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Strengthening Public Health Workforce Capacity in Island Jurisdictions

March 17, 2026 | A.C. Rothenbuecher, Allison Budzinski, Marta McMillion, Melissa Sever

Decorative.Strategic workforce planning helps public health agencies stay prepared, attract and retain the right talent, and build flexible systems that can handle change. When done well, it leads to better services, stronger performance, and a healthier work environment. It also saves money by reducing turnover and helps agencies respond to health emergencies or challenges as they arise.

A Learning Collaborative Approach

For U.S territories and freely associated states, where geography, connectivity, and resources pose unique challenges, strategic planning is especially important. With support from the Public Health Infrastructure Grant (PHIG), the Association of State and Territorial Health Officials (ASTHO) and the Public Health Accreditation Board (PHAB) launched a nine-month Island-Centric Workforce Planning Learning Collaborative to offer support as island health departments strengthen their workforce planning efforts. This pilot included workforce teams from Guam’s Department of Public Health and Social Services and the Commonwealth of the Northern Mariana Island’s (CNMI) Commonwealth Healthcare Corporation, Division of Public Health Services.

The learning collaborative gave participating island health departments a chance to build on their strengths while getting tailored support for workforce planning. Through expert guidance, peer sharing, and coaching — both online and in person — participants worked through each step of ASTHO’s Workforce Planning Guide and explored essential workforce components aligned with PHAB’s Standards and Measures for Accreditation. The collaborative took a “start with what you have” approach, building on previous workforce planning efforts, existing data, and plans in both Guam and CNMI while leveraging resources from several national partners in the process.

From Resources to Results: Putting Workforce Tools to Work

Before the learning collaborative began, ASTHO, PHAB, and the University of Nebraska Medical Center (UNMC) teamed up to streamline and align their workforce planning resources. Early coordination ensured the tools complemented each other and avoided duplication.

The ASTHO Workforce Planning Guide served as the foundation, while PHAB’s Workforce Plan Template gave health departments a clear structure to build upon. UNMC’s Public Health Workforce Planning: A Practical Guide and workforce data from the de Beaumont Foundation’s Public Health Workforce Interests and Needs Survey (PH WINS) helped ground planning efforts with practical guidance for facilitators and up-to-date data reflecting current needs and priorities.

“For me, I like that we had an opportunity to meet as an overall group, and that we had the support. I like the fact that we were given a [point of contact] to work with closely, and ... it wasn't just during the time that we were on here. In between each meeting … we were in constant communication, and as soon as everybody started putting in parts within the template, she was already reviewing and making comments and giving us tips to things.”

– Island-Centric Workforce Planning Learning Collaborative Participant

Collaboration Across Islands: Sharing Challenges and Solutions

Over the course of the learning collaborative, Guam and CNMI’s public health teams built strong relationships by sharing challenges, exchanging ideas, and celebrating progress. Common issues like limited workforce capacity helped them relate to one another, while differences in structure and resources sparked creative solutions. The peer relationships and connections that were built and strengthened during the collaborative continue.

On-Site Support

ASTHO visited both jurisdictions to meet with leaders, review progress, and plan next steps — reinforcing the value of ongoing partnerships in workforce development. During the visits, participants revisited the Workforce Planning Cycle, layered in the latest PH WINS data, refined draft plan sections, clarified alignment with PHAB workforce standards, and considered the sustainability of their work beyond the collaborative. The hands-on sessions blended facilitation, coaching, and dedicated writing time, allowing participants to make measurable progress on their plans.

What Guam and CNMI Achieved

Through the learning collaborative, Guam and CNMI made meaningful progress in their strategic workforce planning efforts. Some near-term successes include:

  • Active Workforce Committees: Both jurisdictions formed or maintained dedicated teams to lead workforce planning efforts.
  • Steps Toward Accreditation: Each agency advanced efforts towards PHAB recognition related to a core domain, “Maintain a Competent Public Health Workforce.”
  • Smart Use of Data: Each agency used human resource, workforce, and PH WINS data to guide decisions and improve planning.
  • Stronger Capacity: Teams gained valuable skills and knowledge to support long-term workforce efforts.
  • Customized Action Plans: Each agency created tailored plans aligned with their unique goals and needs.

While Guam and CNMI achieved many similar milestones, each jurisdiction brought its own strengths and strategies to the table. Their different approaches offer valuable lessons for tailoring workforce planning and technical assistance to local needs. Guam emphasized structural development and broad departmental engagement, while CNMI leaned into data-driven decision-making and sustained leadership support.

“We had a template and a framework, but just having ASTHO help us through this process … a lot of the team members are fairly new to the process, so the technical assistance, the training, the guidance, and just helping us think through.”

– Island-Centric Workforce Planning Learning Collaborative Participant

What Other Jurisdictions Can Learn

The Island-Centric Workforce Learning Collaborative offers practical lessons for other jurisdictions focusing on workforce planning:

  • Start with leadership support and clear roles across teams.
  • Utilize and adapt existing tools and frameworks, like the PHAB Workforce Planning Template, the ASTHO Workforce Planning Guide, and UNMC’s Public Health Workforce Planning: A Practical Guide to jumpstart planning.
  • Request tailored coaching and technical assistance through national organizations such as ASTHO and PHAB.
  • Leverage workforce data, such as PH WINS, to inform decisions and progress.
  • Collaborate across partners to benefit from diverse expertise.
  • Celebrate your wins to build momentum and morale.

What’s Next for Workforce Development in CNMI and Guam

The success of the Island-Centric Workforce Learning Collaborative highlights what’s possible when public health agencies are supported with the right tools, partnerships, and local context. Guam and CNMI’s progress show that even in resource-limited settings, meaningful change is achievable.

Special thanks to ASTHO Island Support team members Dulce Mendoza, Senior Analyst and Alex Wheatley, Senior Director, as well as the University of Nebraska Medical Center College of Public Health staff Celeste Ehrenberg, MS, CHES, Performance Improvement Manager and Colleen Svoboda, MPH, Partnerships & Assessment Manager.

This work was supported by funds made available from the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS), National Center for STLT Public Health Infrastructure and Workforce, through OE22-2203: Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems grant. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.