Sustainability of Public Health Programs Audrey M. Stevenson MSN, FNP, MPH

Utah's Investment in Public Health

Demographics 12 local health departments in Utah (6 multi-county health districts, 6 single county health districts) SLVHD serves Salt Lake County –1 million population in SL County –2.4 million in Utah –808 sq miles in Salt Lake County

Provision of services Services are provided at 8 locations across the county 6 locations provide WIC and immunizations 2 locations provide MCH clinical services

Breakdown of Finances –Local Level – fees, local tax dollars, special grants, State/Federal grants, $2M state general fund –State Level – general fund, federal categorical grants, special grants –Medicaid and Medicare – state general fund matching funds

Trends Declining federal funds in categorical grants (less contractual funding); contractual expectations remain constant.

Trends Greater need for local funding to maintain service deliveries, and to address rising operational costs.

Trends New federal funding priorities (bioterrorism, pandemic influenza).

Trends Shifts in federal funding impacting core public health priorities and work activities (may conflict with identified local priorities and needs); potential impacts on service delivery of core/essential public health services

Trends Limited or no funding for emerging public health issues/needs/concerns (obesity, infectious and communicable diseases, Meth use, WNV).

Trends Financial struggle for limited federal funds and state general funds between primary care issues and public health prevention (Medicaid, immunizations, MCH, STDs, disease surveillance).

Development of Clinical Collaborations MCH Block grant funds insufficient to provide for the MCH needs of the community Continued demand for MCH services SLVHD had the capacity of providing PH services Initially limited antepartum services were provided on site at one SLVHD PH Center

Collaboration origins The communitys MCH healthcare needs quickly outgrew the capacity for existing services To address this need the SLVHD and the University of Utah Department of Medicine, with their community partners, forged a collaboration to provide maternal and child healthcare services at the SM Public Health Center.

Expansion of the partnership Pediatrics Foster/Shelter Health Care Obstetrics High Risk Prenatal Care Midwifery Cancer Screening Las Promotoras Reach Out and Read

Result of the collaboration Establishment of a culturally competent; community based collaborative practice between an academic institution and a local public health department. The inclusion of other community partners in the identification of needed services and the implementation of programs has been essential to the sustainability of the project.

Benefits Collaborating for MCH services has provided for comprehensive academic training for a variety of health professionals in a culturally diverse setting while preserving essential public health functions. Continued services to an at-risk population that might otherwise not have access to health and public health services..

The future of the collaboration Incorporation of the Teen Mother and Child Program Expand services to a second community on the west side of Salt Lake County Continued expansion of services

Additional funding sources identified Foundations Grants Federal funds Fee for service Cost sharing

Sustainability Outsourcing Matching funding to outcomes Determine priorities Combining services to reduce cost (Public Health Nursing)

Recommendations First, recognize the identified trends, and work together to address them.

Recommendations Simplify contracts – adjust performance expectations to funding levels.

Recommendations Legislate sin (cigarette, beer and wine), specific usage (water, utilities, vehicle registration) and product (junk food) taxes with revenues dedicated to specific public health priorities, and not counted toward any cap.

Recommendations Legislate a minimum mill levy tax in each Utah county as a dedicated funding stream for local public health.

Recommendations –Look at ways to restructure the delivery of public health services to make it more cost efficient; minimum performance standards state delivery versus local delivery focus on risk-based services (HIV testing) cost-benefit basis

Conclusion From a local perspective sustainability requires strong partnerships with Federal, State and Local partners. Use of collaborations to expand services –South Main Clinic

Sustainability in Tight Times Combining services to stretch funding dollars Performing continual program and needs assessments Communicating with the community and other stake holders on program budgets and sustainability of programs

Acknowledgements I wish to thank Gary House MPH, Executive Director of the Weber Morgan Health Department for much of the information included in this presentation.