Forty-one percent of local health departments in the U.S. serve small and rural jurisdictions with populations of 25,000 or less. Cross-jurisdictional sharing may increase quality of services, access to resources, and efficiency of resource use. This article characterized perceived strengths and challenges of independent and multi-municipality sharing approaches to assess cost, quality and breadth of services provided by health departments in Connecticut and Massachusetts. Findings highlight advantages and disadvantages of both public health service delivery models. Independent health departments may have more limited resources but strong local knowledge. Multi-municipality departments have more resources but may require more time and investment in governance and decision-making.
Available online: https://www.frontiersin.org/articles/10.3389/fpubh.2018.00115/full