Health departments and health department systems are making great strides as they strengthen and improve their agencies and public health systems.  And yet, even the best efforts may be stymied due to difficulties attracting staff, accessing needed expertise, securing funding, or overcoming geographic barriers.  Sharing services and resources – a strategy that can take many forms – may be the answer to successfully addressing these and other challenges.  

Several new tools for transformation from the PHAB Center for Innovation are designed to facilitate successful service and resource sharing arrangements (SRSAs) and aid health departments in transforming their public health systems, ensure the provision of Foundational Capabilities throughout their jurisdiction, achieve PHAB accreditation or Pathways Recognition, or otherwise strengthen and improve their ability to protect and promote the public’s health.

The PHAB Center for Innovation describes three types of approaches to help health departments and governmental public health systems conceptualize different approaches to SRSAs. The brief definitions of each approach intentionally do not include specific numbers of participating health departments or organizations, and it also is important to note that many SRSAs could be characterized by more than one approach. Moreover, because a wide diversity of approaches exists it is impossible to develop an exhaustive list of all forms of SRSAs and their characteristics. Therefore, the approaches are not intended to suggest that SRSAs ought to be categorized or captured in a discrete model. Rather, the different approaches are meant to reflect a range of possibilities, provide some examples of successful SRSAs, and stimulate ideas about how to increase the efficiency and effectiveness of governmental public health service delivery in a community, region, or state.

Designed specifically for state health departments and state-wide systems approaches, this guide draws on the lessons learned over the past decade from studying state and local level public health sharing arrangements. The guide provides recommendations and examples of several state-level strategies to achieve efficiency, effectiveness, and equity in the provision of public health services and capabilities across the state. Examples include:

• Establishing state-run district offices to provide key expertise that may be difficult for local health departments to access on their own;
• Offering incentives for local health departments to create health districts; and
• Providing grants to support the design and implementation of innovative models by and for local health departments.

Even when states are not actively promoting shared resources and services arrangements, they still play a vital role in facilitating these efforts (e.g., by working to modify legislation that may prohibit innovation in this area, streamlining state reporting requirements, or adjusting IT systems to accommodate new grant processes). The guide provides recommendations to assist states in positioning themselves to be helpful and proactive partners for local health departments that are pursuing SRSAs.

The newly revised Roadmap applies an equity lens to the development and implementation of SRSAs. The advent of an SRSA is an ideal time for health departments to consider how best to ensure that SRSAs are intentionally designed to advance health equity, and the revised Roadmap includes prompts to address in areas such as community engagement, a sense of belonging among diverse staff, cultural competency, and equitable allocation of resources for priority populations. In the process of using the Roadmap, participants are likely to identify ways to enhance other programmatic and operational activities that are not being considered for sharing. New resources materials have been added throughout the Roadmap to support the incorporation of equity-related strategies.

The success factors described in this document are based on the experiences of numerous local health departments that have developed SRSAs.  The factors are categorized as pre-requisites (those that must be in place before planning efforts can successfully proceed in earnest), facilitating factors (those that should be leveraged if they are present), and project characteristics (those needed to ensure a smooth and timely process as an SRSA is developed and implemented).  The revised success factors apply an equity lens to facilitate the advancement of health equity in both the process of establishing the SRSA as well as the way the SRSA is governed and operationalized. 

Given the plethora of SRSAs that are being generated as part of state transformation efforts, agencies that are new to this practice can learn a great deal from their colleagues. Be sure to check out the guides and examples to boost your efforts.