Transcript Sustainability of Public Health Programs Audrey M. Stevenson MSN, FNP, MPH Utah's Investment in Public Health.

Sustainability of Public
Health Programs
Audrey M. Stevenson MSN, FNP, MPH
Utah's Investment in Public
Health
Demographics
• 12 local health departments in Utah (6
multi-county health districts, 6 single
county health districts)
• SLVHD serves Salt Lake County
– 1 million population in SL County
– 2.4 million in Utah
– 808 sq miles in Salt Lake County
Provision of services
• Services are provided at 8 locations across
the county
• 6 locations provide WIC and
immunizations
• 2 locations provide MCH clinical services
Breakdown of Finances
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Local Level – fees, local tax dollars, special
grants, State/Federal grants, $2M state
general fund
State Level – general fund, federal
categorical grants, special grants
Medicaid and Medicare – state general fund
matching funds
Trends
•
Declining federal funds in categorical
grants (less contractual funding);
contractual expectations remain
constant.
Trends
•
Greater need for local funding to
maintain service deliveries, and to
address rising operational costs.
Trends
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New federal funding priorities
(bioterrorism, pandemic influenza).
Trends
• Shifts in federal funding impacting core
public health priorities and work activities
(may conflict with identified local
priorities and needs); potential impacts on
service delivery of core/essential public
health services
Trends
•
Limited or no funding for emerging
public health issues/needs/concerns
(obesity, infectious and communicable
diseases, Meth use, WNV).
Trends
•
Financial struggle for limited federal
funds and state general funds between
primary care issues and public health
prevention (Medicaid, immunizations,
MCH, STDs, disease surveillance).
Development of Clinical
Collaborations
• MCH Block grant funds insufficient to
provide for the MCH needs of the
community
• Continued demand for MCH services
• SLVHD had the capacity of providing PH
services
• Initially limited antepartum services were
provided on site at one SLVHD PH
Center
Collaboration origins
• The community’s MCH healthcare needs
quickly outgrew the capacity for existing
services
• To address this need the SLVHD and the
University of Utah Department of
Medicine, with their community partners,
forged a collaboration to provide maternal
and child healthcare services at the SM
Public Health Center.
Expansion of the partnership
Pediatrics
Foster/Shelter Health Care
Obstetrics
High Risk Prenatal Care
Midwifery
Cancer Screening
Las Promotoras
Reach Out and Read
Result of the collaboration
• Establishment of a culturally competent;
community based collaborative practice
between an academic institution and a
local public health department.
• The inclusion of other community
partners in the identification of needed
services and the implementation of
programs has been essential to the
sustainability of the project.
Benefits
• Collaborating for MCH services has provided
for comprehensive academic training for a
variety of health professionals in a culturally
diverse setting while preserving essential public
health functions.
• Continued services to an at-risk population that
might otherwise not have access to health and
public health services..
The future of the collaboration
• Incorporation of the Teen Mother and
Child Program
• Expand services to a second community
on the west side of Salt Lake County
• Continued expansion of services
Additional funding sources
identified
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Foundations
Grants
Federal funds
Fee for service
Cost sharing
Sustainability
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Outsourcing
Matching funding to outcomes
Determine priorities
Combining services to reduce cost
(Public Health Nursing)
Recommendations
•
First, recognize the identified trends,
and work together to address them.
Recommendations
•
Simplify contracts – adjust performance
expectations to funding levels.
Recommendations
•
Legislate “sin (cigarette, beer and wine),
specific usage (water, utilities, vehicle
registration) and product (junk food)
taxes” with revenues dedicated to
specific public health priorities, and not
counted toward any “cap”.
Recommendations
•
Legislate a minimum mill levy tax in
each Utah county as a dedicated funding
stream for local public health.
Recommendations
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Look at ways to restructure the delivery of
public health services to make it more cost
efficient;
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minimum performance standards
state delivery versus local delivery
focus on risk-based services (HIV testing)
cost-benefit basis
Conclusion
• From a local perspective sustainability
requires strong partnerships with Federal,
State and Local partners.
• Use of collaborations to expand services
– South Main Clinic
Sustainability in Tight Times
• Combining services to stretch funding
dollars
• Performing continual program and needs
assessments
• Communicating with the community and
other stake holders on program budgets
and sustainability of programs
Acknowledgements
• I wish to thank Gary House MPH,
Executive Director of the Weber Morgan
Health Department for much of the
information included in this presentation.