Use of sub-state regionalization to plan for public health emergencies in New Hampshire

Background: A significant gap in preparedness exists for responding to a public health emergency at the local level. The State of New Hampshire has addressed this gap through sub-state regional planning, which is a useful tool for the efficient utilization of scarce resources.

Methods: New Hampshire has been divided into 19 planning regions for public health preparedness and response, which was necessary as the state lacks a public health infrastructure. Each New Hampshire community has signed a memorandum of agreement to participate in this regional planning process. Each region is served by a coordinating council, with representatives from hospitals and health care, local government, public safety, EMS, public health, and private organizations.

Outcomes: The key to success is that any regional structure is supported by the local communities, and that the individuals responsible for planning and response within the region have the necessary support and authorities. Key accomplishments in the Upper Valley Region include the completion of a regional public health emergency response plan, the establishment of a Multi-Agency Coordination Entity, completion of four exercises, and training of local volunteers. The State has provided funding to support planning efforts and purchase necessary supplies. Ongoing challenges include limited participation by smaller communities and the continuation of funding for the region.

Conclusions: This approach to regional planning has significantly increased the ability of the State of New Hampshire and its local communities to respond to a public health emergency.