Our most recent high-risk  update in February 2017 identified 34 high-risk areas. When we rate Interior and  HHS’s progress on Improving Federal Management of Programs that  Serve Tribes and Their Members for the first time in our 2019 High Risk  report, we will provide similar information. Status of GAO’s Recommendations on Indian Education

As we have previously reported, the Office of the Assistant Secretary- Indian Affairs (Indian Affairs), through BIE, is responsible for providing  quality education opportunities to Indian students and oversees 185  elementary and secondary schools that serve approximately 41,000  students on or near Indian reservations in 23 states, often in rural areas  and small towns. BIE’s Indian education programs originate from the federal  government’s trust responsibility to Indian tribes. As discussed below, we have made 23 recommendations to Interior on  Indian education—including recommendations cited in GAO’s 2017 High  Risk report and included in two late May reports. Indian Affairs’ Management and Accountability for BIE Schools

In our 2017 High Risk report, we cited 3 recommendations from a 2013  report on management challenges facing Indian Affairs, with which  Interior agreed, and these recommendations remain unimplemented as of  late August 2017. Safety and Health at Indian School Facilities

We made 4 recommendations in a 2016 report on the safety and health of  BIE school facilities, none of which have been implemented. Further, at one school we visited, we found seven boilers that  failed inspection because of multiple high-risk safety deficiencies,  including elevated levels of carbon monoxide and a natural gas leak. We concluded that unless steps are taken to address  safety program weaknesses, the safety and health of BIE students and  staff may be at risk. For a full description of the agency’s actions and our  evaluation of these actions, see recommendations in table 2 in appendix  I.

		Indian Affairs’ Oversight of School Construction Projects

We made 6 recommendations in a May 2017 report on school  construction projects, none of which have been implemented. Status of GAO’s Recommendations on Indian Energy

As we have previously reported, some tribes and their members hold  abundant energy resources and have decided to develop these resources  to meet the needs of their community, in part because energy  development provides opportunities to improve poor living conditions,  decrease high levels of poverty, and fund public services for tribal  members. In the past 2 years, we have reported that BIA has mismanaged Indian  energy resources held in trust, thereby limiting opportunities for tribes and  their members to use those resources to create economic benefits and  improve the well-being of their communities. Specifically, we issued 3  reports that identified concerns associated with BIA management of  energy resources and categorized those concerns into the following four  areas: (1) BIA’s data and technology; (2) oversight of BIA activities; (3)  collaboration and communication; and (4) BIA’s workforce planning. As discussed below, we made 14 recommendations to BIA to help  address BIA management weaknesses that were cited in our 2017 High  Risk report. However,  none have been fully implemented. Status of GAO’s Recommendations on Indian Health Care

As we have previously reported, the Indian Health Service (IHS), an  agency within the Department of Health and Human Services (HHS), is  charged with providing health care to approximately 2.2 million Indians. One has been fully implemented. Improving IHS Oversight of Quality of Care

We made 2 recommendations in a 2017 report on IHS’s oversight of  quality of care in its federally operated facilities, neither of which has been  fully implemented. These recommendations were based on our finding  that IHS’s oversight of the quality of care provided in its federally operated  facilities has been limited and inconsistent, due in part to a lack of  agency-wide quality of care standards. We found that these  inconsistencies were exacerbated by significant turnover in area  leadership and that the agency had not defined contingency or  succession plans for the replacement of key personnel, including area  directors. In conclusion, although Interior and HHS have taken some actions to  address our recommendations related to federal programs serving Indian  tribes, 49 recommendations discussed in this testimony have not yet  been fully implemented. Appendix I: Status of Unimplemented Recommendations to the Department of the Interior on Indian Education

Appendix II: Status of Unimplemented Recommendations to the Department of the Interior on Indian Energy

Appendix III: Status of Unimplemented Recommendations to the DHHS on the Indian Health Service

Appendix III: Status of Unimplemented  Recommendations to the DHHS on the Indian  Health Service This is a work of the U.S. government and is not subject to copyright protection in the  United States.
Why GAO Did This Study

GAO's High-Risk Series identifies federal program areas needing attention from Congress and the executive branch. GAO added federal management of programs that serve Indian tribes and their members to its February 2017 biennial update of high-risk areas in response to serious problems with management and oversight by Interior and HHS.
This testimony identifies GAO's recommendations to Interior and HHS from prior GAO reports on the federal management and oversight of Indian education, energy resources, and health care that remain unimplemented. It also examines agencies' recent actions to address the recommendations and the extent to which these actions address GAO's recommendations. To conduct this work, GAO reviewed and analyzed agency documentation on actions taken to implement the recommendations and conducted interviews with agency officials.

What GAO Found

As discussed in the 2017 High Risk report, GAO has identified numerous weaknesses in how the Department of the Interior (Interior) and the Department of Health and Human Services (HHS) manage programs serving Indian tribes. Specifically, these weaknesses were related to Interior's Bureau of Indian Education (BIE) and Bureau of Indian Affairs (BIA)—under the Office of the Assistant Secretary-Indian Affairs (Indian Affairs)—in overseeing education services and managing Indian energy resources, and HHS's Indian Health Service (IHS) in administering health care services. GAO cited nearly 40 recommendations in its 2017 High Risk report that were not implemented, and has since made an additional 12 recommendations in two new reports on BIE school safety and construction published in late May of this year. Interior and HHS have taken some steps to address these recommendations but only one has been fully implemented.
Education. GAO has found serious weaknesses in Indian Affairs' oversight of Indian education. For example, in 2016, GAO found that the agency's lack of oversight of BIE school safety contributed to deteriorating facilities and equipment in school facilities. At one school, GAO found seven boilers that failed inspection because of safety hazards, such as elevated levels of carbon monoxide and a natural gas leak. In 2017, GAO found key weaknesses in the way Indian Affairs oversees personnel responsible for inspecting BIE school facilities for safety and manages BIE school construction projects. Of GAO's 23 recommendations on Indian education—including recommendations cited in GAO's 2017 High Risk report and in two late May reports—none have been fully implemented.
Energy resource management. In three prior reports on Indian energy, GAO found that BIA inefficiently managed Indian energy resources and the development process, thereby limiting opportunities for tribes and their members to use those resources to create economic benefits and improve the well-being of their communities. GAO categorized concerns associated with BIA management of energy resources and the development process into four broad areas, including oversight of BIA activities, collaboration, and BIA workforce planning. GAO made 14 recommendations to BIA to address its management weaknesses, which were cited in the 2017 High Risk report. However, none have been fully implemented.
Health care. GAO has found that IHS provides inadequate oversight of its federally operated health care facilities and of its Purchased/Referred Care program. For example, in 2016 and 2017, GAO found that IHS provided limited and inconsistent oversight of the timeliness and quality of care provided in its facilities and that inconsistencies in quality oversight were exacerbated by significant turnover in area leadership. GAO also found that IHS did not equitably allocate funds to meet the health care needs of Indians. Of GAO's 13 recommendations on Indian health care cited in GAO's 2017 High Risk report, one has been fully implemented.

What GAO Recommends

GAO cited nearly 40 unimplemented recommendations in its February 2017 High Risk report on federal programs for Indian tribes in education, energy development, and health care, and added 12 recommendations in two new reports on BIE school safety and construction in late May of this year. Sustained focus by Interior and HHS in fully implementing these recommendations and continued oversight by Congress are essential to achieving progress in these areas.