ALT FIGURE 4.16. The Indian Health Service (IHS) maintains a database of American Indian and Alaska Native (AI/AN) homes requiring sanitation facility improvements within IHS service areas. The figure shows sanitation deficiency levels in AI/AN homes across the country ranging from level 2 (capital improvements are necessary to meet domestic sanitation needs) to level 5 (lacks a safe water supply and a sewage disposal system). The IHS does not collect data for Hawai‘i, the US-Affiliated Pacific Islands, or the US Caribbean, but elevated rates of plumbing deficiencies are documented in those regions.142 Figure credit: Indian Health Service.