This paper aims to explore the genesis and early years (1968-1980) of the Community Health Representative Program (CHR Program), an important community health worker program on Indian reservations throughout the United States. Despite being the only community health worker program directly sponsored by the US federal government and operating for over 40 years, there is very limited published information related to the CHR Program and its origins. Within the past fifteen years, community health workers in general have seen increased popularity in the United States, with attention paid to their role in the larger healthcare system. Understanding the CHR Program will add to the discussion of this growing field and the development of more effective contemporary community health worker programming.

Specifically, this paper examines the origins, political framing, essential components, challenges, and impact of the CHR Program. Two different types of sources are relied upon. The first are the accounts of early CHRs themselves from oral histories (qualitative interviews) conducted with individuals on five reservations in late 2007. These interviews offer insight into the daily reality of the program and what it meant to be an early CHR, from recruitment to duties to the personal benefits of the job. The second are primary documents related to the program, including Congressional hearings; reports commissioned by Congress, IHS, and tribal organizations; health program pamphlets and manuals; internal government correspondence; newspaper and magazine articles; and tribal documents provided by CHRs themselves. By combining these two different types of sources, this paper provides a multi-dimensional picture of a community health worker program that continues to this day.