Increasing Capacity During COVID-19: 5 Tips to Streamline Partnership Development

Gianfranco Pezzino, Director

A Message from the Director of the Center for Sharing Public Health Services

As COVID-19 cases spike in many communities, public health departments are under tremendous pressure to respond with increased testing and contact tracing. Because many health departments do not have the resources to do this work on their own, some have turned to cross-jurisdictional sharing (CJS) to increase capacity.

Developing CJS arrangements on the fly can be difficult at best. Even health departments that have partnered successfully in the past may find that having just one new partner in the mix can be more difficult than anticipated.

The Center’s Roadmap and its interactive companion COMPASS describe a three-phase process to develop successful CJS arrangements. However, pandemic response is needed quickly and it can be impractical to complete the entire process for initiatives focused on testing and contact tracing.

At a time like this, we offer the following thoughts on quickly planning and implementing CJS arrangements for expanded COVID-19 response operations:

  1. Start by determining how much capacity is needed by your own health department. Depending on the nature of your jurisdiction and the current and anticipated disease burden, this could range from occasional “as needed” capacity to the capacity to handle a high number of cases on an ongoing basis.
  2. Identify potential partners and options for sharing. Does it make sense to combine funds with several partners to support a team of staff that is available to all jurisdictions? Or perhaps the most populous jurisdiction could hire additional staff that can be shared, as needed, via contracts? Would it be helpful to generate or update mutual aid agreements and decide on a threshold that, if crossed, would trigger payment for the aid? Which option would provide the highest efficiency while respecting the need for timeliness and increased capacity?
  3. Develop ground rules for the process of developing the CJS agreement. This could be particularly important for new partners. We recommend allowing for the time necessary to fully explore this process. Some suggestions include:
    • Appoint someone to lead discussions and take notes (and potentially rotate),
    • Agree on how decisions will be made (ideally by consensus),
    • Document all decisions,
    • Be candid and respectful when asking and answering questions, and
    • Always assume all partners have a positive intent.
  4. Agree on short-term and longer-term measures of success and monitor accordingly.
  5. Remember that collaboration happens “at the speed of trust.” Be aware of any dynamics that undermine the group’s progress and any trust issues that emerge. These issues must be solved before a CJS arrangement can be successful.

The pandemic is causing many health departments to respond quickly with innovative approaches. While our new normal is certainly difficult, it can provide an unprecedented opportunity to develop new collaborative partnerships. If these partnerships continue in the future, they could have a significant and positive impact on health and health equity in our communities.

We’d love to hear your stories of how cross-jurisdictional sharing has helped your health department respond to the pandemic. If you have a story to share or need technical assistance on a cross-jurisdictional sharing initiative, please contact us at

— Gianfranco Pezzino, Director