Public health leaders are increasingly facing decisions about how to assure Foundational Public Health Services (FPHS) delivery and infrastructure in the context of shifting resources.  By understanding both current capacity and cost, and identifying future needs, health departments can make informed decisions about allocating resources, prioritizing investments, strengthening partnerships, and communicating needs effectively to interest holders, partners, and decision makers. There is a critical need for ongoing insight into the capacity and costs required to deliver these services effectively. 

The FPHS Capacity and Cost Assessment Tool (Tool) offers a practical way forward. At its core, this Excel-based Tool supports health departments and/or health systems in understanding three key questions:

1. What resources are currently used to deliver the Foundational Capabilities and Areas?
2. Do we have the workforce capacity and expertise to do so fully and well?
3. If not, what resources are needed to fully deliver the Foundational Capabilities and Areas?

The Tool, along with a suite of related resources, offers a consistent approach and accessible materials that support agencies in understanding their resources and needs. Health departments can choose to assess capacity alone, costs alone, or both capacity and cost together. When completed by health departments across a state system, it also offers the ability to understand key strengths, opportunities for improvement, and disparities across jurisdictions, regions, and systems. We also recognize that capacity and cost are not solely internal considerations. They are deeply connected to how public health systems operate, including partnerships with health care, community-based organizations, and other sectors. These resources can support more transparent and aligned conversations across partners, helping to ensure that responsibilities and investments are shared in ways that reflect community needs.

To support use of the Tool, PHAB, in partnership with the Center for Public Health Systems at the University of Minnesota, continues to develop a suite of practical and adaptable resources to guide health departments through each step of the process:  

• Core tools and guidance: includes the Excel-based Tool, FPHS operational definitions, FAQs, and comprehensive instructional, decision, and facilitator guides. Together, these core tools provide structure to complete the Tool.
• Short, on-demand videos: offer concise walk-through for key components of the Tool to support just in time learning and instruction.
• Tip Sheets for Interpretation, Analysis, and Action: supports users in understanding how to examine, interpret and act on the data entered into the Tool.
• Crosswalks: tool that provides a health department and/or system the ability to crosswalk programmatic activities to the FAs, FCs and/or CSS.

In addition to these supports for the FPHS Capacity and Cost Assessment, PHAB’s new Strategic Decision-Making tool offers the ability to systematically evaluate whether to sustain, adapt, or discontinue programs and service lines using a structured, criteria rating-based approach, including criteria focused on the FPHS. This tool can be used to discuss prioritization and pivots amidst resource shifts.

Together, these resources are intended not only to support completion of the Tool, but to strengthen strategic decision-making over time. By equipping health departments and systems with clear, actionable information on capacity and cost, this work advances more transparent, data-informed, and collaborative approaches to delivering FPHS.

For more information, contact PHAB at PHABTA@phaboard.org.

Reena Chudgar, MPH, is the Director of Public Health Systems and Services at the Public Health Accreditation Board (PHAB) supporting implementation of the Public Health National Center for Innovations and Center for Sharing Public Health Services efforts. Reena joined PHAB/PHNCI in April 2019 and engages with health departments and communities in using innovation as a tool for transformation. Her work centers around strategy and program implementation, and is passionate about social and systems change, addressing root causes of historical and current racial and health inequities, and local and people-centered decision making. Prior to joining PHAB, Reena served as Director for Performance Improvement at the National Association of County & City Health Officials (NACCHO), where she supports health departments in fostering partnerships, cross-sector collaboration, community and strategic planning, and more. Reena received a Master of Public Health degree and a bachelor’s degree in chemistry from Emory University.

Jason Orr, PhD, is a researcher with the Center for Public Health Systems at the University of Minnesota School of Public Health and is experienced in policy analysis, mixed-methods research, and systems design & analysis. He holds a BS in chemical and biological engineering and an MPH with an emphasis in infectious diseases and zoonoses from Kansas State University, and a PhD in systems engineering from Colorado State University. He has ‘pracademic’ interests in public health services frameworks (eg, Foundational Public Health Services), collaborative service delivery (ie, cross-jurisdictional sharing or cross-sectoral collaboration), public health finance and workforce issues, and other transformation and innovation initiatives for public health systems.