Minnesota Streamlines Public Health Funding and Technical Assistance
October 21, 2024 | Melissa Touma, Andrea L. Lowe
The Public Health Infrastructure Grant (PHIG), which launched in November 2022, is a significant federal investment aimed at strengthening the nation’s public health systems. Requiring that state recipients distribute 40% of funds to local health departments, the grant ensures a direct and significant impact on local public health efforts aimed at protecting and improving community health. In addition, it provides significant flexibility to recipients in how and when they spend it.
The Minnesota Department of Health (MDH) navigated complex challenges of state procurement processes to allocate funds to Minnesota’s local health departments within four months of receiving PHIG funding. Two years into the grant period, the agency continues to support subrecipients with technical assistance, resources, tools, training, and more.
Streamlining PHIG Fund Distribution
Minnesota has a decentralized public health system, with 72 local health departments organized under 51 Community Health Boards (CHBs)—the legal governing authorities for local public health—and 11 tribal nations. CHBs set local health priorities based on assessments of community health needs, and partner with MDH to deliver public health services across the state efficiently. To streamline the grant funding process, MDH and CHBs enter a five-year, unfunded master grant contract to establish the legal foundation for subsequent grant project agreements. When a new grant opportunity becomes available for CHBs (e.g., PHIG), they enter a grant project agreement that references and incorporates the master grant contract.
This process has been well-established in Minnesota’s public health system for over 20 years. Ultimately, it enabled the state to quickly distribute PHIG funds to the local health agencies to address longstanding public health infrastructure needs and increase the size and skills of the public health workforce.
Nailing the Funding Formula
Minnesota received $55,324,263 from PHIG, with a commitment to distribute 40% of the funding directly to CHBs. To ensure fair distribution, MDH convened a small workgroup of local public health leaders to determine the formula for allocating funds to CHBs. They also advised MDH on grant duties as well as other grant aspects like technical support and reporting. The workgroup adapted the PHIG funding formula for state subrecipients as it reflected both community needs and population size. This structured approach included:
- A base allocation of $50k per entity.
- A county incentive of $5k per multi-county entity.
- Population-based funding based on population figures and Community Resilience Estimates.
MDH also allocated $1.5 million to tribal nations, with the goal of addressing health disparities and building capacity in these communities. This funding complements the CDC’s broader initiative “Strengthening Public Health Systems and Service in Indian Country,” which supports federally recognized American Indian/Alaska Native tribes and tribally designated organizations. Additionally, Minnesota maintains the Office of American Indian Health to provide ongoing support and technical assistance tailored to tribal health departments. The Office of American Indian Health distributed funds to tribal governments based on a non-competitive population-based formula.
Providing Support to Local and Tribal Subrecipients
Over the course of 45 years, MDH’s Community Health Division has built a robust infrastructure for supporting local health departments and building the capacity of the state’s public health system. When the Division received PHIG funding, it was well-positioned to leverage its existing partnerships, relationships with locals, and expertise in system transformation to support subrecipients with technical assistance activities to help them achieve their foundational capabilities and workforce goals.
For the eight Foundational Capabilities, locals and tribes can receive direct technical assistance from public health system consultants, participate in learning communities and communities of practice, and obtain capacity-building support to maintain or achieve national public health standards and measures. Additionally, resources, tools, and trainings are available through MDH and the Region V Public Health Training Center to advance the skills of the local public health workforce. Here is a snapshot of available opportunities for some of the Foundational Capabilities:
- Assessment and surveillance: A CHA-CHIP Community of Practice and customized support for the assessment and health improvement planning process.
- Community Partnership Development: Consultation on community engagement process design, facilitation of specific community engagement processes, and coaching for staff who support advisory groups and partnerships with external stakeholders.
- Equity: Consultation and support for partnerships with communities that experience health inequities and coaching on public health interventions that strengthen the capacity of communities to improve health.
- Organizational competencies: Strategic planning consultation and facilitation, orientations for new public health leaders, public health nurse residency for new graduates, and tools for exploring cross-jurisdictional sharing and governance.
- Accountability and performance management: An Accreditation Learning Community, access to quality improvement and problem-solving tools, support for conducting self-assessments against public health standards and quality improvement maturity assessments, and application of the customer focus in performance management.
Consultation and support are also available for communications, policy development and support, and emergency preparedness and response. Additionally, to facilitate the effective use of PHIG funds, simplify administrative processes, and provide clear guidance for managing funds, MDH developed a centralized CDC Federal Infrastructure Grant hub. This allows subrecipients to access invoice templates, reporting materials, recordings for informational webinars, and REDCap for streamlined biannual grant reporting and data submission. MDH also publishes yearly briefs that discuss activities, achievements, challenges, and success stories from each grant period year.
Leveraging PHIG at the Local, Tribal, and State Levels in Year 1
Local
“If not for this grant, the staff person’s FTE [full-time equivalent] would have been reduced, resulting in their resignation.”
—Local Subrecipient
In Minnesota, CHBs found that the flexibility of PHIG allowed them to matrix the funding alongside other funding mechanisms to best meet local needs. As a result, 40% of CHBs did not spend any grant funds in the first year, opting instead to use them later in the five-year grant period. For the 60% that chose to spend funding in the first year, most used funds to hire or sustain public health staff positions, support training, develop staff wellness and well-being programs, assess or implement recruitment and retention strategies, and build workforce capacity and infrastructure.
Tribal
Tribal nations utilized PHIG to support training the future workforce and retention of current staffing as well as gather employee input:
- Training activities include providing emergency medical services training to students and community health worker training to new community health workers.
- Staff retention efforts include providing hiring and retention bonuses, increasing staff availability, and expanding employee well-being programs to address burnout, work-life balance, and job satisfaction.
- Employee input centered around strategic planning, workplace, workforce initiatives, and conducting quality improvement activities.
State
Additionally, at the state level, MDH utilized PHIG to support locals and tribes with strategies and activities for public health system improvement and ongoing technical assistance, including:
- Sustaining its Office of American Indian Health.
- Hiring communications staff with a focus on rural communities.
- Convening a data advisory group that ensures the incorporation of local perspectives into the MDH data vision, roadmap, and modernization efforts.
- Providing data-focused technical assistance to local and tribal health departments.
- Planning the development and implementation of a public health data dashboard.
- Supporting partnerships through extending the regional health equity networks.
- Building relationships between public health, academic institutions, and workforce partners.
- Supporting training for local public health on Results Based Accountability and hiring additional staffing.
Conclusion
Ultimately, MDH’s ability to quickly disburse funding and support local health departments to meet their infrastructure goals is a result of a long-standing state-local partnership, existing funding mechanisms, and teams dedicated to supporting local and tribal health departments. These strategies will also be key to sustaining the advancements made throughout the state under PHIG investments. For more information about how MDH builds capacity and improves performance of Minnesota’s public health system, visit MDH’s Center for Public Health Practice Technical Assistance web page.
Special thanks to MDH for its contributions to this blog.
This work is 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.