EHS)
    2. Sanitation Facilities Construction (SFC)
  3. Background.  The U.S. Department of the Interior's Office of Indian Affairs Commissioner Charles Henry Burke issued a circular in 1912 that directed Agency physicians to serve as health officers on their assigned reservation.

    Over the next several decades, this responsibility for community surveys (inspections) shifted from the physicians toward the sanitary engineering staff.  These surveys came to include a wide range of facilities from water systems to community buildings to dairy plants.

    The responsibilities for AI/AN health care were moved from the Bureau of Indian Affairs (BIA) to the Public Health Service (PHS) by the Transfer Act, Public Law (P.L.) 83-568 in 1954.  At that time, most of the components of the current OEHE Program were in place with Agency policies for food handler training, radiological health, facility surveys, and water fluoridation.

    The emphasis was on establishing, expanding, and resolving basic sanitation services.  Sanitarian Aides were the workforce in the field with a few supervisory Sanitarians at Area Offices.  The early environmental sanitation staff provided direct assistance to Tribes and individuals on sanitary matters and assisted Tribes in accessing funds for sanitation projects from State and other Federal programs.

    When the program was transferred to the PHS, it became the Division of Indian Health (DIH) which included 16 engineers and sanitarians.  Currently, there are over 700 engineering and environmental health professionals (civil service, United States PHS Commissioned Corps Officers, and Tribal hires).

    In 1959, the Sanitation Facilities Program was created when P.L. 86-121 authorized the PHS to take direct action in resolving the sanitation conditions on AI/AN reservations by authorizing the use of Federal funds to design and construct water, wastewater, and solid waste facilities for AI/AN homes.

    In 1962, the first Headquarters Institutional Environmental Health (IEH) Officer was hired; to provide advice and technical guidance on all community-based institutions.

    In 1963, a joint conference of the BIA and the DIH leadership discussed collaborative efforts to combat the community accident mortality problem among Indians.  This conference established a plan for the Accident Prevention Program with the Health Education Branch, DIH, in the lead role and several disciplines supporting implementation in the field.  The Office of Environmental Health (OEH) was established with two branches, the EHS and the SFC.

    The OEH was one of the disciplines responsible for field implementation of the Accident Prevention Program.  In 1969, the Congress provided funding and positions for the Accident Prevention Program in the Health Education Program.  The Accident Prevention Program was formally transferred to the EHS in 1979, when the name was changed to Community Injury Control, and later to Community Injury Prevention.

  4. Policy.  Area EHS and SFC Division Directors will use the Program Elements in 3-11.4 to establish an Environmental Health program that meets the needs of eligible Tribes served by their Area.

3-11.2  PRIORITIES

  1. Environmental Health Services Priorities.  The EHS Division works closely with Tribes, as well as, other partners to develop action plans to address the following EHS priorities; food safety, children's environment, vectorborne and communicable diseases, safe drinking water, healthy homes, reducing injuries and fatalities related to motor vehicles and falls, and employee health and safety.
  2. Sanitation Facilities Construction Priorities.  The SFC Division provides sanitation facilities and technical assistance to Indian Tribes and Alaska Native communities.  Projects are cooperatively developed and transferred to Tribes or individuals who assume responsibility for the continued operation of safe water, wastewater, and solid waste systems, and related support facilities.

3-11.3  AUTHORITIES

  1. Snyder Act (Public Law 67-85)Exit Disclaimer: You Are Leaving www.ihs.gov 
  2. "Transfer Act" Exit Disclaimer: You Are Leaving www.ihs.gov  (Public Law 83-568; 42 USC 2001 et seq., as amended)
  3. Indian Health Care Improvement Act, Public Law 94-437Exit Disclaimer: You Are Leaving www.ihs.gov , as amended.  U.S. Code (2006 Edition and Supplement IV, 111th Congress, 2nd Session, 2010)
  4. Indian Self-Determination and Education Assistance Act (ISDA), Public Law 93-638 Exit Disclaimer: You Are Leaving www.ihs.gov , as amended
  5. Indian Sanitation Facilities Act (Public Law 86-121) Exit Disclaimer: You Are Leaving www.ihs.gov 
  6. Indian Lands Open Dump Cleanup Act Exit Disclaimer: You Are Leaving www.ihs.gov (Public Law 103-399; 25 USC 3901 et seq)

3-11.4  ORGANIZATION

  1. National Level.  The OEHE is organized into five divisions:
    1. Environmental Health Services
    2. Sanitation Facilities Construction
    3. Facilities Planning and Construction (FPC)
    4. Facilities Operation (FO)
    5. Engineering Services (ES)
  2. Area Level.  Due to small staffing numbers, Area level OEHE may be organized into branches or sections, rather than Divisions.  For simplicity, this chapter will use the term, "Division" throughout to describe branches and sections.  In most Areas, OEHE is organized into three divisions:
    1. Environmental Health Services
    2. Sanitation Facilities Construction
    3. Facilities Management (a combination of FPC and FO)

3-11.5  RESPONSIBILITIES

  1. Director, EHS and SFC.  The principal responsibilities are:
    1. Support information exchange among the Areas and external partners.
    2. Establish nationwide environmental health objectives and priorities.
    3. Provide technical assistance to the Areas to assure determination of objectives.
    4. Provide funds to Areas for projects, to strengthen capacity for services.
    5. Assure that Area actions and services are in the public interest of the IHS healthcare system.
    6. Further program guidelines and procedures for the Director, SFC, are at Part 5, Chapter 2, IHM, specifically at 5-2.6F, "Memorandum of Agreement," IHM, and "Criteria for the Sanitation Facilities Construction Program"; IHS, OEHE, March 2003.
  2. Area Division Directors, EHS and SFC.  The principal responsibilities of the Area Division Directors is to:
    1. Assess public health needs within the Area.
    2. Assure adequate policies for health activities.
    3. Establish Area-wide health objectives.
    4. Provide access to needed services as stated in 3-11.5.
    5. Guarantee a minimum set of essential health services as stated in 3-11.5.
    6. Support the Field capacity in order to achieve adequate service levels.
    7. Further program guidelines and procedures for the Director, Area SFC, are at IHM Part 5, Chapter 2, specifically at 5-2.6C.
  3. Field Staff.  The principal responsibilities of the EHS and SFC Field Staff is to:
    1. Assess, monitor, and conduct surveillance of local health problems.
    2. Identify, develop and implement projects to address needs, develop policy and provide leadership that fosters community involvement and a sense of ownership.
    3. Assure high-quality services, as stated in 3-11.5, are available and accessible to all.
    4. Assure that communities receive proper consideration in the allocation of resources.
    5. Assure the community is informed about how to obtain services.
    6. Further program guidelines and procedures for the Field Staff, Area SFC, are at IHM Part 5, Chapter 2, specifically at 5-2.6D and E.
  4. Licensing.  All IHS EHS and SFC personnel are encouraged to seek professional registration or licensure appropriate to their work and discipline.  For EHS and SFC staff in leadership or supervisory positions at the District level or higher, professional registration as a Registered Environmental Health Specialist/Sanitarian or Professional Engineer, respectively, is required.
  5. Planning Environmental Health Priorities.  The OEHE EHS and SFC Divisions at both the Headquarters and Area levels should consult or partner with Tribes and Tribal organizations to encourage maximum participation in planning environmental health priorities.
  6. Tribes.  Contracted or compacted Tribal environmental health programs may be encouraged to adopt these same program elements and services to ensure comprehensive services are available for all community members.  Tribes may choose to:
    1. receive services directly from the IHS, or
    2. contract with IHS to assume control over the administration and funding for programs and services that the IHS would otherwise provide, or
    3. compact with IHS to assume control over the programs that the IHS would otherwise provide.

      In addition to managing the SFC Program under the applicable Title of P.L. 93 638 as amended, eligible Tribes or Tribal Organizations may enter into Construction Contracts under Title I, Subpart J or Construction Project Agreements under Title V for planning, design and construction for sanitation facilities construction projects.  Alternatively, Tribes may elect to enter into an agreement that is authorized by P.L. 86-121.

3-11.6  PROGRAM ELEMENTS

  1. Program Elements' Common Services.  Services that should be conducted for all sixteen program elements, as applicable to specific Divisions and as resources permit, are listed below:
    1. Monitor the environmental health status through survey, surveillance, or investigative program.
    2. Provide training and educational materials to increase awareness of environmental health issues.
    3. Ensure a competent workforce with a continuing education program for all staff that includes survey and investigation standardization.
    4. Evaluate programs for effectiveness and quality.
    5. Research, develop, and apply best practices and innovative approaches to reduce hazardous conditions or risk factors that could lead to environmentally-related illness or injury.
  2. Air Quality Program.
    1. Objective.  The objective if an Air Quality program is to prevent illness among populations which may be caused by indoor and outdoor air quality.
    2. Comprehensive.  A comprehensive Air Quality program includes the five services listed in Section 3-11.6A, as applicable, and the following:
      1. Identify potential air pollution sources, report finding to the appropriate official and make recommendations.
      2. Collaborate with Federal, Tribal, and other partners to mitigate existing and preventive future air quality issues.
      3. Assist with plan review and policy development.
    3. Applicability and Scope.  This program is intended for Federal or Tribally-owned, leased, or operated facilities, including but not limited to:  homes, schools, head start centers, daycare centers, health care facilities, jails, and other community buildings.  For additional resources and materials in planning, implementing and evaluating an air quality program see Manual Exhibit 3-11-B
  3. Community Facilities and Institutions.
    1. Objective.  The objective of a community facilities and institutions program is to prevent illness and injury within these facilities.
    2. Applicability and Scope.  This program is intended for Federal installations, or when assisting tribes and native health corporations develop a program at Tribal community facility and institution operations including, but not limited to schools, daycares, Head Starts, community and multi-purpose buildings, nursing homes, elder centers, casinos, tattoo parlors, day spas, beauty salons and jails/prisons.
    3. Community Facility and Institution Program.  A comprehensive community facility and institution program includes the five common services listed in Section 3-11.6A and the following:
      1. Utilize the national environmental health data system to record surveys, and monitor trends and risk factors.
      2. Collaborate with Federal, Tribal, and other partners to identify resources to mitigate and prevent illness and injury.
      3. Review and make recommendations for proposed new construction or major remodeling of establishments or operations.

        For additional resources and materials in planning, implementing and evaluating a community facility and institutional program see Manual Exhibit 3-11-B.

  4. Community Injury Prevention.
    1. Objective  To reduce severe injuries and deaths among AI/AN and increase the ability of Tribes to address their injury problems.
    2. Applicability and Scope.   Environmental health staff must use the public health approach to prevent injuries.  This program is intended for the prevention of unintentional and intentional injuries occurring in AI/AN communities and villages.  A comprehensive injury prevention program includes the five common services listed in Section 3-11.6A and the following:
      1. Analyze existing data and investigate cases to identify local injury problems.
      2. Foster collaborative partnerships with Tribal, local, State, and national entities.
      3. Quantify need and identify resources for program development.
      4. Plan, develop, and implement evidence-based or promising interventions that employ multiple strategies.
      5. Advocate for public policy.

        For additional resources and materials in planning, implementing, and evaluating a community injury prevention program see Manual Exhibit 3-11-B.

  5. Drinking Water Quality.
    1. Objective.  Assist AI/AN to acquire an adequate, potable water supply and to encourage the continued use, operation and maintenance of the system in a manner that protects public health.  The objective of the Drinking Water Quality program is to prevent water, sanitation and hygiene-related diseases and ensure access to potable water.
    2. Applicability and Scope.  This program applies to all Federal and Tribal drinking water operations and systems.  A comprehensive Drinking Water Quality program includes the five common services listed in Section 3-11.6A and the following:
      1. Determine the state of repair, use, care, maintenance and operation of the installed systems.
      2. Develop multi-agency funded sanitation projects through interagency coordination, assist with grant applications, and leverage IHS funds.
      3. Monitor existing data systems for risk factors and use surveillance data to determine the health impact of potable water projects.

        For additional resources and materials in planning, implementing and evaluating a drinking water quality program see Manual Exhibit 3-11-B.

  6. Emergency Management.
    1. Objective.  The objective of the Emergency Management program is to prevent and mitigate illnesses, injuries, and fatalities related to natural or manmade disasters or emergencies.
    2. Applicability and Scope.  This program is intended for Federal or Tribally owned or operated facilities and Tribal communities.  The scope of activities pertains to environmental health and environmental engineering, and is only a part of a comprehensive Emergency Management program.
    3. Emergency Management Program.  An Emergency Management program includes the five common services listed in Section 3-11.6A and the following:
      1. Assist in community hazard identification, conduct hazard vulnerability analyses, and develop emergency management plans.
      2. Establish response teams by developing and maintaining partnerships with Tribal Epidemiology Centers, Tribes, local, State, and Federal Agencies.
      3. Develop and implement collaborative policies with public health entities involved in emergency management to include planning, mitigation, response, and recovery.

        For additional resources and materials in planning, implementing and evaluating an OEHE emergency management program see Manual Exhibit 3-11-B.

  7. Environmental Sustainability.
    1. Objective.  The objective of an Environmental Sustainability program is to reduce the impact of Federal and Tribal operations on the local and global environment.
    2. Applicability and Scope.  This program is intended for all Federal or Tribal operations.  The scope of activities pertains to environmental health and environmental engineering, and is only a part of a comprehensive Environmental Sustainability program.  Other IHS programs are responsible for aspects of environmental sustainability such as procurement of environmentally preferred products, fleet management, telecommuting and electronics sustainability.
    3. Environmental Sustainability Program.  A comprehensive environmental sustainability program includes the five common services listed in Section 3-11.6A and the following:
      1. Identification of significant environmental impacts caused by Federal and Tribal operations and community activities.
      2. Monitor existing data systems for sentinel events and risk factors.
      3. Collaborate with environmental and public health entities to establish and implement policies, alert programs of known or potential environmental issues, and participate in investigations and efforts to reduce environmental impacts.
      4. Assess and ensure compliance with the applicable Presidential Environmental Executive Orders, environmental regulations, and IHS policies and guidance.
      5. Review and make appropriate sustainable building recommendations for proposed new construction or major remodeling of all buildings.

        For additional resources and materials in planning, implementing and evaluating an environmental sustainability program see Manual Exhibit 3-11-B.

  8. Food Safety.
    1. Objective.  The objective of the Food Safety program is to prevent foodborne illness and control foodborne outbreaks.
    2. Applicability and Scope.  This program is intended for Federal or Tribal food service operations including, but not limited to bakeries, restaurants, institutional kitchens, food warehouses, grocery stores, bars, and temporary food venues at celebrations.
    3. Food Safety Program.  A comprehensive food safety program includes the five common services listed in the Section 3-11.6A introduction and the following:
      1. Establish and implement collaborative policies with other public health entities to alert programs of food recalls and investigate suspected foodborne illnesses.
      2. Utilize the latest version of the Food and Drug Administration's Food Code in the implementation of the survey and education program.
      3. Utilize the national environmental health data system to record surveys, and monitor trends and risk factors.
      4. Review and make appropriate recommendations for proposed new construction or major remodeling of food service establishments or operation.

        For additional resources and materials in planning, implementing and evaluating a food safety program see Manual Exhibit 3-11-B.

  9. Health Care Institutions.
    1. Objective.  The objective of the environmental health program as it relates to Health Care Institutions is to protect patients, staff, and visitors from chemical, biological, radiological, and ergonomic hazards.
    2. Applicability and Scope.  This program is intended for Federal or Tribal health care operations.  Examples include hospitals, ambulatory care clinics, dental clinics, dialysis centers, addiction treatment centers, long-term care, hospice and assisted living programs.
    3. Health Care Institutions Program.  A comprehensive program includes the five common services listed in the Section 3-11.6A and the following:
      1. Establish and implement collaborative policies with other public health entities to address emerging environmental health issues related to healthcare institutions.
      2. Utilize national environmental health data systems to record surveys, and monitor trends and risk factors.
      3. Evaluate programs for effectiveness and quality.
      4. Review and make appropriate recommendations for proposed new construction or major remodeling of health care facilities.

        For additional resources and materials in planning, implementing and evaluating a health care program see Manual Exhibit 3-11-B.

  10. Healthy Housing.
    1. Objective.  The objective of the Healthy Housing program is to prevent and reduce injuries and illnesses associated with permanent and temporary housing facilities.
    2. Applicability and Scope.  This program is intended for Federal or Tribally owned or operated facilities, including but not limited to foster care homes, dormitories, migrant labor camps, hotels, motels, and residences.
    3. Healthy Housing Program.  A comprehensive Healthy Housing program includes the five common services listed in Section 3-11.6A and the following:
      1. Respond to referrals, complaints, and inquiries by conducting environmental and epidemiological investigations.
      2. |
      3. Collaborate with Federal, Tribal, and other partners to ensure effective delivery of services.
      4. Collaborate with Federal and Tribal programs in developing policies and procedures.
      5. Utilize existing national or tribal regulations to make recommendations for the implementation of an inspection and education program.

        For additional resources and materials in planning, implementing, and evaluating a healthy housing program see Manual Exhibit 3-11-B.

  11. Mass Gatherings and Recreational Sites.
    1. Objective.  The objective of the Mass Gatherings and Recreational Sites Program is to prevent illness and injuries through the control of health and safety hazards.
    2. Applicability and Scope.  This program is intended for Federal or Tribal mass gatherings and/or recreational sites, including but not limited to campgrounds, recreational areas, Pow-wows, celebrations/fairs, and itinerant food vendors.
    3. Mass Gatherings and Recreational Sites Program.  A comprehensive mass gatherings and recreational sites program includes the five common services listed in the Section 3-11.6A and the following:
      1. Utilize the national environmental health data system to record surveys, monitor trends and risk factors.
      2. Establish and implement collaborative policies with other public health entities to report and prevent illnesses and injuries.
      3. Investigate all inquiries, complaints, or referrals cooperatively with the appropriate parties and report findings with recommendations.
      4. Review and make appropriate recommendations for existing or proposed events and recreational sites.

        For additional resources and materials in planning, implementing and evaluating a mass gathering and recreational sites program see Manual Exhibit 3-11-B.

  12. Operation and Maintenance of Sanitation Facilities.
    1. Objective.  The objective of the Operation and Maintenance (O&M) program is to promote and assist in the establishment of an effective and economical mechanism for the operation and maintenance of Tribal water, sewage and solid waste systems.
    2. Applicability and Scope.  This program is intended to support Tribal O&M organizations and individuals that operate and maintain drinking water, wastewater disposal, and solid waste systems when resources are available.
    3. Operation and Maintenance Program.  A comprehensive O&M program includes the five common services listed in Section 3-11.6A and the following:
      1. Regularly update the O&M data system to reflect changes and updates to systems and organizations that operate sanitation facilities on tribal lands.
      2. Assist utility organizations to develop and maintain composite utility drawings and asset inventories.
      3. Collaborate with partners to establish and implement policies and procedures.
      4. Advocate for and consult with Tribes, Tribal organizations, and individuals to encourage appropriate and sustainable capital improvements.
      5. Collaborate with Federal, Tribal, and other partners to promote a sustainable O&M program.

        For additional resources and materials in planning, implementing and evaluating an operation and maintenance program see Manual Exhibit 3-11-B.

  13. Project Management.
    1. Objective.  The objective of Project Management is to plan, schedule, organize, identify, and manage resources to complete projects in a timely and successful manner.
    2. Applicability and Scope.  This program is intended for personnel involved in identifying, scoping, initiating, scheduling, managing, and otherwise supporting projects for Tribal communities.
    3. Project Management.  A successful project management practice includes, but not necessarily is limited to, the five common services listed in Section 3-11.6A and the following:
      1. Initiating a project by identifying a need, collaborating with project stakeholders, and identifying resources necessary for completing the project.
      2. Planning and designing which includes developing a well-defined scope of work, establishing the time and budget boundaries, and identifying project outcomes and evaluation criteria.  In the case of larger projects, developing a project charter is highly recommended.
      3. Executing the project through the optimal deployment of resources, management of people involved in the project, and communication with project stakeholders.
      4. Monitoring and controlling the project phases via milestone tracking, cost tracking, and successful risk management.
      5. Closing the project by achieving the project outcomes, evaluating results, finalizing the deliverable(s), and debriefing with project stakeholders.
  14. Recreational Water and Water Features.
    1. Objective.  The objective of a Recreational Water and Water Features program is to prevent illnesses and injuries related to aquatic activities.
    2. Applicability and Scope.  This program is intended for the operation of Federal or Tribal recreational water and water features including, but not limited to swimming pools, swimming beaches, swimming lakes, spas, spray parks, water slides, indoor waterfalls, fountains, and mist systems.
    3. Recreational Water and Water Features Program.  A comprehensive recreational water and water features program includes the five common services listed in the Section 3-11.6A and the following:
      1. Review and make appropriate recommendations for proposed new construction and major remodeling of water recreation facilities and treatment systems for water features.
      2. Collaborate with Federal, Tribal, and other partners to identify resources to mitigate and prevent illness and injury.
      3. Respond to referrals, complaints and inquiries by conducting environmental and epidemiological investigations. For additional resources and materials in planning, implementing, and evaluating a recreational water and water features program see Manual Exhibit 3-11-B.
  15. Safety Management.
    1. Objective.  The objective of the Safety Management program is to prevent occupational injuries, illnesses and fatalities in the work environment.
    2. Applicability and Scope.  This program is intended for Federal or tribally owned or operated facilities and Tribal communities.  The scope of activities pertains to environmental health and environmental engineering, and is only a part of a comprehensive Safety Management program.
    3. Safety Management Program.  A Safety Management program includes the five common services listed in Section 3-11.6A and the following:
      1. Utilize the national environmental health data systems to record surveys, incidents, and monitor trends and risk factors.
      2. Respond to referrals, complaints, and inquiries by conducting environmental and epidemiological investigations.
      3. Collaborate with Federal, Tribal, and other partners to mitigate existing and prevent future safety issues.
      4. Develop and implement safety policies and procedures.
      5. Review and provide appropriate recommendations for proposed new construction or major remodeling projects.

        For additional resources and materials in planning, implementing and evaluating an OEHE safety management program see Manual Exhibit 3-11-B.

  16. Vectorborne and Communicable Disease Control.
    1. Objective.  The objective of the Vectorborne and Communicable Disease (VCD) Control program is to control and prevent the spread of vectorborne and communicable diseases.
    2. Applicability and Scope.  This program is intended for the control and prevention of VCD.  Although there are several public health models that can be applied to the control of these diseases, this program will conduct activities that target the various links in the "chain of infection" (e.g., source, mode of transmission, and susceptibility).  Comprehensive programs will incorporate activities that target all three links for control of VCD, and will expand or contract activities as dictated by the situation and applicable recognized guidance.
    3. Diseases of Concern.  Diseases of concern include, but are not limited to: Plague, Rocky Mountain Spotted Fever, Hantavirus, Encephalitis, West Nile Virus, Tularemia, Lyme Disease, Rabies, Hepatitis, Campylobacter, Shigellosis, Norwalk Virus, Salmonella, Methicillin Resistant Staphylococcus aureus.
    4. Vectorborne and Communicable Disease Control Program.  A comprehensive VCD control program includes the five common services listed in the Section 3-11.6A and the following:
      1. Promote the establishment of response teams by developing and maintaining partnerships with Tribal Epidemiology Centers, Tribes, local, State and Federal agencies.
      2. Encourage the use of multiple strategies to prevent and control VCD.
      3. Monitor existing data systems for sentinel events and risk factors.
      4. Respond to complaints, inquiries, or human case referrals of VCD by conducting environmental and epidemiological investigations.

        For additional resources and materials in planning, implementing, and evaluating a VCD control program see Manual Exhibit 3-11-B.

  17. Waste Management.
    1. Objective  The objective of the Waste Management program is to protect public health by promoting the safe treatment and disposal of solid waste and wastewater and to prevent and control illnesses related to the improper disposal of solid and liquid waste.
    2. Applicability and Scope.  This program is intended for Federal or Tribal solid waste or wastewater treatment and disposal operations and systems.
    3. Waste Management Program.  A comprehensive Waste Management program includes the five common services listed in Section 3-11.6A and the following:
      1. Develop and maintain an inventory of sanitation deficiencies and open dumps.
      2. Provide assistance with utility master planning, solid waste management plans, and waste disposal system operation and maintenance.
      3. Develop multi-agency funded projects through interagency coordination, assist with grant applications, and leverage IHS funds.
      4. Provide professional engineering design and construction services for treatment and disposal facilities.
      5. Provide an appropriate response to complaints, inquiries, or case referrals.
      6. Monitor existing data systems for risk factors and use surveillance data to determine the health impact of wastewater and solid waste projects.

        For additional resources and materials in planning, implementing and evaluating an OEHE waste management program see Manual Exhibit 3-11-B.