Top-Down or Bottom-Up: Which Approach to CJS is Better?

A Message from the Co-Directors

November 28, 2018

Is it better for a state health department to take a top-down or a bottom-up approach when encouraging cross-jurisdictional sharing at the local level? It turns out that it’s not an either/or proposition. State health departments can successfully use a combination of both approaches concurrently.

That was a key takeaway from a webinar we hosted last month, State Health Departments and Cross-Jurisdictional Sharing (CJS): Driving Effectiveness and Efficiency at the Local Level.

Michael Fraser, chief executive officer of the Association of State and Territorial Health Officials and a member of our advisory group, introduced two speakers whose states have had success maximizing public health efforts by encouraging local collaboration across jurisdictions.

The Minnesota Department of Health (MDH) historically has encouraged cross-jurisdictional sharing but has relied on local health departments to work out the details, according to Chelsie Huntley, Director of the Center for Public Health Practice at MDH. In this way, the state doesn’t take a top-down approach by mandating such collaborations. Instead, it incentivizes CJS in state grants in a way that “bakes it in” from the beginning. They have learned that successful collaboration often leads to more sharing between health departments.

The Montana Department of Public Health and Human Services recently used a slightly different approach to maximize efforts within its Chronic Disease Prevention & Health Promotion Bureau, according to Mandi Zanto, Healthy Lifestyles Section Supervisor. They began by forming a work group to look at the internal processes of four programs within the bureau. Eventually, the four programs combined their contracts and issued them to 13 chronic disease regions. Within each region, a hub county receives the contract and relies on the spoke counties to help implement it. Using this approach, the state was able to reduce the total number of contracts issued, while local health departments benefited from coordinated deliverables and reporting.

In both cases, the state played an important role (by specifying the overall program goals and providing incentives for resource sharing), and the local health departments collaborated on program design and implementation. Whether using a top-down or a bottom-up approach (or both), two-way communication is essential.

If you have questions about this topic or the Center in general, please email us at If you would like to watch the entire webinar, we have posted a recording on our website at 

We hope you can join us for our next webinar, Ways to Organize Cross-Jurisdictional Sharing: The Role of Third Parties. It will take place on December 7, 2018, at 10:00 a.m. PT/11:00 a.m. MT/12 noon CT/1:00 p.m. ET. For more information and to register, follow this link.

Pat Libbey and Gianfranco Pezzino, Center Co-Directors

New Webinar: December 7

Ways to Organize Cross-Jurisdictional Sharing: The Role of Third Parties

While many cross-jurisdictional sharing (CJS) arrangements involve only the participating health departments, sometimes a third party can play a vital role in supporting health departments’ efforts to share services. The speakers in this webinar will describe two different models through which health departments enhanced their efficiency and effectiveness due to the work of a third party. The first model is based in western Massachusetts and the second model is based in northern Michigan.

Register for the webinar at: 

The Center for Sharing Public Health Services has launched COMPASS: Comprehensive Assistance for Shared Services, an interactive, online tool that guides public health departments and local governments as they consider and adopt cross-jurisdictional sharing approaches. 

Packed with online resources and interactive multimedia elements, COMPASS can help you plan for success. Visit to learn more.