Orchestrating the Voice of the People: Alaska Public Health Nurses strategically Positioned to Influence the Allocation of Scarce Health Resources

Public Health Nurses in Alaska are strategically positioned to influence the allocation of scarce health resources. With the exception of the Anchorage Municipality and the North Slope Borough, the Alaska Section of Public Health Nursing is responsible for providing local public health services to state residents. Many are connected to the local communities they serve by virtue of long term residency and are considered local community leaders. At the same time they represent the state policy level as they are part of the Division of Public Health. The PHNs provide services at nurse-managed public health centers and through itinerant services to 250 communities including the Alaska Native villages. The legacy of public health nursing is one of trust and respect from the people. When PHNs testify at legislative hearings they have credibility. The advocacy role is well established and evidenced in many arenas. At the inception of the Denali Kid Care (CHIP) program, PHNs were part of the movement to establish a high percentage of poverty level (250%) as the cut off for eligibility and credited with facilitating the enrollment of clients to meet the quota faster than any other state. Alaska PHNs build relationships and connect with the local community stakeholders and collaborate with other agencies and partners. In the nineties, PHNs were instrumental and successful in community organization and collaboration with local partners that resulted in capital funding for construction of three major public health centers. The perspective of the PHN is frequently invited to the table as state health policy develops. Often, the PHN role in policy development is invisible as they encourage the powerless to give voice to their concerns. As a case study, this presentation is based on the author's perspective as Deputy Chief of Public Health Nursing (ret 2003) and recent interviews with expert PHNs in Alaska as part of the author's PhD studies.