CHIP Implementation Efforts at PHIG-Funded Local Health Departments

September 15, 2026 | Anna Bradley

Community health improvement plans (CHIPs) help public health agencies and community partners coordinate action around shared priorities. CHIPs create a framework for collective action and measurable progress toward improving community health by bringing together organizations from multiple sectors around shared priorities.

ASTHO, in partnership with the Big Cities Health Coalition, conducted key informant interviews with staff from Wake County Health Department, San Diego County Health Department, Pima County Health Department, and Harris County Public Health to explore how local health departments funded by the Public Health Infrastructure Grant (PHIG) sustain CHIP implementation over time. Interviewees emphasized four strategies that support successful implementation: treating the CHIP as a living document, leveraging existing partnerships and community strengths, sharing ownership, and maintaining momentum through measurement and communication.

Treat the CHIP as a Living Document

Each jurisdiction emphasized the importance of grounding implementation in existing programs, community priorities, and realistic expectations that can evolve through regular engagement, feedback, and adaptation. This mindset maintains momentum and builds trust with partners, even when resources are limited or timelines are compressed. Applying lessons learned from previous cycles is a hallmark of CHIP implementation and an opportunity for continuous quality improvement. Across jurisdictions, staff described improving and refining their approach from cycle to cycle.

Strategies for keeping a CHIP active and relevant throughout implementation included:

• Establish regular opportunities to review progress and refine strategies with steering committee and workgroup members.
• Focus on early adopters and meet partners where they are, allowing implementation efforts to build momentum gradually over time. San Diego County highlighted this balance in an example where one region required an additional year of reviewing and collecting more data before moving ahead, a decision viewed as an important and necessary part of the process.
• Continually refine engagement approaches based on participant needs and experience. Harris County intentionally designs facilitation activities and participation formats to strengthen collaboration, build trust, and support specific implementation goals, often choosing to focus on just one outcome per meeting.
• Look beyond the current implementation cycle by considering how partnerships, priorities, and implementation structures may need to evolve over the next cycles. San Diego County intentionally plans not only for the current implementation cycle, but also for where they hope partnerships and collaborative efforts will be in future cycles.
• Use each implementation cycle as an opportunity to improve. Wake County highlighted efforts to strengthen future engagement through clearer participant roles, orientation materials, and additional opportunities for community input.

Leverage Existing Partnerships and Community Strengths

Successful CHIP implementation requires dedicated capacity. Interviewees emphasized that implementation becomes more feasible and sustainable when health departments build on existing relationships, expertise, and infrastructure rather than creating entirely new systems. Across jurisdictions, staff described the CHIP as a tool for aligning and elevating existing work, not shifting responsibility away from community partners or creating parallel initiatives. In both Wake and San Diego Counties, for example, CHIP implementation is situated within broader community health improvement networks — Live Well Wake and Live Well San Diego — which provide an established foundation for collaboration and action.

Several strategies emerged for leveraging existing partnerships and community strengths:

• Dedicate staff capacity to coordinate implementation while drawing on expertise that already exists within the organization. In Harris County, two staff led CHIP implementation with support from multiple internal offices that contribute communications, facilitation, community engagement, data analysis, and programmatic expertise.
• Build on existing initiatives rather than creating new structures whenever possible. Pima County emphasized alignment with existing programs and community priorities, including youth, housing, and other community-led efforts already addressing CHIP priorities.
• Align planning efforts across organizations. San Diego County described ongoing efforts to strengthen alignment among hospitals, managed care plans, behavioral health programs, and other partners to support collaborative and interdependent planning cycles.
• Position public health as a convener rather than the sole owner of implementation to incorporate community expertise. Wake County described public health's role as supporting collaboration, convening partners, and sharing resources while recognizing that community organizations and other sectors often serve as the lead experts in their respective areas.

Share Leadership and Ownership

A shared strength across the interviewed jurisdictions was their commitment to community-centered planning and implementation. Rather than positioning the CHIP as a health department initiative, jurisdictions emphasized creating meaningful opportunities for community partners to influence decisions, shape implementation strategies, and lead activities. These approaches help build trust, strengthen buy-in, and create a greater sense of ownership over the plan and its outcomes.

Practical strategies for sharing leadership and ownership used by interviewees included:

• Create opportunities for community partners to serve in leadership roles, such as co-chairs, workgroup leads, or steering committee members.
• Connect with partners between meetings to strengthen relationships and maintain engagement.
• Design meetings with clear objectives and decision points so participants can see how their contributions influence implementation efforts.
• Clearly communicate when changes are made in response to partner feedback to demonstrate that participation influences decision-making.
• Demonstrate the value of participation by helping partners understand how CHIP activities support their organizational goals and priorities.
• Celebrate successes and milestones to reinforce a shared accomplishment.
• Provide orientation materials and clearly defined roles and responsibilities so new participants can engage effectively and contribute with confidence.

In Wake County, leadership for the Live Well Wake initiative is shared among the Live Well Wake Action Team, which provides strategic guidance and high-level feedback, a steering committee that offers broad community input on priorities and engagement strategies, and workgroups that drive strategy development and implementation with community-based co-chairs supported by the health department. This structure creates multiple opportunities for partners to contribute while ensuring implementation remains community-driven.

Other jurisdictions demonstrated different approaches to sharing ownership. Harris County intentionally creates opportunities for external partners to present, share data, and lead activities during meetings, helping partners move from participants to leaders over time. Pima County emphasized recognizing community and government partners as leaders within their areas of expertise. These approaches reinforce the idea that partners’ sense of ownership grows when they have meaningful opportunities to contribute their expertise and leadership.

San Diego County offered another perspective on community ownership. Engaging with a consultant to facilitate regional updates every three to five years helps create additional buy-in because the plan feels more community-owned and less health department-driven. In this model, the health department participates as a resource and partner rather than serving as the sole designer of the final product. Similarly, San Diego County's five region-specific subplans emphasize regional autonomy and community leadership, allowing approaches to reflect local priorities and community context.

Across jurisdictions, the most successful ownership strategies created meaningful opportunities for partners to influence decisions, assume leadership roles, and see the impact of their contributions on implementation efforts over time.

Maintain Momentum Through Measurement and Communication

Interviewed jurisdictions emphasized that measurement and communication serve a purpose beyond reporting results. Communication maintains momentum, demonstrates accountability, reinforces the value of participation, and shows progress toward long-term goals that may take years to achieve. Staff described the importance of humanizing data, highlighting community contributions, maintaining transparency, and using realistic, iterative storytelling rather than polished, static narratives. Interviewees viewed regular meetings, reporting, and progress updates as important tools for keeping partners engaged and informed throughout implementation.

Measuring and communicating progress happened in several ways:

• Use a mix of dashboards, reports, newsletters, and visual tools to communicate progress to different audiences.
• Focus on a small number of meaningful measures rather than attempting to report everything at once. Harris County shows one metric in multiple ways to improve understanding.
• Highlight community contributions, partnership successes, and implementation milestones alongside quantitative measures.
• Create regular opportunities to share progress, gather feedback, and demonstrate how implementation efforts are evolving over time, like the six-month reporting timeline used by Pima County Health Department.
• Use communication tools to help partners understand the process and how they can contribute, such as the roadmap visualization The Road to a Healthier Harris County.

A common challenge across jurisdictions was balancing long-term outcomes, such as population health improvement, with the need to demonstrate short-term progress. Interviewees emphasized the importance of measuring both implementation activities and outcomes. Examples of short-term indicators included workgroup activity, partner engagement, communications reach, collaborative projects, and implementation milestones. Long-term indicators focused on population health outcomes identified through the community health assessment or community health needs assessment and other established health measures.

By measuring and communicating progress throughout implementation, jurisdictions can demonstrate that meaningful work is occurring even before population-level outcomes begin to change. This approach helps reinforce the value of continued participation in CHIP implementation efforts.

Looking Ahead

While each jurisdiction approached CHIP implementation differently, interviewees described a common shift toward more collaborative, transparent, and sustainable implementation practices. Rather than focusing solely on completing activities or prioritizing activities that the health department has ownership over so that the path to success is more controlled, jurisdictions are increasingly investing in the systems and relationships that support long-term success with cross-sector and community partners.

These approaches suggest that successful implementation depends on more than a well-written plan. It requires ongoing adaptation, shared ownership, clear communication, and a commitment to continuous improvement. As health departments continue to refine their implementation efforts, the experiences of Wake County, San Diego County, Pima County, and Harris County offer practical examples of how jurisdictions can move from planning to sustained action and impact.

Reviewed by Lindsey Myers, MPH, Vice President, Public Health Workforce & Infrastructure.