WASHINGTON, D.C. — For the first time in nearly two years, the Indian Health Service has a permanent leader.

By a voice vote, the U.S. Senate on Wednesday confirmed Roselyn Tso to serve as director of the IHS, which is part of the Department of Health and Human Services. She is a citizen of the Navajo Nation who has worked for the IHS for almost four decades.

“This is a historic achievement for all of our Navajo people and tribal nations across the country,” Navajo Nation President Jonathan Nez said in a news release from the largest reservation in the United States. “To have one of our own Navajo members in the highest position within IHS is remarkable.”

“Ms. Tso was born and raised on the Navajo Nation and understands the health care needs that many first people of this country deal with on a daily basis,” Nez added. “Her work ethic, value system, and approach to problem solving demonstrates the resilience of indigenous peoples, and the commitment to combat the systemic inequities that impact tribal nations.”

Tso is not only the first Navajo citizen to lead the IHS, she is only the second woman in history to become director of the agency responsible for delivering health care to more than 2.5 million American Indians and Alaska Natives. Her confirmation has long been awaited in Indian Country as they seek to hold the U.S. government accountable for its trust and treaty responsibilities.

“Tribes assert that the absence of a confirmed director has impeded the ability of the tribes and the administration to advance the president’s bold vision for the Indian, tribal, and urban health,” said Chair William Smith of the National Indian Health Board, which has advocated for tribal needs since 1972.

“We look forward to seeing, supporting, and partnering to ensure that significant progress will be made to advance the IHS mission which is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level,” Smith, who also serves vice president as of the Valdez Native Tribe, said in a news release on Thursday.

The National Council of Urban Indian Health also hailed the development. It comes as urban Indian providers are finally seeing an increase of resources amid the ongoing COVID-19 pandemic, which has affected American Indians and Alaska Natives at disproportionate rates.

“We look forward to working with Roselyn Tso to carry out the mission of IHS in fulfilling the trust responsibility to provide health care equity for all American Indians and Alaska Natives,” NCUIH Chief Executive Officer Francys Crevier said on Wednesday. “We continue to work with Congress and this administration to elevate this position within HHS where it belongs to lift Native voices and improve health outcomes.”

The IHS had gone without a permanent leader for six of the last seven years, including for most of the Donald Trump administration. The last Senate-confirmed director was Michael Weahkee, a citizen of the Pueblo of Zuni who stepped down on January 20, 2021, at the request of President Joe Biden. He had only been on the job for less than a year.

Elizabeth Fowler, a citizen of the Comanche Nation, then stepped in as “acting” director of the IHS. It took another two months for Biden to announce Tso as his nominee to run the agency.

“When I travel across the region to different IHS facilities, I am reminded of the many health disparities facing American Indians and Alaskan Natives — — health disparities that in many cases were made worse by COVID-19,” Tso said at her nomination hearing in May.

“For example, sadly, today, too many Navajo families still do not have access to running water in their homes,” said Tso, who most recently served as director of the Navajo Area of the IHS. “Access to clean, safe drinking water is essential to the health and well-being of our people.”

Following decades of underfunding, the onset of the COVID-19 pandemic in 2020 prompted Congress to provide historic levels of funding for the IHS. An appropriations bill that Biden signed into law in March, for example, provides $6.6 billion to the agency for fiscal year 2022.

Yet tribal leaders and advocates say the U.S. is still failing to meet Indian Country’s health needs, amid rising costs across the nation. The IHS Tribal Budget Formulation Workgroup has called for the agency to receive at least $12.8 billion to address long-running and chronic disparities in Native communities.

“Dedicated, long-serving leadership at the Indian Health Service is vital to fulfilling its mission,” said Sen. Brian Schatz (D-Hawaii), the chair of the Senate Committee on Indian Affairs. “I’m confident that Ms. Tso will lead the Service with distinction, having the qualifications, willingness to serve Indian Country, and commitment to educating other HHS agencies on the federal government’s special political and trust relationship with the Native Hawaiians, who also receive healthcare services through HHS.”

“Ms. Tso has demonstrated that she has the background and experience needed to succeed as the Director of the Indian Health Service,” added Sen. Lisa Murkowski (R-Alaska), the vice chair of the legislative panel with jurisdiction over Indian issues. “I congratulate Ms. Tso on her unanimous confirmation in the Senate. I am confident she will work to ensure IHS fulfills its mission to raise the health status of American Indians and Alaska Natives across the country by providing top notch quality health care. Native people deserve nothing less.”

Tso went before the committee for her confirmation hearing on May 25. Her nomination was advanced during a business meeting on July 13.

With her confirmation as director of the IHS, Tso joins other Native women in leadership positions and prominent roles in the Joe Biden administration. The trailblazers include:

• Deb Haaland, Pueblo of Laguna, first Native person and first Native woman to serve as Secretary of the Interior, a Senate-confirmed position
• Janie Simms Hipp, Chickasaw Nation, first Native person and first Native woman to serve General Counsel for the Department of Agriculture, also confirmed by the Senate
• Lynn Malerba, Mohegan Tribe, first Native woman to serve as Treasurer of the United States
• Ann Marie Bledsoe Downes, Winnebago Tribe, Principal Deputy Solicitor at the Department of the Interior
• Elizabeth Carr, Sault Ste. Marie Tribe of Chippewa Indians, first person to hold title of Tribal Advisor to the Director of the White House Office of Management and Budget
• JoAnn Chase, Mandan, Hidatsa and Arikara Nation, Director of the American Indian Environmental Office at the Environmental Protection Agency
• Danna Jackson, Confederated Salish and Kootenai Tribes, Senior Counselor to the Director for the Bureau of Land Management at the Department of the Interior
• Wahleah Johns, Navajo Nation, Director of the Office of Indian Energy at the Department of Energy
• Natalie Landreth, Chickasaw Nation, Deputy Solicitor for Land Resources at the Department of the Interior
• Heather Dawn Thompson, Cheyenne River Sioux Tribe, Director of the Office of Tribal Relations at the Department of Agriculture