The delivery of efficient and effective daily health care and public health across the nation is essential for a successful response to, and recovery from, a major public health and medical incident. Consistent with the fundamental concepts spelled out in the National Health Security Strategy – released by the Department of Health and Human Service (HHS) in December 2009 – and the Whole Community approach introduced by the Federal Emergency Management Agency (FEMA) in the agency’s 2011-2014 Strategic Plan released in February 2011, optimal preparedness and response must be inclusive of a broad range of partners who maintain a high level of service excellence in their daily roles, which then enables their maximal participation in disaster response.
These partners include representatives of all levels of government, as well as many individual citizens, families, robust social networks, emergency management and response agencies, private sector entities, and medical and public health communities. Collectively, they serve as the building blocks of the foundation for healthy and resilient communities. A more effective response results from the participation of these partners when all entities understand their interdependent roles and are able to quickly transition from them into a coordinated and integrated response effort over the course of an incident. However, in an environment of increasingly constrained fiscal resources, fostering and maintaining truly integrated and scalable public health and health care response capacity across the nation challenges all of these partners in preparedness.
Multiple federal departments and agencies currently distribute grant or cooperative agreement funds, and/or provide technical assistance and national strategies, in support of various emergency preparedness activities. This funding is usually awarded to state, local, tribal, and territorial public health and health care entities, organizations, and jurisdictions to foster resiliency in public health and health care. As the national preparedness strategies evolve to address existing and emerging threats, the long-term sustainability of these significant preparedness investments requires that the nation as a whole more clearly demonstrate how those investments have increased capabilities and operational efficiencies, and improved coordination and integration among government agencies at all levels, as well as with all preparedness partners and the public.
Responsible Stewardship & the Reduction of Administrative Burdens To promote responsible stewardship of federal funds and reduce administrative burdens on awardees, several federal departments and agencies are cooperatively assessing current emergency preparedness grant programs. These federal departments and agencies have already begun toentify best practices, and innovatively streamline and coordinate the grants application, management, and reporting process. From HHS, this includes the Office of the Assistant Secretary for Preparedness and Response (ASPR), the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA); HHS is joined by FEMA from the Department of Homeland Security (DHS), and the National Highway Traffic Safety Agency (NHTSA) from the Department of Transportation (DOT). The funding from these federal partners have separate authorizations, appropriations, applications, reporting, and measurement requirements but the interagency partners feel it is critical to the future success of national preparedness to emphasize and support the importance of collaboration and integration in preparedness across all public and private response disciplines – starting with the federal government itself.
The overarching goal of the interagency partners is to acquire a full understanding of the processes, procedures, and systems that all of the other agencies and departments with public health and medical preparedness grants use to monitor and manage their grants and cooperative agreements, and to establish time benchmarks for alignment success in selected areas. Efforts to align the emergency preparedness grants, in conjunction with improved joint metrics, will offer a more clear return on federal investment and the opportunity to share a clear national preparedness success story with all stakeholders. In addition, these alignment efforts should enhance state and local customer service while reducing their administrative burden. Ultimately, the agencies participating in the grant alignment efforts hope to optimize the nation’s investments in public health and health care preparedness that are consistent with national strategies and priorities, and improve preparedness outcomes.
The interagency partners are currently in the process of signing a Memorandum of Understanding (MOU) that creates a standing interagency body that will meet regularly and work toentify and discuss opportunities for grant coordination. This interagency body will support a framework for the joint federal planning needed for streamlining the grant mechanisms and maximizing the efficiency of grant funds. The MOU will also facilitate creation of a common pathway for the joint review of policies, coordination of program timelines, coordination of grant administration, management, and reporting mechanisms,entification of mutual and complementary targets and functional capabilities, as well as joint evaluation and metrics.
These activities will be undertaken in a manner consistent with the applicable laws and missions of the respective agencies. All activities must meet the three cardinal tenets of the interagency grant alignment effort, which are to reduce awardee burden, create federal efficiencies, and advance preparedness. An inclusive stakeholder engagement plan is envisioned for all aspects of grant alignment.
________________________ Rear Admiral Clare Helminiak, MD, MPH, is Deputy Director for Medical Surge in the Office of Preparedness and Emergency Operations (OPEO), a component of the Office of the Assistant Secretary for Preparedness and Response (ASPR), in the U.S. Department of Health and Human Services (HHS). In that post, she is responsible for directing and coordinating medical surge through the supervision of three programs: the National Disaster Medical System (NDMS); the Hospital Preparedness Program (HPP); the Emergency Care Coordination Center (ECCC); and the Emergency System for the Advance Registration of Volunteer Health Professionals (ESAR-VHP).