Key Concepts & Definitions

Communities across the nation continually face new challenges and opportunities. To serve people more effectively with fewer resources, many public health officials and policymakers are exploring new ways to structure the management and delivery of public health services.

One strategy is the sharing of services, resources, and functions across multiple public health agencies and jurisdictions. Collaboration allows communities to solve issues or problems that cannot be easily solved by a single organization or jurisdiction.

The Center for Sharing Public Health Services developed a formal definition for cross-jurisdictional sharing in 2013: “The deliberate exercise of public authority to enable collaboration across jurisdictional boundaries to deliver essential public health services.”

Cross-jurisdictional sharing approaches vary across a broad spectrum—from informal agreements to the creation of new public health entities, and from sharing equipment or staff to establishing fully integrated regional organizations—as illustrated by this graphic from the Center for Sharing Public Health Services.

This graphic depicts the spectrum of cross-jurisdictional sharing arrangements through four columns.  From left to right these are as follows:  1) Informal and customary arrangements might include handshake agreements, MOUs, information-sharing, equipment sharing, coordination; 2) Service-related arrangements include service provision agreements, mutual aid agreements, purchase of staff time; 3) Shared Functions with Joint Oversight include joint projects addressing all jurisdictions involved – ongoing or episodic, shared capacity, e.g., epidemiology covering all jurisdictions,  inter-local agreements; and 4) Regionalization includes examples such as the creation of a new public health entity by merging two more existing agencies, or consolidation of one or more public health agencies into an existing public health agency.