Indian Country Today interviews Robert McSwain, the new director of the Indian Health Service.

McSwain is a member of the North Fork Rancheria of Mono Indians of California. He was sworn into office on May 7, after being confirmed by the Senate on April 29.

"Indian Country Today: What are your immediate challenges?

Robert McSwain: I think the main challenge is much the same as what we've been dealing with, which is certainly a very limited budget outlook because of the president's vision about the deficit reduction budgets ... and of course that means that the discretionary programs are very, very limited. ...

I think the other challenges are the continued progress of self-determination, and working with the tribes on their decisions to assume the programs. Over half the program is currently contracted to tribes under self-determination, but I'm also reminded that there's still a significant - a little less than half the program - that's still direct. So we must provide direct care, and the biggest challenge is going to be the balancing of the two, ensuring that the tribes who choose to have us deliver the care are not treated any less than the tribes that have decided to take over their programs. ...

And the fact that we're dealing with some new health challenges in health care. We're dealing with the behavioral health issues. While we have the old issues of alcoholism and substance abuse, we have some new issues. ... On the behavioral health side, the health challenges are about methamphetamine abuse, certainly suicides amongst our youth - those are challenges that we didn't have 20 years ago, so those are the new challenges as we move forward. Plus, how do we continue to work smartly in the system, how do we become more effective and efficient?

I think the challenge is, given the budget constraints, how do we continue to expand the program through quality improvement in the health care delivery?

ICT: How do you feel about President Bush's proposed 2009 budget?

McSwain: ... It's a budget that is flat. But ... if you look inside at the detail of the changes, you'll see that the budget demonstrates maintenance of the program for basic primary care on Indian reservations. And less on infrastructure, less on those populations like the urban Indians that are in the cities, and it's a focus on and a shift in the program towards those folks who do not have alternate resources out on or near reservations in more isolated parts of the country."

Get the Story:
New IHS director shares his vision. (Indian Country Today 5/23)

Related Stories:
Senate confirms McSwain as director of IHS (4/30)
Senate panel vows speedy action on IHS nominee (2/8)
Slight cut seen in IHS budget for 2009 (2/6)
Senate confirmation hearing for IHS director (2/4)
Bush nominates McSwain as director of IHS (12/19)
Charles Grim withdraws nomination for IHS (9/6)
White House blocked testimony on trust responsibility (7/27)
IHS slow to resolve audit recommendations under Grim (7/26)