The Milwaukee Health Department has an incomplete strategic plan, understaffed community outreach programs and needs to figure out the function and role of the Board of Health.
These are some of the concerns raised by the state Department of Health Services that generated headlines this month.
Here’s what you need to know:
Why this matters
The Department of Health Service’s review cites these concerns as a reason to delay recertifying the Milwaukee Health Department as a Level III department. This means the health department could lose valuable grant funding.
Marlaina Jackson, who has served as interim health commissioner since the departure of Jeanette Kowalik, said the exact dollar amount and programs that could be affected were not known.
She said she is confident the department will pass the review, as it will have 12 months to address the issues raised.
What are the concerns?
Reviewers from the Department of Health Services expressed concerns in three areas: the Milwaukee Health Department’s strategic plan, its implementation of the Community Health Assessment and Community Health Improvement Plan and the role and function of the Milwaukee Board of Health.
The strategic plan is a document meant to define how the Milwaukee Health Department will engage community stakeholders, establish standards and goals for itself and decide the vision for the department going forward over multiple years.
At the time of the review, the strategic plan was incomplete and had not been implemented. It was supposed to be drafted from July 2017 to November 2018. As of December 2019, it had not been completed.
Why is the plan incomplete?
The strategic plan, Jackson said, was incomplete at the time of the review due to leadership changes. Former Commissioner Kowalik was addressing systemic issues in the department and arranging for a major reorganization, Jackson said.
What about the community programs?
The Milwaukee Health Department is expected to conduct Community Health Assessments to collect data and information to determine health policies for the department.
A Community Health Assessment that ran from 2015 to 2016. determined that the department would create a Community Health Improvement Plan to address concerns found in the assessment.
The Community Health Improvement Program is designed to receive community input for health department operations and to engage stakeholders.
At the time of the review, the Department of Health Services found the program was understaffed, with one person in charge of it as of December 2019. The Community Health Improvement Program had also failed to launch, despite being slated to do so by 2017.
Officials during the review said the program had no organizational support until Kowalik became leader of the Milwaukee Health Department.
Since the review, the program has increased to having four staffers, which Jackson believes will be adequate for the review.
What’s the concern about Board of Health?
The Milwaukee Board of Health, a nine-member governing body that helps make policy decisions and advises the health department, was found to have an unclear role in the department’s operations at the time of the review.
The Board of Health, which was re-established in 2019 and had only held two meetings, has now had 11 meetings and its members have been integrated into the health department, Jackson said.
The review process
The review originally took place in December 2019, but the Milwaukee Health Department received preliminary feedback from the Department of Health Services in January. A letter from the department acknowledged that a long time had elapsed since the review and some concerns might have already been addressed.
In addition, in-person site visits and reviews were suspended from March to September to focus on the COVID-19 pandemic.
During the review, which is called DHS 140, officials from the Department of Health Services conduct site visits, interview staff and review operations of local health departments to determine if standards are being met. The review is held every five years.
What are the three levels?
Health departments fall into one of three levels. Level I and Level II health departments serve smaller communities, therefore receiving fewer resources.
Milwaukee was designated as a Level III health department during previous reviews.
Level III health departments are the largest in the state. According to Elizabeth Goodsitt, a spokeswoman for the Department of Health Services, there are 40 Level III health departments in Wisconsin.
Level III health departments are distinct because they serve as community health strategists, develop and advocate for policies to address social determinants of health and must have an environmental health plan, Goodsitt said in an email.
These requirements are determined by state law.
There are three potential outcomes for the department: It gets recertified at Level III, it loses its certification, or it is downgraded to a Level II health department. Lowering the health department’s level could jeopardize grant funding.
What happens now?
The health department will need to finish the plan in order to receive its designation.
The Milwaukee Health Department has 60 days from Feb. 4th to submit a plan to address the concerns, according to the letter from the Department of Health Services. If the plan is approved, the health department will have a year to implement the changes.
The department will be expected to provide monthly updates and an “MHD liaison team” will be assigned, staffed by the Department of Health Services.
The health department will hold on to its Level III designation as long as it complies with state guidelines.
“I’m very comfortable that we’ll meet all the needs,” Jackson said.
Now that Kristen Johnson has been appointed health commissioner, Jackson will return to her previous role as deputy commissioner of community health in the department.
She said the department had more strengths in the review letter than concerns, including recognition for health equity and community engagement.
“Findings are routine, and we fix them,” Jackson said. “That’s what we do in health care.”