Since 2012, the Center for Sharing Public Health Services has served as a national resource on cross-jurisdictional sharing (CJS), building the evidence and producing and disseminating tools, methods and models to assist public health agencies and policymakers as they consider and adopt CJS approaches.
The Center for Sharing Public Health Services is a national initiative managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation. For more information about the Center, download our brochure.
Cross-jurisdictional sharing is the deliberate exercise of public authority to enable collaboration across jurisdictional boundaries to deliver essential public health services and solve problems that cannot be easily solved by single organizations or jurisdictions.
The Cross-Jurisdictional Sharing Spectrum identifies four main categories of sharing arrangements, as shown in the chart below.
On the left side of the Spectrum there are informal arrangements, where one jurisdiction collaborates with other jurisdictions. On the right side of the Spectrum is formal regionalization, where multiple jurisdictions are served by a single governmental entity that delivers all services and formally assumes the risks, costs and decision-making across the jurisdictions involved.
In between there are two other Spectrum categories: service-related arrangements and shared functions with joint oversight. Unlike informal sharing, service-related arrangements involve regular and predictable sharing, usually formalized through contracts. If all entities contribute resources and have a formal role in decisions about how and when to deliver services, then the arrangement is a shared function with joint oversight.
The governance model, financial structure and decision-making process are different for each Spectrum category. Moving from left to right along the Spectrum, the level of service integration increases, the level of jurisdictional autonomy decreases, and the arrangements become more complex. Each model can produce gains in effectiveness and efficiency, if implemented correctly following the steps indicated in the Roadmap to Develop Cross-Jurisdictional Sharing Initiatives.