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National Public Health Improvement Initiative

2011 National Public Health Improvement Initiative (NPHII)
Grantee Meeting

Atlanta, Georgia
March 30 – April 1, 2011

Cross-jurisdictional Sharing and Regionalization Efforts

Speakers: Grace Gorenflo, MPH, RN, Director, Accreditation Preparation and Quality Improvement, NACCHO; and Geoff Wilkinson, MSW, Senior Policy Advisor, Office of the Commissioner, Massachusetts Department of Public Health

Description: Creating cross-jurisdictional and regional public health collaborations is an emerging trend among public health agencies. Potential benefits include more efficient delivery of services, shared capacity and expanded access to expertise. Potential drawbacks include reduction of services. This session:

  • Described the results of a national study of cross-jurisdictional services
  • Highlighted case examples of cross-jurisdictional approaches
  • Outlined key considerations in creating cross-jurisdictional approaches

Cross-jurisdictional Sharing and Regionalization Efforts [PDF - 796KB] - G. Gorenflo
Cross-jurisdictional Sharing and Regionalization Efforts - G. Wilkinson
Cross-jurisdictional Sharing and Regionalization Efforts - G. Matthews

Questions and Answers:

Q:  How exactly can consolidation work in vast rural areas?

A:  Massachusetts paid stipends for people to travel.  Kansas’ regionalization process wasn’t formal consolidation as much as it was functional sharing of services.  Each health department remained intact, but worked with other sister departments on such things as health education/promotion and community assessment.

Q:  Is it easier to convene localities that “do it all” to discuss change, than it is to meet with siloed state health departments?

A:  It depends.  At the state level, Massachusetts was strongly supportive.  The real problem is the programmatic funding that fuels our work and drives our organization; regardless of the level. 

Q:  Has there been any effort to document the resources saved through these approaches?

A:  This was not part of the formal environmental scan, but RWJ is very aware of this issue.  A couple of Massachusetts’ jurisdictions have tried to document this as well but it is difficult.  How to operationalize and define costs and associated savings? 

Q:  Given the silofication of programs and funding, what should the feds know?  What could we do to inform them?  For instance, could health departments document improvements and receive more funding?

A:  Anything is possible, but it is important to emphasize that it is too late to give localities the flexibility to fund administration under the current Terms and Conditions.  But that is why it is important that we keep funding the infrastructure block grant that provides the flexibility to do things more efficiently and effectively outside of normal categorical boundaries.  As a field, public health MUST become savvier politically.

Look at education and transportation.  We need to model after them.  We lost our voice in the 60’s. 

Q:  If county attorneys say “no” to accreditation, cross-jurisdictional sharing, what can we do?

A:  Go to the state attorney and convince them to call the local attorneys to get them on board.

Back to presentation page


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