Building Local Public Health Infrastructure Through Cross-Jurisdictional Service Sharing: Successes, Challenges, and Policy Implications for a Home Rule State

In 2010, Massachusetts Department of Health (MDPH) catalyzed the formation of regional public health collaborations through a grant mechanism from the Centers for Disease Control. Massachusetts public health leaders have long grappled with the question of how to provide consistent, equitable, and high-quality services in a home rule state where each municipality (n=351) is responsible for meeting public health service mandates.  Few municipalities have been able to consistently offer all state mandated services, and most have little capacity to meet national public health performance standards.  The five-year Public Health District Incentive Grant (DIG) program provided an opportunity to develop and evaluate the feasibility and impact of cross-jurisdictional public health service sharing models.

 Five districts, including 58 municipalities, worked collaboratively to provide regulatory and community health services. Service sharing models varied along a continuum of comprehensiveness, ranging from coordination of discrete services to a single administrative structure providing all public health services to partnering municipalities. Evaluation metrics included service delivery data, workforce and board of health training, governance, and partnership development.  Findings demonstrate that there has been improvement in several domains, including an increase among participating municipalities in meeting state mandated food and beach inspectional requirements, qualified local Board of Health members and workforce, access to sharps disposal sites, communicable disease management, and community health programming.  Challenges with implementing shared service models include understanding differences in service delivery across municipalities, standardizing regulatory practices in a home rule state, disparities in resources across partnering municipalities for community health programming, and sustainability of funding for continued collaboration. Despite challenges, findings from the evaluation suggest that municipalities working together can improve the breadth, quality, and delivery of essential public health services within a highly decentralized public health system.