In March 2020, as the World Health Organization declared the COVID-19 outbreak a pandemic, local and tribal health departments across the nation braced for the hard decisions and immense workload ahead. Montana health departments were no different. While Montanans are fortunate to live against a backdrop of tremendous natural beauty, the state faces significant health challenges and inequities and has a public health system that accomplishes a great deal with limited funding and staff.
Montana’s local governmental public health system is decentralized, with 58 unique county, city-county, district, and tribal agencies providing a varying array of public health programs, services, and protections. The populations served by these agencies range from fewer than 1,000 residents to more than 160,000. Before the pandemic, it was estimated that more than half of the Montana local and tribal health departments employed fewer than five full-time equivalent staff, and only three employed more than 50. An estimated 74 percent of health departments had a total annual budget of $500,000 or less, six had a budget of $50,000 or less, and five had a total annual budget over $3 million. Given this range of fiscal capacity, there is wide variability in the level of preparedness among health departments to handle the COVID-19 response.
Before the pandemic, Montana had been exploring the idea of a public health institute. The Montana Healthcare Foundation funded a feasibility study and design process that involved partners from multiple sectors over nearly two years. The study highlighted opportunities to improve the public health system and identified services not currently provided in Montana a public health institute could provide. The draft plan outlined a pathway for Montana achieving the goal of an institute in late 2021 or 2022, but COVID-19 pushed that decision forward.
“The Montana Healthcare Foundation had been funding the work to create a new nonprofit public health institute when COVID-19 hit. We knew we had many counties and tribes with limited resources and staff that were now going to be responsible for testing, case investigations, contact tracing, quarantine, isolation, community education and so much more,” said Montana Healthcare Foundation CEO Dr. Aaron Wernham. “We consulted members of the public health institute design team, and all agreed it would make sense to accelerate the launch.” Wernham then approached his Board of Trustees, and the Board agreed to become the first funder of an institute.
The Montana Public Health Institute (MTPHI) was incorporated in April 2020, and the first staff member began work in mid-July. A 10-member Board of Directors leads MTPHI with representation from local, tribal and state public health agencies, academia, and behavioral health and healthcare partners. The Board was designed to ensure statewide geographic representation and representation across disciplines and from areas often under-represented, including tribal, rural, and frontier communities.
With the response of COVID-19 consuming much of the focus and capacity within the public health system, MTPHI’s first project was to partner with the Montana Department of Public Health and Human Services (DPHHS) to conduct key informant interviews with lead local public health officials (LLPHO). Interviews were attempted with the LLPHO in each of the 58 local and tribal jurisdictions and were completed with 40 jurisdictions (69 percent). Interview questions were designed using the appreciative inquiry theory of change, an evidence-based, strengths-focused framework intended to change conversations from gap analyses (the negative) to envisioning successful futures (the positive). Interview questions focused on the COVID-19 experience, related successes, factors that contributed to successes, and ways successes could be built upon.
MTPHI’s first product, based on data from the interviews, was a report that describes how health departments used the Coronavirus Relief Funds received through the State of Montana. Then, facilitated by MTPHI, representatives of statewide public health organizations (including DPHHS, MTPHI, Montana Public Health Association, Montana Association of Public Health Officials, Montana Healthcare Foundation, Montana Public Health Training Center, the University of Montana’s School of Public and Community Health Sciences and We Are Montana) developed a plan to address the needs identified in the interviews. The strategies, objectives, and activities are reviewed at weekly collaboration sessions among these organizations and continue to be adjusted and refined to meet the increasing and changing needs of the local and tribal public health system during the pandemic.
To implement the plan, MTPHI assembled a team of public health professionals to offer technical assistance to local and tribal health departments. The wide variety of services provided includes:
- Help with public information and communications,
- Adoption of COVID-19 related technology,
- Use of data and metrics,
- Documents to support communities and health department operations during the pandemic, and
- Mentorship and leadership support.
MTPHI is also working to support the increased need for behavioral health services. The institute is developing marketing materials for counseling services available to those impacted by COVID-19, facilitating a learning community of behavioral health crisis coordinators, and providing programmatic support to communities working to strengthen local and statewide behavioral health crisis systems.
MTPHI will continue to support local and tribal public health agencies, healthcare and behavioral health system partners, and community-based organizations to deliver effective public health programs and services well beyond the pandemic, including:
- Leveraging funding and re-granting to communities to support health and system improvements,
- Providing backbone administrative support for public health and other community-based organizations,
- Convening and supporting multi-sector health improvement initiatives, and
- Monitoring the public health system to continue to identify and address specific capacity needs.
“I had the honor to be part of the design team for the Montana Public Health Institute,” said Matt Kelley, Gallatin City-County Health Officer and MTPHI Board Chair. “As part of the design process, we visited with public health institutes across the nation. We heard many of their origin stories. Each had a unique origin story. The MTPHI origin story will always be tied to the COVID-19 pandemic, and we intend to make the organization a positive legacy born from the largest public health crisis of our lives.”
For additional information, visit mtphi.org.