Four Ways Public Health Agencies Are Strengthening Grants Management

February 24, 2026 | Colton Anderson, Kristin Sullivan

Strong financial and grants management is an important part of creating resilient public health infrastructure, yet managing grants in public health is rarely straightforward. Health departments must navigate federal and state requirements, shfits in funding, and persistent capacity constraints; all while continuing to deliver essential services to their communities.

At the same time, health departments seek to modernize outdated systems and move away from paper-based processes, introducing both opportunities and new complexities. Potential funding shortfalls further heighten the need for agencies to adapt how they manage public health grants to ensure efficiency. These challenges highlight why improving grants management remains a critical and complex priority for public health agencies.

Health departments are taking steps to strengthen how they manage their grant funds. While approaches vary based on agency size, structure, and resources, jurisdictions are using some common strategies.

Approaches to Improving Grants Management

Public health agencies are using several approaches to strengthen grants management:

• Reorganizing or centralizing grant management functions.
• Modernizing systems.
• Improving internal processes and oversight.
• Improving subrecipient management, oversight, and support. 

Each of these strategies addresses pain points, and some agencies are pursuing more than one approach simultaneously.

Reorganizing or Centralizing Grant Management Functions

One approach agencies are exploring is centralizing certain grant management functions to improve consistency, efficiency, and oversight. To support this work, ASTHO, with CDC funding, commissioned the development of the Grants Management Office Optimization (GMO) Toolkit in collaboration with V2A Consulting.

ASTHO designed the GMO Toolkit to help agencies assess their current grants management practices and evaluate whether they would benefit from centralizing those processes. It provides resources to help departments:

• Estimate the cost and value of centralizing grant functions.
• Evaluate workload and staffing needs.
• Identify where processes can be strengthened. 
• Inform decisions about how best to organize grant-related work.

Since 2022 and the inception of the Public Health Infrastructure Grant (PHIG), three organizations have implemented or piloted the toolkit. Puerto Rico Department of Health initially piloted the toolkit, which led to completion of a broader, agency-wide assessment.

Since then, two health departments piloted the toolkit. At the Illinois Department of Public Health, the agency’s performance improvement unit used the GMO Toolkit to examine whether the agency had sufficient structures and staffing to meet their needs. By mapping workload demand against staff capacity, Illinois validated areas of strength while also identifying opportunities to better align staff time with program needs and improve overall efficiency. In North Carolina, the department used the toolkit to collect a baseline assessment of how its programs managed their individual grants rather than pursuing centralization. The pilot helped clarify roles and responsibilities and supported conversations about how to sustain critical work in the event of funding reductions or grant discontinuation.

The Washington State Department of Health (DOH) is using a different, multi-year approach, although it used the GMO Toolkit to inform considerations for role clarification. In 2018, DOH centralized all financial support positions. With the subsequent influx of COVID funds, DOH sought to better support funding across programs and established a five-phased Funding Transformation Project to ensure agency priorities drive funding, and that equity, innovation, and engagement guide strategy, decisions, and outcomes. Phase 1 focused on aligning discretionary funding streams to agency priorities. Phase 2 focused on building leadership awareness and accountability of budgets and included a training, Budgeting for Non-financial Managers. In Phase 3, DOH addressed grants, including highlighting grant funding and aligning that funding with agency priorities with the following outcomes:

• Grant lifecycle process improvements.
• Improved determinations of subrecipient/contractor status.
• With PHIG investments, DOH established an agency-wide grants coordination team including a strategic investments manager, two grants coordinators, and two grant writers to support federal grant applications.
• Improved the clarity of staff’s roles in grant coordination and grant management.
• Ongoing engagement of administrative and programmatic teams to support organizational change management.

Modernizing Systems

Many agencies are strengthening grants management by modernizing the systems used to track, manage, and report on grants, contracts, and funding. Electronic grants management systems can streamline workflows, improve data accuracy, increase transparency, and support better coordination across teams. By replacing manual or paper processes, agencies can reduce administrative burden, improve compliance, and gain clearer visibility into how funds are utilized across the organization.

The U.S. Virgin Islands Department of Health undertook a multi-year, interagency improvement process to better organize and coordinate federal grant and financial set up processes across six health and human service agencies and several administrative agencies that touch federal grant approvals and spending. Improvements include moving from paper to electronic process using a new grants management system, updating and documenting procedures, and establishing an interagency community of practice for ongoing coordination and communication.

The Tennessee Department of Health’s Division of Administrative Services developed the Contract Tracking, Review, and Compliance (CTRAC) system. This centralized system is designed to streamline how it routes contracts through internal review and approval processes, providing real-time visibility into contract status, funding allocations, and compliance requirements across stakeholders and approval stages. CTRAC includes workflow management, funding and tracking, and invoice integration. It also serves as a central operational tool for contract management, supporting consistency, visibility, and oversight. Other agencies, such as the Iowa Department of Health and Human Services, use a Contract Lifecycle Management system that guides users through procurement pathways and supports contract execution and management. The Connecticut Department of Health built a custom Grants Management System using Microsoft Dynamics 365 and Power BI that streamlines workflows and enhances accountability and tracking across the grant and procurement lifecycle. By centralizing data and automating reporting, they can now track status in real time, ensure compliance through built-in validation and audit trails, generate dashboards on spending, identify timelines and bottlenecks, and standardize documentation and approvals.

The Wisconsin Division of Public Health is developing an application and reporting tool to replace an outdated grants and contracts system with the goals of supporting subgrantee processes and reporting, subrecipient monitoring functions, audit responsiveness, and provide executive level information to the agency and subrecipients. Through partner engagement, review of existing systems, and exploration of other grant management systems, Wisconsin is preparing to launch the tool, which is based on Smartsheet as an enterprise software.

Improving Internal Processes and Oversight

Not all grants management improvements require new systems or major structural changes. Many agencies are making meaningful progress by strengthening internal processes within their control, improving documentation, and clarifying roles within and across teams. These efforts often include mapping workflows, reducing redundancies, improving staff onboarding and training, and establishing clearer accountability.

With CDC funding, ASTHO supports up to three Overdose Data to Action recipients annually to streamline a process that contributes to efficient and effective spenddown of their federal award. Leveraging this support, the Massachusetts Department of Public Health worked to improve its Bureau of Substance Addiction Services’ internal procurement process, which was largely informal and inconsistently documented. And while standard operating procedures may exist at higher levels of an agency, how divisions or units employ those procedures is not always well defined. The Bureau identified goals to reduce waste, shift from crisis to strategic culture, and to identify areas for streamlining and efficiency gains. Participants mapped the current process, identified wastes and necessary improvements, and developed a process for an improved, future-state that included agreed-upon, formal standard operating procedures, staff training, and checklists and templates to reduce variation and errors.

The Maryland Department of Health utilized Overdose Data to Action technical assistance to review and improve its current procurement and contracting processes and then leveraged ASTHO’s Peer Assessment Program through PHIG technical assistance to help advance implementation through a two-day event that included facilitated discussions and prioritization of actions, identification of procurement best practices, and recommendations for next steps.

Improving Subrecipient Management, Oversight, and Support

Effective subrecipient monitoring is essential to ensuring accountability, compliance, and appropriate use of federal funds. Many agencies, like the Nebraska Department of Health and Human Services, are refining their approaches to meet an auditor’s standard. The Department created a monitoring team and to develop policy, guidance, and tools to improve the structure for subrecipient monitoring. This saved millions of dollars each year and reduced the large amount of time spent on questioned costs and appeals. They accessed tools shared by other states through ASTHO’s CFO and Financial Leaders Peer Network, including invoice documentation requirements and pre-award risk assessments. This informed the creation of a new suite of tools to enhance subrecipient monitoring and compliance.

Wisconsin is also modernizing its approach to supporting subrecipients by simplifying administrative processes and improving how funds move to local and tribal health departments. Strategies include centralizing burden at the state level, for example, by placing the work in a partnership-focused office, refining communications, and taking on procurement and purchasing authority decisions. The state also uses a streamlined regional granting model with a minimal selection process and designated fiscal hosts to move funds quickly and codesign projects closer to the point of service.

Lessons Learned

Across health agencies ASTHO engaged with, several common themes emerged:

• Clarity matters: Roles and responsibilities for grants management are often unclear or overlapping, leading to inefficiencies. Strong communication and collaboration among programmatic and administrative units are essential.
• Standardization: Lack of standardized procedures and documentation makes it harder to ensure compliance and efficiency.
• Technology: Outdated or manual systems slow routine tasks, limit transparency, and hinder interoperability and data-driven decision-making.
• Small changes add up: Incremental improvements, such as process standardization or targeted training, can yield big benefits.
• Managing change: A change management strategy that includes regular internal communications and partner engagement is critical for improvement and sustainability of effort.

Key Takeaways

Strong grants management is a key part of a health department’s infrastructure. By approaching grants management strategically, rather than just administratively, health departments can strengthen their operations and be better prepared to respond to changing public health priorities.

Requesting Additional Information

Jurisdictions interested in learning more about how to improve their grant management functions can visit the ASTHO State and Territorial Administrative Readiness Center or contact ASTHO at performanceimprovement@astho.org.