Service Sharing: A Powerful Tool for Public Health Transformation

This entry is part 34 of 42 in the series Focus on Accreditation and Innovation

PHAB’S expertise in and support for public health transformation expanded in July when the Center for Sharing Public Health Services (CSPHS) became part of the PHAB enterprise. Service sharing can serve as a powerful tool for local and state public health leaders who are rethinking public health systems and considering the most efficient and effective ways to deliver public health services. 

Service sharing has been studied and supported by CSPHS for the past decade. Service sharing can take many forms, and the best form is entirely dependent on what partners are trying to achieve; hence, “form follows function” has become an important mantra for our work. We also have seen that pursuing sharing arrangements with a singular goal of saving money can be highly problematic, while seeking to achieve a balance between improved efficiency and improved effectiveness is not only more attainable but also much more likely to be sustainable. Put another way, we encourage health departments to focus is on “getting the biggest bang for the buck.” Finally, all shared service arrangements need to be developed from the “bottom up.” By far, trust is the most important factor at the heart of a successful sharing model, and therefore all who will be engaged need to weigh in on critical decisions such as who will participate in the sharing, how the arrangement will be governed, and how accountability will be demonstrated. Our experience has demonstrated that absent trust, public health programs can flounder or even fail.

Service sharing often entails contiguous counties sharing staff, expertise, and/or programs. Sharing also can include redesigning how state resources are deployed; agreements between non-contiguous counties; and new state/local partnerships. CSPHS advocates that specific steps be followed when new arrangements are designed (see the “Roadmap” document below); as for the resulting structure, however, we encourage innovation, risk-taking, and a willingness to “fail forward.”

CSPHS has provided grant funding to 53 teams and technical assistance to grantees and a host of others in the practice community working on shared service arrangements. CSPHS translates what has been learned into guidance documents, tools, and stories, and curates a growing collection of recorded webinars, articles, templates, and other materials to help guide service sharing efforts. What we have learned has been affirmed many times over, and just a few of our key resources include:

As state and local health departments seize the moment to transform public health, we urge you to consider how shared service arrangements can help create stronger, higher-performing agencies that collectively comprise a strengthened and transformed public health system.

Stay tuned for an announcement about our upcoming webinar, “Top 10 Things to Know About Service Sharing,” (Date TBD), visit our website, and contact us at for more information on how we can help you.

Author Profile

Grace Gorenflo
Grace Gorenflo, MPH, RN, is the director of the Center for Sharing Public Health Services. She has been with the Center for Sharing Public Health Services since its inception in 2012, moving from a senior consultant to the position of director in 2022. During her tenure she has led the development of all webinars, conference sessions, workshops, grants, and technical assistance for CSPHS. Grace also is the principal of Gorenflo Consulting, Inc. With over 30 years of experience in governmental public health, she specializes in cross-jurisdictional sharing, public health system and agency transformation, accreditation, and the intersection among them; community health improvement planning processes with a focus on health equity and racial justice; and public health agency quality improvement and performance management. Her clients include local, state, Tribal and territorial health departments; state and national public health organizations; and non-profit hospitals. Grace is an adjunct professor for the Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University; and she is on faculty for the Northwest Public Health Practice Center’s Public Health Management Certificate Program in the School of Public Health, University of Washington. She received a Master of Public Health from Johns Hopkins University and has a Bachelor of Science in Nursing from the University of Virginia. Grace worked for 10 years as a registered nurse in acute care and research settings, and for 30 years she volunteered for community organizations dedicated to medically underserved populations.
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