Building Accountability for Public Health Investments

Washington State Department of Health

Introduction

The first recommendation in the report Public Health Forward: Modernizing the U.S. Public Health System calls for decision-makers to provide flexible funding, avoid issue-specific grants, and maximize existing assets to support public health services and capabilities, including those needed to address health inequities. The report charges departments with building accountability mechanisms to track how current funding is spent and the impact of that spending. Showing accountability helps public health practitioners to build the trust and political will needed to protect public health services.  

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context

Washington state has a decentralized governmental public health system comprising 35 autonomous local health jurisdictions under the authority of county government and local boards of health, a state department of health, a state board of health, and 29 federally recognized sovereign tribal nations and Indian health programs. The Foundational Public Health Services Steering Committee is the decision-making body for efforts to support the provision of foundational services across the state. Legislation passed with bipartisan support in 2019 (RCW 43.70.512 and 43.70.515) reflects recommendations from elected officials to mandate the provision of Foundational Public Health Services (FPHS). The accountability process described in this case study is part of Washington’s system-wide effort to secure and maintain adequate and stable funding for FPHS by demonstrating the value and impact of these services across the public health system. 

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introduction

The first recommendation in the report Public Health Forward: Modernizing the U.S. Public Health System calls for decision-makers to provide flexible funding, avoid issue-specific grants, and maximize existing assets to support public health services and capabilities, including those needed to address health inequities. The report charges departments with building accountability mechanisms to track how current funding is spent and the impact of that spending. Showing accountability helps public health practitioners to build the trust and political will needed to protect public health services.  

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context

Washington state has a decentralized governmental public health system comprising 35 autonomous local health jurisdictions under the authority of county government and local boards of health, a state department of health, a state board of health, and 29 federally recognized sovereign tribal nations and Indian health programs. The Foundational Public Health Services Steering Committee is the decision-making body for efforts to support the provision of foundational services across the state. Legislation passed with bipartisan support in 2019 (RCW 43.70.512 and 43.70.515) reflects recommendations from elected officials to mandate the provision of Foundational Public Health Services (FPHS). The accountability process described in this case study is part of Washington’s system-wide effort to secure and maintain adequate and stable funding for FPHS by demonstrating the value and impact of these services across the public health system. 

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key actions

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Achieve consensus on what to measure.

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Define a measurement framework.

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Develop specific measures.

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Create a Baseline.

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Conduct Ongoing Measurement.

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Communicate Results.

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recommendations

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Work with legislative champions to develop an accountability process.

Policy
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Demonstrate the impact of funding policies that strengthen the entire public health system.

Policy
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Funding to establish and implement the accountability process.

Financial
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Use a reputable vendor.

Financial
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Engage staff throughout the public health system.

Workforce
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Minimize the burden on staff.

Workforce
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Dedicate staff time to engaging in the measurement process.

Workforce
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Allocate time for staff to participate in designing and conducting assessments.

Workforce
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Develop a set of functional definitions for each service that will be measured.

Accountability Process Features
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Have reasonable expectations about how to measure a system.

Accountability Process Features
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Use assessment results for continuous improvement.

Accountability Process Features
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Anticipated Impacts for Public Health Departments

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Health

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Equity

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potential challenges to implementation

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Unique resources, skills, and time.

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Measuring system performance is complex.

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Public health professionals may be concerned about how policy makers will interpret results.

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sustainability

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Sustaining the accountability system in Washington relies on:

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