Public Health Systems Performance and Capacity Improvement

Dates: 1998-2012

State: New Hampshire

Client(s): National Network of Public Health Institutes, NH DHHS Division of Public Health Services, Robert Wood Johnson Foundation (RWJF)

Services: Health Care & Public Health Planning, Health Communication, Health Information Technology, Applied Research & Evaluation, Health Systems Transformation, Training & Technical Assistance

Technical Expertise: Community Health Coalitions, Emergency Preparedness and Response, Health Care Reform, Population Health, State and Local Public Health


Numerous reports and studies, including two landmark Institute of Medicine reports, The Future of the Public's Health in the 21st Century and Who Will Keep the Public Healthy?, have identified serious weaknesses in the Nation’s public health infrastructure. JSI’s New Hampshire office, founded as the Community Health Institute (CHI) in collaboration with the NH Department of Health and Human Services (NHDHHS), has for many years provided technical assistance, training and other support services to strengthen state and local public health capacity. With support from the Robert Wood Johnson Foundation (RWJF), JSI/CHI led the NH Turning Point Initiative to transform the public health infrastructure in the state. The final product of the planning process was a Public Health Improvement Plan that outlined priority actions for public health capacity improvement. Many of the recommendations have been implemented including establishment of a Public Health Services Improvement Council through an Act of the State Legislature.

A central recommendation of the Turning Point planning phase was to initiate a demonstration program for innovative approaches for improving local public health systems. In 2001, JSI/CHI began funding four local public health partnerships comprised of inter-municipal governmental and non-governmental agencies. The quantifiable success of the demonstration led the NHDHHS to expand the initiative in 2003 through formalization and funding of the NH Public Health Network (PHN). JSI/CHI was contracted to provide support for development of regional PHNs and administered the initial round of the PHN Grants Program. JSI/CHI facilitated assessment of local public health system capacity using the National Public Health Performance Standards, worked with community partners to achieve consensus on priorities, conducted community health assessments, developed community health profiles, drafted public health improvement plans and assisted with implementation of health improvement initiatives. JSI/CHI also conducted bimonthly trainings for PHN staff on topics such as core principles of public health, community health assessment methods, community engagement, and community health improvement processes.

This work has since expanded statewide under NH’s Public Health Regionalization Initiative. JSI/CHI is currently contracted to provide TA and training to NH's now fifteen Public Health Regions (PHRs) configured geographically to incorporate all cities and towns in NH. JSI/CHI worked with each region to assess public health capacity, financing and governance, using tools adapted from the NACCHO Operational Definition of a Functional Local Health Department.

Public Health performance improvement work also supported by RWJF has further contributed to significant public health system advancements in New Hampshire. Through the Multi-State Learning Collaborative: Lead States in Public Health Quality Improvement initiative, JSI/CHI partnered with the NH DHHS to prepare for national accreditation and improve community and public health practice by implementing a series of learning collaboratives for Quality Improvement.

In related work, JSI/CHI provides TA and training to assist the PHRs in developing regional response plans for public health emergencies. JSI/CHI has developed plan templates; HSEEP-compliant public health emergency exercises; checklists, job action sheets and just-in-time training materials. JSI/CHI has also worked with the NH DHHS and NH Homeland Security and Emergency Management on development of public information resources including, New Hampshire's emergency preparedness website; a guide to personal preparedness distributed to households statewide; and support of the state’s National Preparedness Month activities, including a Joint Informational Virtual Exercise (JIVE) to demonstrate and evaluate social media uses by public health and safety organizations.