Regionalizing Public Health
Systems: A CyberSeminar
Presented by
Dave Palm
Office of Public Health
Nebraska Health and Human Services System
May 23, 2007
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Development of Regional
Health Departments
 In 2001, 16 local health departments
covered 22 counties
 Limited fiscal resources – no dedicated
state funds
 Lack of skills in most of the core
competencies
 Very limited visibility and
understanding of public health
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Development of New Local
Health Departments
 Turning Point was the impetus for
change
 New legislation passed in May 2001
that led to the creation of 16 new
regional health departments
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Criteria for Development of New
Local Health Departments
 Counties with more than 50,000 people
could maintain a single county health
department
 Counties with less than 50,000 people
must have a minimum of three
contiguous counties and at least
30,000 people
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Funding
 In 2001, Tobacco Settlement Funds
provided a stable, dedicated funding
source for local health departments
($5.6 million)
 Base
 Per
funding of $100,000 to $150,000
capita funding of about $2.00
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Funding
 In 2006, another $1.8 million was
appropriated through State General
Funds for local health departments
 Only one regional health department
receives financial support from local
government
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Rationale for Regional Approach
 Takes advantage of economies of scale
so fiscal and human resources can be
spread more evenly across the state.
 Creates a better opportunity to plan for
and respond to public health
emergencies, detect patterns of
disease, and leverage new resources.
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Rationale for Regional Approach
 Improves the coordination of activities
and programs between departments
and the State agency
 “Spreading
resources too thin
creates turf wars”
 Bottom line: Nebraska could not
support 93 health departments nor
recruit qualified staff
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Critical Success Factors
 Providing autonomy and choice in
selection of county partners
 Avoiding duplication of services and
programs (e.g. immunization) has
allowed the new departments to
become more balanced
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Positive Impact of
Regionalization
 Public health capacity has been
expanded
 Health
protection and emergency
preparedness
 Disease
 Health
surveillance
promotion
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Positive Impact of
Regionalization
 With greater capacity at the local level,
the State agency has become more
focused on providing technical
assistance, monitoring and training
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Challenges
 Some regions may be too large
geographically
 Most new ordinances and regulations
must be approved by each county and
community
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Challenges
 Performance measures need to be
developed to measure success of
regional systems
 Because staff is still limited, it is
sometimes necessary to provide
services in multiple regions (e.g.
epidemiology)
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Conclusion
 It is possible to establish a
regional public health system
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Future success depends on...
 Expanding the scope and capacity of
local health departments
 Continuing to develop personal
relationships and collaborative
partnerships
 Establishing performance standards to
evaluate the effectiveness of the public
health system
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Dave Palm
Office of Public Health
Box 95007
Lincoln, NE 68509
Telephone: (402) 471-0146
Fax: (402) 471-8259
E-Mail: david.palm@hhss.ne.gov
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