Finding the balance: Aligning public health resources with community needs

In large Public Health departments, resource allocation decisions are often driven by the need to provide more service with less funding, or to satisfy requirements of a categorical grant. Less often do departments take the opportunity to critically assess the work they are doing in relation to changing community needs. In response to changes in disease trends and demographic shifts within the county, Public Health's Office of Planning, Evaluation, and Development conducted an in-depth analysis of how and where field work is performed. In Los Angeles County, field work encompasses everything from follow-up on TB, STD, and other communicable disease cases and suspects, to community education and policy work on a broad range of public health topics, and is conducted by geographic-based Public Health Nurses and Public Health Investigators (meaning that they serve a particular geographic region rather than working for a categorical program). Office of Planning staff interviewed field staff and their leadership, went on ride-alongs with Public Health Nurses and Investigators, analyzed workload data, and researched other jurisdictions' practices. They also constructed a geographic needs-based formula that included demographic and morbidity data as well as current resource allocation. The analysis recommended a change to the geographic distribution of resources as well as changes to work processes to create efficiencies. However, the analysis also led to broader discussions about the way the department conducts communicable disease follow up, the optimal role for Public Health Nurses, better methods for measuring workload, and integration of multiple surveillance information systems.