August 2008

Grant Results


Staff at the Association of State and Territorial Health Officials (ASTHO) and its Michigan-based subcontractor, TSI Consulting Partners, developed a program to train state health officials in strategic effectiveness skills. An emphasis on strategic effectiveness is designed to help state health officials articulate their vision for public health, gain acceptance for that vision, promote public support for public health and provide tools to measure results.

Key Results

  • Agencies from eight states contracted with ASTHO for strategic effectiveness services during the first year of the program. State health officials at each participating agency produced a new strategic map or plan to capture the vision for their agencies and the performance outcomes they would measure.
  • ASTHO produced a variety of marketing materials and branding tools in order to sustain its strategic effectiveness consultation service and generate revenue.

The Robert Wood Johnson Foundation (RWJF) supported this unsolicited project with two grants totaling $230,473 from June 2005 through October 2007.

 See Grant Detail & Contact Information
 Back to the Table of Contents


Enhancing the leadership capacity of state health officials is critical to improving the effectiveness and impact of public health activities. The project described in this report builds on the early experiences of the State Health Leadership Initiative, an RWJF national program, launched in 2007 and designed to build that capacity. This initiative is housed at the Association of State and Territorial Health Officials (ASTHO).

Shortly before this grant, ASTHO began developing a peer consultation service to help meet the needs of current state health officials and their senior staff. Based on frequent requests from the states for technical assistance in strategic planning, ASTHO chose strategic effectiveness as the first component of its new consultation service.

Strategic effectiveness skills can help state health officials define and communicate their vision for public health, obtain rapid understanding and acceptance of that vision, promote public awareness and support for the critical functions of public health and provide effective instruments to ensure accountability and to measure results.

 Back to the Table of Contents


The primary goals of the project were:

  • To train former state health officials in the process of increasing strategic effectiveness. ASTHO subcontracted with TSI Consulting Partners, a Michigan-based consulting firm, to provide that training.
  • To engage these newly trained individuals in consulting about strategic effectiveness strategy with current health officials in as many as six states.
  • To offer scholarships and discounts as incentives to the first six states to participate in the process.
  • To create a self-sustaining capacity at ASTHO to offer consultation on building strategic effectiveness.

RWJF provided a supplemental grant (ID# 059231) to support ASTHO's efforts to sustain its consultation service by developing marketing and branding tools and Web-based materials to help train new consultants.

 Back to the Table of Contents


Project staff reported the following results to RWJF:

  • ASTHO recruited four former state health officials to serve as strategic effectiveness consultants. After a two-day training session led by TSI, they participated in field experiences in which they first observed and then assisted states in formulating and implementing strategic effectiveness processes.
  • Eight state health agencies contracted with ASTHO to receive strategic effectiveness consultation services during the first year of the project. ASTHO priced the strategic effectiveness consultation contract at $24,500 but awarded discount incentives of $10,000 to the first six states to sign up (Alaska, California, Michigan, Minnesota, North Dakota and Oklahoma). Pennsylvania and Tennessee participated without incentives.
  • Guided by ASTHO consultants, senior staff members at each participating state health agency produced a new strategic map or plan to capture the vision for their agency or for an agency program. The strategic map was a useful way to enhance communication and to ensure accountability because it included performance outcomes and time lines. According to the project director, understanding the concept of strategic effectiveness offered staff members "a tool to look at their jobs as something broader than running a program."
  • ASTHO staff produced a variety of marketing materials and branding tools in order to sustain its strategic effectiveness consultation service and generate revenue for the organization. ASTHO recognized that it needed to increase the volume of consultations it was providing in order to continue the project. To market the project, staff produced a print brochure, an e-mail brochure and promotional videos.
  • ASTHO began developing tools to train consultants to offer strategic effectiveness services. These included a formal training protocol and a credentialing process to assure quality control over the consultation service.
  • The use of strategic effectiveness tools has helped participants identify other opportunities to strengthen public health leadership and develop collaborative activities. For example:
    • After completing its strategic effectiveness process, North Dakota created a coalition, which included the Office of the Governor, the state health department, Blue Cross/Blue Shield of North Dakota, the chamber of commerce and others, to explore cross-sector collaboration.
    • ASTHO brought together senior leaders of the Centers for Disease Control and Prevention, the National Association of County and City Health Officials and its own organization for a day-and-a-half session to explore ways to align the strategic effectiveness of the three organizations. The group remains active as "The Healthiest Nation Alliance" and has involved additional organizations, including the American Medical Association, AARP and the National Business Group on Health.

      "It was a very small investment for RWJF," said Paul Jarris, M.D., executive director of ASTHO and project director. "But the ripple effect has been quite amazing."

 Back to the Table of Contents


  1. State health officials have very little discretionary money in their budgets. It was difficult for most agencies to cobble together the funds for strategic effectiveness consultation services, even with a discount. Often, states have to employ competitive bidding processes before contracting for anything. (Report to RWJF)
  2. Efforts to increase strategic effectiveness shift leaders toward performance measures and outcomes. "A stronger outcome orientation, higher accountability and more effective measurement systems are now coming in behind the strategic effectiveness work," said the project director. (Project Director/Jarris)

 Back to the Table of Contents


ASTHO began licensing TSI to provide strategic effectiveness consultation services directly to the states, rather than training consultants to do so. Along with saving on training costs, this change reflects ASTHO's recognition that consultants did not always have the full range of skills necessary to deliver optimal training. "What appears to be 'natural' and 'simple' when observing gifted experienced consultants is, in fact, neither," according to an ASTHO report to RWJF.

TSI staff has conducted strategic effectiveness training in North Carolina, Arkansas and Ohio. ASTHO staff markets the program at all national and regional ASTHO meetings and is currently pursuing corporate sponsorship to make it self-sustaining.

ASTHO is working to ensure that strategic effectiveness skills become a required element of the voluntary accreditation process that the Public Health Accreditation Board established for state and local health departments in May 2007.

 Back to the Table of Contents



Improving and Marketing Strategic Effectiveness for State Public Health Agencies


Association of State and Territorial Health Officials (Arlington,  VA)

  • Improving Strategic Effectiveness for State Public Health Agencies
    Amount: $ 130,473
    Dates: June 2005 to June 2006
    ID#:  053327

  • Developing Branding and Marketing Tools To Improve Strategic Effectiveness for State Public Health Agencies
    Amount: $ 87,758
    Dates: November 2006 to October 2007
    ID#:  059231


Paul E. Jarris, Executive Director, Association of State and Territorial Health Officials, M.D., M.B.A.
(202) 371-9090

Web Site

 Back to the Table of Contents

Report prepared by: Nina Berlin
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: Pamela G. Russo

Most Requested