The New Jersey Department of Health plans to alter how it supports local public health offices by creating a regional assistance program with department liaisons assigned to work with counties and communities in the south, central and northern parts of the state.

Department officials said the initiative, funded through a five-year $80 million federal grant designed to strengthen public health infrastructure, is designed to improve communications with the more than 100 local offices and cut down on the time it takes for the state to respond to their questions.

“The program, with an emphasis on health equity, aims to strengthen the local health workforce and the public health services they provide to their communities,” said Dalya Ewais, the Health Department’s Director of Communications.

But several local health leaders have raised concerns about the plan, which they said won’t benefit their work. New Jersey’s municipal, county and regional health offices say their budgets and staff were stretched thin before COVID-19 emerged, and the pandemic exacerbated this strain. While these offices received tens of millions in federal COVID-19 emergency funding to help offset these new costs, that money will run dry this summer, they said.

“This problem isn’t going to be fixed by a regional advisor. The problem is money,” said Paul Roman, chair of the state Public Health Council and president of the New Jersey Local Boards of Health Association. “It’s not a communication problem, it’s a money problem.”

Details scarce

Chris Merkel, president of the New Jersey Association of County and City Health Officials and head of Monmouth County’s public health department, said some of his members have been briefed on the concept but have few details about the regional plan. “The (state) department is our partner and we will continue to work with them, but we don’t have much information,” he said.

Based on what the association has been told, Merkel said his members are not convinced this is the most “productive use” of the funds. “Our members are the experts in the state, and we would prefer the funding come directly to local health departments who really know their communities best and what they need to be successful,” he said.

New Jersey has received more than $48 billion in federal pandemic-relief funds since 2021, according to data compiled by the state comptroller, and more than $4.7 billion has gone to the state Health Department to fund vaccination clinics, long-term care operations and other needs. In November 2021, nearly $117 million of this was distributed to county and local health offices to support their pandemic response.

Several local health leaders have raised concerns about the plan, which they said won’t benefit their work. New Jersey’s municipal, county and regional health offices say their budgets and staff were stretched thin before COVID-19 emerged, and the pandemic exacerbated this strain.

COVID-19 revealed weaknesses in the public health safety net nationwide, as local offices struggled to keep pace with the need for vaccinations, testing and contact tracing, in addition to their other duties. The pandemic has since ebbed, but as of last week nearly 20,000 people were hospitalized with COVID-19 across the country, including some 650 in New Jersey.

To help address these needs, the federal Centers for Disease Control and Prevention set aside $3.5 billion for public health infrastructure grants. Last January New Jersey’s Health Department announced it had received more than $80 million from this fund, to be used over five years to bolster the public health workforce, improve program management and analytics, advance reproductive health and health equality in general and reduce outcome disparities.

Health opportunity knocks

Judy Persichilli, the health commissioner at the time, called it the “beginning of a very exciting new chapter” for the state. “We have a great opportunity to build a more resilient health department with a robust, well-trained workforce, a modernized infrastructure, and a stronger system for a healthier New Jersey. Everyone stands to benefit,” she said in announcing the new funding.

The federal Government Accounting Office highlighted the importance of this public health infrastructure in a November report, and the federal Centers for Disease Control and Prevention funding that has long sustained this work. But it also raised concerns about the temporary nature of the fund, which makes it hard to build a workforce and other infrastructure. “This pattern can make it hard for jurisdictions to invest in long-term sustainable efforts to prepare for future public health threats,” the report notes.

Local health officials in New Jersey were also encouraged by the CDC’s infrastructure grant, of which 40% was to be used to fund work at the county and municipal level, according to Roman, Merkel and others. But state health officials apparently had other ideas. “It’s not 40% of the dollars going directly to local public (health), it’s in support of local public health,” Persichilli told the Public Health Commission at their meeting in June. “So we will be strengthening our office of local public health and looking at regional focus to support the needs of local public health throughout the state,” she said.

The Health Department’s annual budget does include tens of millions in state and federal dollars that it distributes to local health offices to address HIV/AIDS, lead poisoning in children, tobacco smoking and other needs. But accessing this money involves a competitive grant process with applications that are beyond the capacity of some small departments, according to local officials.

Ewais, the communications director, said that while the regional liaison program will not provide direct funding to local departments, the state “continues to administer grants (to local departments) and will continue to explore additional opportunities for local health funding.”

Ewais said under the current structure, when local health offices need technical assistance they contact the state Health Department, which then identifies the best subject matter or program expert and puts them in touch. The regional system seeks to streamline this communications process. The department will be holding listening sessions during the first quarter of 2024, she said, and hopes to implement the program before July.