Local public health units around the country are under significant financial constraints. Seven counties in the Southeast Central Region of North Dakota established a cross-jurisdictional collaborative to increase financial efficiency through shared delivery of public health services. This paper reports on the cost-benefit analysis instrument designed by the collaborative and the ways it was used to analyze current financial efficiency with regard to service delivery. The instrument allowed for the cost-per-beneficiary to be calculated, as well as the portion of the cost of delivering the service that was dependent on public subsidization. Emergency preparedness and tobacco prevention were determined to be the lowest cost per beneficiary, while the Ryan White program and chronic disease management were determined to be the highest cost per beneficiary. These results were used by the collaborative to do strategic planning with regard to service delivery and opportunities for collaboration.