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 Regional Health 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

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4 Development of New Local Health 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

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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  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 Future success depends on...

18 Telephone: (402) Fax: (402) Dave Palm Office of Public Health Box Lincoln, NE 68509