Resource Allocation and Funding Challenges for Regional Local Health Departments in Nebraska

Funded by the Robert Wood Johnson Foundation, this study intends to examine how resources allocation decisions are made and what funding challenges exist in regional local health departments (RLHDs). In 2008, we conducted a state-wide survey of RLHD directors to collect the information about their perceived benefits of RLHD model in Nebraska. In 2009, we conducted a case study at two Nebraska RLHDs to gain insight into their experiences of resource allocation. Sixteen interviews were conducted with RLHD directors, RLHD staff, and Board of Health members. The benefits of RLHD model identified in the state-wide survey included the ability to better leverage resources, to build a stronger structural capacity, and to provide services to underserved communities. In the case study, interviewees stated that resource allocation decisions were made based on community needs. The decision-making process to allocate resources across communities was less formalized. Interviewees also suggested that the size of vulnerable population had a significant impact on the resources needed to support RLHD programs. RLHD's decisions about resources are very dependent on the amount and type of resources received from the State. The funding challenges identified by interviewees included continuing to receive adequate financial resources and providing services equally across communities in the RLHD jurisdiction. Strategies used by RLHDs to address these challenges included seeking grants to support programs, leveraging existing resources, and building community partnerships to share resources. Future research is needed to examine how scale and scope economies can be maximized when allocating resources within RLHD jurisdiction.