Toolkit: Public Health District Planning

The resources found in this toolkit are intended to help communities assess opportunities for shared public health services and plan for implementation. There are three essential elements that need to be in place for communities to share public health services: a formal structure with a legal agreement, a governing body and a fiscal agent.

The outline below provides toolkit resources that can assist communities as they walk through the planning process to establish three essential elements.

Step 1: Initiate the Discussion and Engage Stakeholders

Roadmap for Getting Started - A detailed overview of the steps that should be considered by communities when beginning to plan for any type of public health regionalization.
Strategic Planning and Organizational Consultants 2011 - This list is for informational purposes only and does not constitute an endorsement of any particular consultant. You are free to select any service provider of your choosing.

Step 2: Explore the Details

Town-by-Town Comparison Chart (Excel sheet) – A tool that can be useful in helping communities compare local characteristics, public health duties, budgets, and current staffing levels.
User Guide for the Town-by-Town Comparison Chart - A user guide that provides guidance on how to use the Town-By-Town Comparison Chart.
Manual of Laws and Regulations Relating to Boards of Health - The December 2009 manual released by the Massachusetts Department of Public Health that provides a comprehensive listing of all laws and regulations relating to Boards of Health.

Step 3: Assess the Options

Brief Examples of Regional Health Districts - A brief overview of the various models communities have used throughout the state in regionalizing public health services.
A Comprehensive District Model: A Case Study of the Quabbin Health District - An in-depth analysis of the Quabbin Health District, an established comprehensive health district located in western Hampshire County.

Step 4: Determine Legal Structure

Draft Intermunicipal Agreement under M.G.L. Chapter 40 - An example of a contract that allows multiple municipalities to share services. This should be used when collected regional partners are not considering the establishment of a new unified health district.
Regional Health District Template Bylaws Based on Provisions of Chapter 111 Section 27B - An example of an agreement that establishes a new unified health district through the legislative branch of participating municipalities.

Step 5: Determine Fiscal Structure and Additional Considerations

Town-by-Town Comparison Chart (Excel sheet) - Please refer to the Chart for assistance. Additional fiscal tools are currently being developed and should be available soon.
District Incentive Planning Grant program - The MA Department of Public Health is offering technical assistance to communities which have been awarded District Incentive Planning Grants. This assistance includes fiscal and legal advising.
Funding Formula Analysis Worksheet and Tutorial - an ASTHO analytic tool for public health practitioners, researchers, and policy makers to measure the impact of various formula adjustments, assessing the financial, equity, and political implications of funding formula changes.

Step 6: Performance Management: Improving Public Health Services in the District

Community Health Assessment Resource: - Health Resources in Action created this website to assist District Incentive Planning Grant applicants in preparing a community health assessment (CHA) as part of their grant proposals, however, a CHA is highly recommended for any group of communities who are considering a regional district model. The CHA identifies factors that affect the health of a population and determines the availability of resources to address those factors. Communities who perform a CHA together develop a foundation for shared responsibility and a district wide approach to tackling identified issues.
The Public Health Improvement Resource Center - This online searchable database of resources and tools exists to help build better public health systems. Use this resource to identify opportunities for how your proposed district can improve the scope and/or quality of public health services for their populations.
National Public Health Performance Standards Program - This CDC backed program outlines performance standards for state and local public health systems and their governing bodies.Their website includes resources to support performance assessment and systems improvement.
The Public Health Performance Improvement (PHPI) Toolkit - The toolkit is an online collection of tools such as archived trainings, sample QI products, templates, and related resources.These are important resources for the proposed health district performance improvement activities.
Workforce Qualification Grid - This tool offers written qualifications for Board of Health (or health department, as applicable) staff and contractors to help shape job and contract postings. Strengthening the qualifications of the state’s local public health workforce enhances their ability to perform their legal responsibilities, and serves to set professional standards to increase staff’s professional capacity.
Evaluation: Logic Model Template - All Public Health departments should have a method for evaluating their work. The local evaluation plan should minimally include goals, objectives and a plan for documenting process and outcome data, including program, policy and financial impacts of the PHDIG program in the grant-funded districts. This model template can be used in planning the district evaluation plan.

If communities in your area are considering sharing public health services, but have not received a District Incentive Planning Grant, please contact Geoff Wilkinson, Senior Policy Advisor, at This e-mail address is being protected from spambots. You need JavaScript enabled to view it to learn more about the possibility of additional technical assistance.

Roadmap for Getting Started