Creative contracting: Boon or bane in meeting preventive health needs of rural Native children in Northwest Alaska

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This article describes the use of a private contract by a public health nursing program in Northwest Alaska to supply early and periodic screening, diagnosis, and treatment (EPSDT) services to children primarily of Inupiaq Eskimo heritage. Though a creative solution to the difficult problem of providing EPSDT examinations in this remote region, contracting had its drawbacks. An argument is presented to suggest that responsibility of EPSDT assessments be given to the first-line health care providers in the region's villages, the community health aides/practitioners. Why this has not happened already and major barriers to effecting this change are discussed

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