Improving Local Health Through Partner Engagement and Policy: Establishing the First Performance Standards for Massachusetts Local Public Health.

Abstract

Context: The Massachusetts (MA) local public health system is highly decentralized. All 351 municipalities autonomously manage local public health infrastructure and budget, resulting in service delivery disparities. The MA Department of Public Health (MDPH) recognizes that achieving equitable access to public health services requires systems change, and successful systems change demands active participation and input from partners at all levels.

Objectives: To collaboratively establish the first Performance Standards (PS) with and for MA local public health to reduce inequities in public health system delivery.

Design: Partner engagement and the Framework for Applying Qualitative Methods in Health Policy and Systems Research guided PS establishment. Relevant standards from MA laws were compiled and organized using document and thematic content analyses. Partner elicitations guided edits for finalizing PS.

Setting: In 2021-2023, MDPH facilitated statewide partner collaboration to establish PS.

Participants: Six key MA public health organizations, representatives from 4 state agencies, and widespread MA local public health.

Intervention: Targeted engagement with internal partners enabled drafting PS. Widespread engagement with external partners elicited open comments to improve and finalize PS.

Main outcome measures: MDPH and partners collaboratively formalized PS after analyzing 283 comments and 66 edits.

Results: Through active collaboration with partners, MA formalized the first official PS for local public health, released in October 2023. PS comprise 5 subjects, including 87 standards written into MA legislation across 4 subjects (environmental health, tobacco control, disease control and prevention, administration), plus recommended workforce standards. PS set minimum expectations for local public health credentialing and support consistent public health service delivery.

Conclusions: PS are a steppingstone toward MA public health systems change. Collaboration is critical for partner buy-in, to establish and implement PS using shared resources structures. Effective PS implementation, synergistic with other efforts, will reduce disparities in local public health services and delivery and provide MA residents with more equitable access to public health services.