Regional Strategy

The primary finding from the case studies is that a regional strategy can be effective in managing resources for bioterrorism preparedness. Funding from federal agencies to state and local public health agencies has generally been allocated on a per capita basis. Certain portions of funding can be used centrally to establish region-wide capabilities and capacities ( e.g, epidemiology).  This can be more effective than using a population-driven formula for distribution of funds, which leaves rural counties with deficiencies in essential services. 

The Public Health Director of Region 8 elected to withhold certain portions of the CDC funds that, by the per capita funding formula, would have been allocated to the individual counties.  He did this in order to provide for "essential services" at the regional level that the individual counties could not have purchased with their distributed shares of the region's money.  The regional Director used a "proportionality approach" to allocate the CDC funds.  He required each county to submit a plan for bioterrorism preparedness.  He considered communicable disease control a central component of planning.  If a county included at least some planning for communicable disease control, that county was funded at 66% of the funds that would have been allocated on a per capita basis.  If the county had little or no communicable disease control in the plan, the county was funded at 50%.  Only the metropolitan area of San Antonio needed and included a full-time epidemiologist for communicable disease control in the planning.   San Antonio was funded at 100% of the per capita allocation. The Director held centrally the funds from the counties that were funded less than 100%, and he used those funds to provide essential services for several counties that, separately, would not have been able to provide for themselves. In his own words, "  As we developed regional capacities based on the counties' populations, we spent proportionally on each of their capacities.  So we could go back to those county judges in charge of public health and say, "Well, proportionately your share of the training and education focus area was this much." One example of regional services is that the Director  employed an additional epidemiologist in the Region office to serve several counties' communicable disease needs.