1. MLC-2 New Hampshire October 12, 2007

2. Quality Improvement Activities for MLC-2 1.Articulate measures to monitor improvement for New Hampshire’s performance on our 6 strategic priorities – and others –Examine measures used by MLC partners, NACCHO’s operational definitions of local health department etc. –Determine measures to track progress of 6 action plans –Develop reporting tools for state and local partners –Pilot local measures in local agencies –Evaluate the process

3. Final Strategic Priorities 1) Inform, educate and empower people about health issues 2) Monitor health status to identify and solve community health problems 3) Mobilize community partnerships and actions to identify and solve health problems 4) Develop policies and plans that support individual and community health efforts 5) Communication plan 6) Workforce development

4. Sample Action Plan

5. Accomplishments to Date The Public Health Services Improvement Council enacted in statute to sustain and monitor progress. Additional funding from EFH to implement a public health communication campaign to improve the visibility of public health A Call to Action drafted to better coordinate and support broad-based vs. single focus community partnerships.

6. Accomplishments to Date A survey is under development to collect information on and create a web portal to public health promotion efforts and community partnerships. Collaborating with the Citizens Health Initiative and others on tobacco and substance abuse prevention, physical activity and nutrition.

7. Quality Improvement Activities for MLC-2 Improve the quality of public health practice using existing standards to create a tiered approach to credentialing/ accreditation of local public health professionals. –Review public health workforce competencies –Incorporate into course offerings –Develop tiered local standards and credentialing for local public health ranging from volunteer health officers to full service health departments

8. Aligning of Initiatives While the MLC-2 project was looking at credentialing of local public health officials….. DPHS was discussing regionalizing of various public health initiatives

9. Why Regionalization ?

10. The Public Health Networks: The NH Context In many New Hampshire communities, non-governmental organizations provide a significant sub-set of essential public health services At the State level, DHHS is the lead public health agency. The Department of Environmental Services, Department of Education, and Department of Safety also play key roles in promoting and protecting the public’s health. Each of New Hampshire’s 234 cities and towns are statutorily required to have a health officer Only three New Hampshire communities maintain public health departments; no county health departments

11. There are many maps New Hampshire Public Health Networks Ensure that local communities have the capacity to assure continued improvement in the health of individuals, families and communities. o 14 Coalitions o 118 Towns o 50% of NH towns o 70% of the NH population covered o 5-11 communities per coalition

12. All Health Hazard Regions 19 Regions organized to respond to any public health emergencies statewide

13. Regionalization Goal Overall Goal – A performance-based public health delivery system, which provides all 10 essential public health services throughout New Hampshire

14. Approach A tiered system of public health regionalization that recognizes varying resources, infrastructure and capacity to carry out core public health functions and the 10 essential services at different levels Regions will be organized in a way that recognizes geographic features, existing health care infrastructure and population The Division of Public Health Services envisions one public health agency per region that must be or be associated with a governmental agency that coordinates or is responsible for the 10 essential services. The agency may subcontract or create memoranda of understanding for some essential services

15. Approach Will be based on standards for agency infrastructure and performance. Will be an evolutionary process – some areas may not meet the first tier from the beginning but may move there in time. May require statutory changes.

16. Proposed Framework

17. Work to Date Review potential framework for a 3 tiered system Raised many questions such as – is there a recommendation for public health staffing per capita Gathering information to determine the function of a local health agency versus form

18. Work to Date Attempting to define –What is the role of the state at the local level? –What is the role of the health officer?

19. Next Steps Conduct an assessment of some public health networks to compare current functions with those put forth by national groups as definitions of a local public health agency.

20. So … While much of the country continues to or moves to accrediting local public health agencies….. New Hampshire looks for local public health agencies to accredit But we have the luxury of building a public health infrastructure based on existing standards – what will be rather than what is

21. Thank you! Joan H. Ascheim NH Division of Public Health Services 603-271-4110 Jascheim@dhhs.state.nh.us Jonathan Stewart –CHI –603-573-3303 –Jonathan_Stewart@jsi.com@jsi.com