Regionalizing Public Health Systems: A CyberSeminar

1. Regionalizing Public Health Systems: A CyberSeminar Presented by Dave Palm Office of Public Health Nebraska Health and Human Services System May 23, 2007

2. Development of RegionalHealth Departments • In 2001, 16 local health departments covered 22 counties • Limited fiscal resources – no dedicated state funds • Lack of skills in most of the core competencies • Very limited visibility and understanding of public health

4. Development of New LocalHealth Departments • Turning Point was the impetus for change • New legislation passed in May 2001 that led to the creation of 16 new regional health departments

5. Criteria for Development of New Local Health Departments • Counties with more than 50,000 people could maintain a single county health department • Counties with less than 50,000 people must have a minimum of three contiguous counties and at least 30,000 people

7. Funding • In 2001, Tobacco Settlement Funds provided a stable, dedicated funding source for local health departments ($5.6 million) • Base funding of $100,000 to $150,000 • Per capita funding of about $2.00

8. Funding • In 2006, another $1.8 million was appropriated through State General Funds for local health departments • Only one regional health department receives financial support from local government

9. Rationale for Regional Approach • Takes advantage of economies of scale so fiscal and human resources can be spread more evenly across the state. • Creates a better opportunity to plan for and respond to public health emergencies, detect patterns of disease, and leverage new resources.

10. Rationale for Regional Approach • Improves the coordination of activities and programs between departments and the State agency • “Spreading resources too thin creates turf wars” • Bottom line: Nebraska could not support 93 health departments nor recruit qualified staff

11. Critical Success Factors • Providing autonomy and choice in selection of county partners • Avoiding duplication of services and programs (e.g. immunization) has allowed the new departments to become more balanced

12. Positive Impact of Regionalization • Public health capacity has been expanded • Health protection and emergency preparedness • Disease surveillance • Health promotion

13. Positive Impact of Regionalization • With greater capacity at the local level, the State agency has become more focused on providing technical assistance, monitoring and training

14. Challenges • Some regions may be too large geographically • Most new ordinances and regulations must be approved by each county and community

15. Challenges • Performance measures need to be developed to measure success of regional systems • Because staff is still limited, it is sometimes necessary to provide services in multiple regions (e.g. epidemiology)

16. Conclusion • It is possible to establish a regional public health system

17. Future success depends on... • Expanding the scope and capacity of local health departments • Continuing to develop personal relationships and collaborative partnerships • Establishing performance standards to evaluate the effectiveness of the public health system

18. Telephone: (402) 471-0146 Fax: (402) 471-8259 E-Mail: david.palm@hhss.ne.gov Dave Palm Office of Public Health Box 95007 Lincoln, NE 68509