agement and programatic ineffectiveness. Furthermore, termination and refusal to refund grantees has the far-reaching effect of improving the performance of other CAA's, who naturally become aware of such actions on the part of OEO.

PARTICIPATION OF POOR IN PROGRAM ADMINISTRATION

Mr. CONTE. There has been much controversy in the past over the role the poor should play in running local anti-poverty programs. Is this a problem that has been satisfactorily worked out?

Mr. BATCHELOR. The 1967 amendments to the Economic Opportunity Act recognized that successful community action must help enlist and assure effective use of the resources of the poor and in this spirit clearly mandated that the poor and the residents of poverty areas participate in the planning, conduct, and evaluation of the programs which affect their lives.

In promulgating this congressional mandate, OEO reminded community action agencies of their basic responsibilities in this area and detailed the areas within the CAA itself in which the poor should play a major role; for example, program planning, goal setting, hiring, evaluation of program, as staff members, and so forth. Thus the door was opened for the poor to have a strong voice and role in the activities aimed at eliminating poverty in their communities.

Although the above points up the participation of the poor only, the drafters of the EOA, the Office of Economic Opportunity, and OEO grantees also recognize that the effectiveness of a Community Action Agency depends heavily on its ability to work with public officials and the private sector. To this end the EOA has specifically mandated that the Board of Directors be composed of one-third elected public officials, and one-third private sector in addition to the one-third, low-income representatives. OEO, in turn, has reminded each CAA that one of its fundamental responsibilities is to “*** improve its own effectiveness as a channel through which the poor, local government, and private groups can communicate, plan, and act together in partnership."

Especially in the early days, groups of people who had been long isolated and alienated from each other had to learn to understand each other's perceptions, language, and needs. In this mutual learning process, misunderstandings and long-hidden tensions often came to the surface, and there were some sharp conflicts over sensitive issues. However, we believe that by working together in the CAA boards and on specific projects and using the new channels of communication which have been opened and are expanding daily, all sectors of the community are achieving increased sophistication and effectiveness in working together to solve local problems. We believe this aspect of community action is not only moving toward a satisfactory solution, but will ultimately stand as one of the major contributions of this program toward livable, workable communities.

INDIAN PROGRAMS

Mr. CONTE. President Nixon has called for Federal policy to encourage "self-determination" for our Indian population. What is OEO doing to carry out this policy?

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Mr. BATCHELOR. In 1972 OEO initiated a major effort to implement the recommendations on Indian policy which the President presented to Congress on July 8, 1970. A key element of this effort is an OEO emphasis on development of effective approaches to Indian self-maintenance. Work was begun in 1971 to develop the capabilities of reservation Indians to take over services now provided by non-Indian-controlled organizations.

During 1972, Indian local initiative programs placed an increased emphasis on projects to serve Indians living in urban areas as OEO entered into a model urban Indian center program with DHEW, HUD, and DOL to fund centers in Los Angeles, Fairbanks, Minneapolis, and Gallup. Additionally, OEO has funded nine other centers throughout the country.

Another new program jointly initiated with HUD will develop Indian-owned construction firms and assist them in obtaining contracts for construction of reservation housing. Other fiscal year 1972 accomplishments included the continued interagency development of the aquaculture program for the Lumni in Washington State, completion of the construction phase and a training program for Indian operation and initial operation of the Quechan controlled environment farming program, startup of a pollution testing laboratory employing 20 Indians on a reservation in Utah and development of a management model for possible use by tribal governments in fiscal year 1973.

The self-determination thrust will continue in fiscal year 1973 through assistance to tribes and local leadership for development and exercise of greater control over their communities and resources through CAA's and special impact grants for management training and aid to tribal governments. The urban Indian centers will be maintained.

In association with HUD and DOL programs OEO will provide $1 million to fund tribally owned housing construction companies on six Indian reservations. OEO will fund the administration of development companies authorized to contract with HUD and DOL. These companies will develop manpower training programs in coordination with DOL programs and construct Indian housing under contract with HUD. HUD has agreed that Indian-owned construction companies need not be the low bidder, but may obtain contracts through the standard 8a procedures on the basis of reasonable bids. Such contracts are expected to provide 5,000 jobs paying over $7,000 annually and up to $12 million in profits for use by tribes in further economic and social development efforts. It is anticipated that six construction companies may be formed through grants ranging in size from $100,000 (100 houses per year) to $400,000 per year.

The aid to tribal government program is designed to serve the objective of self-determination by assisting tribal councils in developing the managerial skills required to efficiently and effectively operate programs. This program has enabled tribal leaders to actively participate in the revitalization of the reservation environment and has increased the possibilities for eventual reduction of dependency on the Federal Government. An increase of $2.800 million is requested for this program to further the ultimate goal of Indian leadership and participation in the development of the natural and human resources of reservations.

Approximately $2,200 million will be used to continue and complete a tailormade management system for reservations. The management systems approach to tribal self-determination will require the flexibility to purchase computer time and to address to many individual needs of each reservation. Moreover, funds will be provided to support a fiscal control and fiscal management program which, coupled with the management program which, coupled with the management systems and aid to tribal governments programs, will enhance the Indian population's opportunities toward self-sufficiency and economic independence.

Mr. CONTE. In light of administration plans for a sweeping reorganization of the executive branch, where is it proposed to transfer the Indian programs?

Mr. BATCHELOR. The President's reorganization proposal provides that current OEO Indian programs will remain in the Office of Economic Opportunity. This decision represents a departure from the Ash Council recommendation which transferred these programs to the Department of Human Resources. It is felt that since poverty is so intense among Indians, it is well to keep their programs in an agency which has a special focus on poverty.

SENIOR OPPORTUNITIES AND SERVICES

Mr. CONTE. How exactly do you plan to intensify the ability of existing senior opportunities and services projects to mobilize resources?

Mr. BATCHELOR. OEO through its 980 CAA's and 222 senior opportunities and services program (SOS) plans to intensify the ability of existing SOS projects to mobilize resources by means of the following strategies:

1. Provide the SOS projects with new and strengthened capability to initiate, plan, and coordinate local and area wide comprehensive programs and services for the elderly. This new and increased capability is resulting from intensified OEO regional, State, and contract training of and technical assistance to individual projects. The T. & T.A. has focused on better management, use of volunteers, directories of available local programs and services, information and instruction on the rights and entitlements of the elderly poor, and techniques and strategies on how to organize at the local, area, and State levels to bring about institutional change.

2. Provide the CAA's and SOS projects with new and clarified directives to insure that every SOS project director and staff members is aware of the "eligible activities" of CAA's. OEO memorandum on instruction 6001-1 states: "Community action agencies may accept grants for programs not specifically aimed at low-income people but rather at specified groups; for example, children, the aged, et cet*** confirming the eligibility of CAA's to apply for and accept such grants should strengthen the position of community action agencies in mobilizing resources. Examples of funds of this kind which are now or will soon be available are in programs for the elderly; that is, the new nutrition program for the elderly program (title VII of the Older American Act) will have an authorized $100 million for

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fiscal year 1973 and the regular title III, AOA, appropriations have been increased to $100 million. CAA's are encouraged to assist in planning and implementing these programs.'

3. Provide the SOS projects with an understanding of how to better utilize CAA and other public and private local resources for the elderly poor; for example, legal services, health services, food and nutrition programs, housing programs and home repair, consumer education and cooperatives programs and transportation facilities.

4. Provide "a combination of elderly and multigenerational programing, all of which is intended to effect institutional change while meeting needs with available resources" *** thereby, "our programs are having a catalytic effect well beyond their own dollar limits."

5. Provide the CAA's and SOS projects with T. & T.A. that will enable them to maximize their involvement in, coordination with, and operation of the areawide and State planning systems authorized by the AOA amendments and A-95.

6. Provide the SOS projects with training on how better to integrate into other programs their developed and special expertise of Outreach, information and referral and the involvement of older poor persons themselves in planning and project operation.

7. Provide the CAA's and SOS projects with new methods of organizing and educating the elderly poor at the local level to enable them to facilitate coalitions of the elderly. These coalitions, local, area wide, and statewide, are proposing, initiating, and influencing new legislation that has particular relevance for the elderly poor, for example, reduction of property taxes, reduction or rebate of State and local taxes, and reduced prices for transportation, medicines, meals, health care, and so forth.

8. The effect of providing the CAA's and SOS projects with a new capability will be to provide a focus and coordination of initiatives that will hopefully eliminate duplication of effort by different agencies and will permit different programs carried on by different private and public agencies to complement one another.

HEALTH CARE DELIVERY

Mr. CONTE. Please describe for the committee some of the new ways of organizing and delivering health care in low-income communities that ŎEO has developed and demonstrated.

Dr. COOPER. The Office of Health Affairs sponsors at any one time 50 to 60 large and small urban and rural comprehensive health services programs. These programs are distributed geographically throughout the United States.

Comprehensive health services programs are research and demonstration health services delivery programs with a variety of unique characteristics. These significant new and innovative health programs focus upon, but are not limited to, serving the needs of the poor. In addition to the health services delivery programs, the Office of Health Affairs supports health manpower development programs and several technical assistance grants and contracts. In general, these programs are administered by a grantee agency which has a substantial amount of consumer input and is often a consumer-controlled, communitybased, single-purpose, nonprofit health corporation. These programs

are designed to serve populations ranging in size from 5,000 to 20,000 persons. A program may have one or more facilities ranging in size from 7,000 to 50,000 square feet.

General program characteristics include a mandate for comprehensive rather than categorical, family-oriented, high quality, ambulatory health services. Programs generally provide diagnostic, curative, and preventive medical and dental care, and supportive services such as laboratory, X-ray, pharmacy, social-mental health services, and outreach services. There is a strong emphasis on preventive services and health education in the consumers' home, work, and community environments. Consumer participation in the form of consumer-controlled policymaking groups and the employment and training of community indigents contributes to the general community development of these poverty neighborhoods and a break in the vicious cycle of poverty for numerous individuals and families.

In fiscal year 1970, 23 new demonstration projects were developed to focus on communitywide efforts for health care planning, restructuring hospital outpatient services, initiating additional rural health systems, and expanding existing and new prepaid group practices. Of major import was the award of 12 grants in 1971 and 1972 designed to test the concept of community health networks.

Community health networks are designed to implement and assess alternative ways of planning, organizing and financing health services for populations of 100,000 to 200,000. These networks, which are the most ambitious health service demonstrations yet undertaken by OEO. or any Federal agency will coordinate and integrate the services of multiple providers and community agencies, develop long-term financing mechanisms-including prepayment on a capitation basis-using all available Federal, State, and local resources, and invoice significant consumer participation including membership on the boards of directors of the health corporations which sponsor the projects.

Significant questions which continue to be explored in most of the CHS programs include: the organization of health manpower to deliver a variety of services in the most efficient manner; evaluation of the cost and quality of primary health care services; methods of communication, information retrieval, and recordkeeping; the influence of outreach services and transportation services on the utilization of health services, health outcomes, and costs; and the influence of consumer participation and consumer control in establishing priorities for health are delivery systems.

Many of the program are currently exploring alternative methods of health care financing. The community networks in particular, are developing prepayment benefit packages which will be available to third-party payers, and the private sector, that is, employees or individual clients will provide services through the entire health-illness cycle including hospitalization, extended care, and home care. Experience is accumulating in the negotiation of health contracts between provider groups, marketing and enrollment techniques for health services, and the training of health manpower to develop and implement a multiprovider system. Several urban and neighborhood health centers are also exploring prepayment mechanisms for poor, partial pay, and full pay patients, as well as new ways to organize provider services, that is, group practice, contract services, and full-time salaried staffs.