Sharing Public Health Functions and Capabilities: Models of Full and Partial Integration

Increasingly, local health officials and policymakers are turning to shared public health functions and capabilities across political boundaries as a means of increasing efficiencies and effectiveness.  The Center for Sharing Public Health services, funded by the Robert Wood Johnson Foundation, supports and captures the learning from 16 teams across the country that are engaged in a range of activities related to exploring, developing, implementing, and/or improving cross-jurisdictional sharing (CJS).  The goal of this session is to learn about two models of CJS arrangements that are supported by the Center and involve different levels of integration.

Fully integrating two or more health departments’ capacities and functions is a fairly daunting task, made more so as the number of health departments increases.  Horizon Community Health Board (Minnesota) is in the process of pursuing full integration of three existing health departments.  Leadership has made a commitment to staff that they all will be offered a position in the newly established organization; all existing facilities will continue to be used; and a new governance and financing structure is being developed.  Some challenges include establishing new fee structures, cost allocations across the participating counties, employee benefits and staffing patterns.

Genesee and Orleans Counties (New York) are in the process of integrating many capacities and functions while maintaining distinct health departments with their own governance structure.  Initial steps have resulted in shared leadership, senior management, and some contractors.  Now that labor issues have been successfully resolved, a next step will be to phase in shared field staff.  Some challenges include understanding how to provide shared leadership in a manner that satisfies all stakeholders, aligning current policies and practices, and institutionalizing collaboration between the governance structures.  Cost savings achieved through this arrangement are being tracked and preliminary results are quite impressive.