Background The indigenous tribal groups of North American (American Indian and Alaska Native, AI/AN) suffer from higher rates of fatal unintentional injuries, specifically motor vehicle related injuries, in comparison to all US population. The Indian Health Service (IHS) is the US Federal Agency responsible for providing health services to members of federally-recognised AI/AN by a government to government relationship established by law. IHS health and preventive services include injury prevention (IP). In 1997, IHS initiated national funding thru a cooperative agreement grant (CA) process aimed at building tribal capacity and infrastructure in injury prevention. CA grants have substantial involvement by awarding agency and the grant recipient. CA involves collaboration, participation or intervention in the program activities. An external monitoring contractor is hired for technical assistance to the grantees.

Methods The five-year CA provided funding to hire and train full-time staff. Strategies targeted motor vehicle injury prevention through policy development, increasing occupant restraints, engaging key stakeholders, and roadway hazard identification. In addition, occupant restraint observational surveys, employing effective strategies, and on-going evaluation occurred in the five years.

Results The AI/AN grantee took the lead in the planning, organising, implementing and evaluating their programs to address motor vehicle related injuries and fatalities. Results included increasing adult seat belt use by 75 per cent and distributing 8,900 child safety seats, costing approximately $508,155 and generating over $21.3 million in benefits to society.

Conclusions IP’s mission seeks to build the capacity of the US indigenous tribes to increase understanding of the injuries; to implement effective strategies to address the injury disparities. Utilising CA grants had great successes attributing to injury reduction in vulnerable populations. Many successes have been achieved over the years in decreasing the high motor vehicle injury fatality rates.