Case Studies and Reports


Case Studies Published by the Center

The Center for Sharing Public Health Services convened the Shared Services Learning Community in January 2013. It was comprised of 16 demonstration sites that were considering or adopting CJS arrangements. The sites represented 76 public health departments, districts and tribal health agencies that provided services to 126 different geo-political jurisdictions and tribes. The Centers work with this group ended in 2015. In 2016, the Center began a new initiative to follow up with a subset of the original demonstration sites for an 18-month period. Case studies and reports about some of these sites are below.

CJS Case Report: Genesee and Orleans Counties in New York
Published December 2017
Genesee County and Orleans County health departments in rural New York implemented a plan to share a director and deputy director. Additional sharing has developed over time, resulting in enhanced quality of services and reduced costs. Visit the grantee’s web page to read the Center’s 2017 case report and to access several policies, procedures, tools and reports associated with the CJS initiative.

CJS Case Report: San Luis Valley Public Health Partnership
Published May 2017
The San Luis Valley Public Health Partnership was formalized to facilitate cross-jurisdictional sharing (CJS) arrangements between and among three rural and three frontier counties, with a specific goal of optimizing the effectiveness, efficiency, capacity and performance of core public health services. For the complete story, visit the grantee’s web page to read the Center’s 2017 case report and to access several policies, procedures, tools and reports associated with their CJS initiative.

CJS Case Report: Ohio’s Portage County
Published April 2017
Portage County Health District expanded to include the city of Ravenna, resulting in enhanced services for Ravenna. Simultaneously, the health district and the city of Kent engaged in a joint community health improvement planning process that has successfully engaged numerous partners in countywide efforts to further protect and promote the health of all residents. Visit the grantee’s web page to read the Center’s 2017 case report and to access several policies, procedures, tools and reports associated with their CJS initiative.

Southwest Washington
Published October 2014
The Southwest Washington Cross-Jurisdictional Sharing project was formed to explore the idea of implementing a governance structure that would support a shared approach to delivering efficient public health services in ways that respect the unique political, organizational and financial realities of four Southwest Washington counties and one tribal nation. The overall goal of the project was to explore a cross-jurisdictional sharing structure, develop an effective implementation plan and develop a basic set of procedures to ensure the provision of efficient public health services and better health outcomes across the Southwest Washington region. After several meetings, the team ultimately determined that further pursuit of the original goal would not be productive. This case study details how the effort progressed, factors that hindered the desired progress and lessons that could inform other jurisdictions interested in similar pursuits.


Case Studies Published in Collaboration with the Center

International City/County Management Association


Sharing Administrative Services Across Jurisdictions
Published December 2014
The International City/County Management Association (ICMA) (ICMA), in collaboration with the Center for Sharing Public Health Services, conducted a national survey of local governments in early 2014 to study the use of shared administrative service agreements across local health department jurisdictions. ICMA conducted three follow-up case studies to examine in greater depth how the collaborations worked and to identify specific elements that make such agreements successful.

Crittenden County, Kentucky
This case study presents a five-county public health district that provides all administrative and program services for the participating counties.

Prowers County, Colorado
This case study examines how an inter-governmental agreement (IGA) has been used to enable Prowers County, Colorado to provide public health administrative services for its neighbor, Kiowa County.

Mansfield, Connecticut
This case study features a regional public health district formed by ten towns in Eastern Connecticut, the largest of which provides many administrative services through a long-term service agreement.

Center for State and Local Government Excellence


Staff Sharing Arrangements for Local Public Health
Published November 2017
The Center for State and Local Government Excellence, in collaboration with the Center for Sharing Public Health Services, published three case studies on shared staffing arrangements in local public health organizations. These cases were selected for study based on a national environmental scan of arrangements in place and with attention to variation in location, size of jurisdictions, and type of local government. The full report can be found here. Descriptions of the cases it describes are below.

Massachusetts
The city of Melrose and the town of Wakefield in Massachusetts have had a formal agreement to share local health department staff. Melrose is the formal employer of all the shared staff included in the arrangement and is responsible for the provision of compensation and benefits. Wakefield reimburses Melrose for the staff time dedicated to its public health needs.

Iowa
Webster County, Iowa, is the largest of a group of rural counties northwest of Des Moines. These counties are working together to apply for grants and share staff in the delivery of public health services that might not be economical if each county were to attempt to provide those services on their own. Other counties in the partnership are Buena Vista, Calhoun, Clay, Dickinson, Emmet, Greene, Hamilton, Hardin, Humboldt, O’Brien, Palo Alto, Pocahontas, Sac, and Wright Counties.

Oregon
Three counties in Oregon–Multnomah, Washington and Clackamas–have shared the staffing of their health officer positions since 2006, with a resulting increase in efficiency and expertise.


Other Case Studies

West Central Public Health Partnership: A Case Study in Public Health Collaboration
Source: Colorado Trust in September 2012
Health officials from six counties along Colorado’s Western Slope came together with a common goal of strengthening the region’s public health infrastructure. Their effort culminated in the establishment of the West Central Public Health Partnership (WCPHP). In the years that followed, officials enacted intergovernmental agreements outlining partnership roles and responsibilities, and participants embarked on numerous cross-jurisdictional public health campaigns and programs. This report describes an in-depth evaluation of the WCPHP to identify the organizational elements that contributed to the group’s successes.

Case Study: Public Health Shared Services: Northeast Kansas (NEK) Multi-County Health Department
Source: Kansas Health Institute
The Northeast Kansas (NEK) Multi-County Health Department is a collaboration between three rural counties: Atchison, Brown and Jackson. It operates as a single agency, but provides public health services in each county. It also operates a home health agency, which is located in the city of Hiawatha and serves all three counties. The arrangement allows the counties to share one administrator and one accountant between all four locations. The counties receive many benefits by offering public health services through this sharing arrangement, such as staffing efficiencies, a revenue stream from the home health agency (which contributes to the financial stability of the entire health department), and moral support among peers from different counties.

Case Study: Public Health Shared Services: Southeast Kansas (SEK) Multi-County Health Department
Source: Kansas Health Institute
The Southeast Kansas (SEK) Multi-County Health Department is a collaboration between four rural counties: Allen, Anderson, Bourbon and Woodson. It operates as a single agency, but provides public health services in each county. The arrangement allows the four counties to share one administrator, one accountant and one medical director between the four public health locations. The counties receive many benefits by offering public health services through this sharing arrangement, including efficiencies in administration, increased flexibility for staff members, and cooperation and moral support between counties.

Case Study: Exploration of Public Health Shared Services: Butler and Greenwood Counties
Source: Kansas Health Institute
This case study features two county health departments in Kansas that considered sharing a family planning program. Although the CJS arrangement did not move forward, some important lessons were learned as a result of the process.

Case Study: Public Health Shared Services: South Central Kansas Coalition for Public Health
Source: Kansas Health Institute
Seven rural counties–Barber, Comanche, Edwards, Harper, Kingman, Kiowa and Pratt–collaborate through the South Central Kansas Coalition for Public Health (SKCPH). While each county has its own health department, they work together through the SKCPH to offer three shared public health programs in the region: family planning, emergency preparedness and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Each program is offered in all seven counties, but only one county must provide the administrative oversight for each program. This reduces the administrative burden on the other health departments while allowing the staff coordinating the program to become specialists in each program area. The counties and health departments receive many benefits through the sharing arrangement, such as more efficient administration of the shared programs and increased collaboration and knowledge transfer between the counties.