Iowa Promotes Public Health Infrastructure by Supporting Local Health Departments

June 25, 2025 | Christy Roby, Mona Poblete, Anna Bradley

State public health agencies provide support to local health jurisdictions in a variety of ways: funding, technical assistance (TA), and developing training opportunities are a few examples. In Iowa, the Department of Health and Human Services (Iowa HHS) established a team of specialists supported by funding from the Public Health Infrastructure Grant (PHIG) to receive and respond to technical assistance requests.

The Local Public Health Performance (LPHP) Section in the Environmental and Local Public Health Bureau is led by Local Public Health Supervisor Christy Roby. The team is composed of a diverse group of professionals who bring unique expertise to support local public health efforts. This includes:

• Two population health advisors.
• Two workforce development consultants.
• Two strategic planning and performance consultants.
• Four regional community health consultants (CHCs).
• A contract program planner.

Together, these team members serve as valuable resources to local public health agencies by offering topic-specific TA upon request. They also strengthen and complement the existing support network led by the four CHCs, who work closely with local boards of health and public health administrators.

In late 2024, the LPHP team at Iowa HHS started to brainstorm ideas on how to improve their process for tracking TA requests coming from the local public health workforce. At the time, instead of one centralized system, a request could end up routed to any one of the team members regardless of subject matter expertise. Additionally, there was no established standard method across team members for ensuring the quality of the assistance provided or the length of time a request took to receive a response. Iowa HHS wanted to establish a streamlined referral system that promotes communication and collaboration across the LPHP team, that easily highlights the impacts of TA, and that quickly identifies quality improvement opportunities through regular performance monitoring and evaluation to ensure effective and efficient services are delivered to local public health staff.

Insights from Peer-to-Peer Connection

As a PHIG recipient, Iowa HHS was able to directly request TA from the PHIG National Partners. Members of ASTHO’s Public Health Infrastructure team met with them to discuss their needs and desired outcomes. Iowa HHS already had a process formulated but was interested in how to execute this plan, particularly focusing on and utilizing existing tools, such as SharePoint.

In addition to an initial scoping call and a resource summary, ASTHO coordinated a space for peer-to-peer connection; four jurisdictions came together with similar experiences in providing TA to local health departments and creating tracking systems. These collaborations allowed Iowa HHS to exchange best practices, learn about innovative strategies, and gain insight into how other jurisdictions structure their referral and TA processes. This shared knowledge directly influenced the design of Iowa’s new tool, helping ensure it aligns with national standards while meeting the unique needs of Iowa’s local public health system. Key recommendations that resulted from the conversation included:

• Develop a standard operating procedure. Write down the process, procedure, and/or policy for how the team as a whole will address technical assistance requests from start to finish.
• Consider evaluation and performance monitoring from the beginning. Defining the functional parameters of the system you hope to create helps ensure regular collection of data that can be used for identifying quality improvement opportunities and program outcomes. This includes development of overall evaluation questions and indicators that can fully answer those questions.
• Engage the end users in the design. Both the state staff responding to requests and the requestors at local health agencies should be included in conversations about process design.
• Consider how the data will be stored and accessed. Look for tools that allow multiple users to securely access and update the data. Relational databases allow for efficient querying and report building across larger, complex datasets, as opposed to spreadsheets, which may be limited in their ability to grow with the program over time as more data are entered. This could include software such as Power Apps or Agile Apps, or even a Customer Relationship Management solution.
• Tailor the tracking system to your specific jurisdiction. Peers came from states with very different governance structures and population sizes, so a software solution for tracking TA requests may not be necessary for every health agency. The standard operating procedure should be specific to the scale and scope of work unique to each jurisdiction.

The Final Product

In the beginning of March 2025, the LPHP team released their new tool for submitting, tracking, and evaluating requests from local public health agencies for TA from subject matter experts at Iowa HHS. Requestors can now complete a brief online form through Microsoft Forms, which automatically routes the request to the appropriate LPHP team members via email using Power Automate while simultaneously adding data into a centralized list available in SharePoint. However, local public health staff can continue to contact the LPHP Team directly without using the form if they prefer.

For continuous improvement, the LPHP team created a customer satisfaction survey and hope to gather data over the next year to evaluate the tool’s effectiveness. During regional meetings led by the four Regional CHCs, local health agency administrators are also being asked questions about their experiences using the tool. This new tool is designed to make accessing TA easier and has already shown benefits; more specific requests can now be submitted directly to the right team member, which has reduced response times and resulted in more tailored support. Ultimately, local health agency staff can get the resources they need to provide essential public health services that help their communities stay safe and healthy in a timely manner.

“This project was a true team effort,” said Roby. “While I was leading and facilitating the project, our entire LPH Performance team owned actions to make this all come to fruition.”

The Power of Connection

ASTHO often hears from their members how important the power of collaboration is within public health work. Though many types of TA are offered for PHIG recipients, we encourage them to participate in opportunities that build connections with other jurisdictions. In this example with Iowa HHS, having the ability to learn from the experiences of other jurisdictions was very beneficial when putting together their final product.

Several topical peer networks exist for direct PHIG recipients, such as evaluation, workforce directors, and principal investigators. You can learn more about opportunities for connection on the PHIG Partners website. Peer connections can also be facilitated by the national PHIG TA partners after a recipient submits a TA request through the PHIVE system (login required). Lastly, the my.ASTHO platform (login required) is a one-stop-shop for communications with other jurisdictions and covers a wide variety of public health topics. The “Open Forum” page serves as a space where members can ask questions to all ASTHO members. This platform may also serve as a central point for ASTHO peer networks.