Community Health Assessment and Improvement Planning

The fundamental purpose of public health is defined by three core functions: assessment, policy development and assurance. Community health assessments (CHAs) provide information for problem and asset identification and policy formulation, implementation, and evaluation. CHAs also help measure how well a public health system is fulfilling its assurance function.1,2

 A CHA should be part of an ongoing broader community health improvement process. A community health improvement process uses CHA data to identify priority issues, develop and implement strategies for action, and establish accountability to ensure measurable health improvement, which are often outlined in the form of a community health improvement plan (CHIP).A community health improvement process looks outside of the performance of an individual organization serving a specific segment of a community to the way in which the activities of many organizations contribute to community health improvement.3

A variety of tools and processes may be used to conduct a community health improvement process; the essential ingredients are community engagement and collaborative participation. Below you will find a description of the steps in a CHA/CHIP, and links to additional resources for each of the six steps.2

[1] Public Health Accreditation Board. Accessed 12/23/10 at http://archive.constantcontact.com/fs030/1102084465533/archive/1103695445388.html#LETTER.BLOCK21  

[2] Institute of Medicine of the National Academies. (2003) The Future of the Public's Health in the 21st Century. Washington, DC: The National Academies Press. 

[3] Durch J.S., Bailey L.A., & Stoto M.A. (1997). Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: National Academy Press. 

Public Health Infrastructure

Healthy People 2020 and SDOH

Find Healthy People 2020 and Social Determinants of Health Resources

Public Health Infrastructure

Healthy People 2020 and SDOH

Public Health Infrastructure

Mobilizing for Action through Planning and Partnerships

MAPP is a community-driven strategic planning initiative. Find resources like the MAPP Handbook here

Public Health Infrastructure

Mobilizing for Action through Planning and Partnerships

Organizing and Engaging Partners

The first steps of a CHA/CHIP process involve two critical and interrelated activities: organizing the planning process and developing the planning partnership. The purpose of this phase is to structure a planning process that builds commitment, engages participants as active partners, uses participants' time well, and results in a plan that can be realistically implemented. This is the first phase of the MAPP process.

Visioning 

Visioning guides the community through a collaborative process that leads to a shared community vision and common values.

Vision and values statements provide focus, purpose, and direction to a CHA/CHIP process so that participants collectively achieve a shared vision for the future. A shared community vision provides an overarching goal for the community—a statement of what the ideal future looks like. Values are the fundamental principles and beliefs that guide a community-driven planning process.

Visioning is ideally conducted at the beginning of the CHA/CHIP process, as it offers a useful mechanism for convening the community and building enthusiasm for the process, setting the stage for planning, and providing a common framework throughout subsequent phases. This is the second phase of the MAPP process.

Collecting and analyzing data

Collecting comprehensive data about a community is essential to understanding the health status and contributing and root causes that affect the local public health system and the community.   This is the third phase of the MAPP process.  Phase 3 contains four distinct assessments: the Community Themes and Strengths, Local Public Health System, Forces of Change, and Community Health Status Assessments.

Each assessment yields important information for improving community health, but the value of the four MAPP Assessments is multiplied by considering the findings as a whole. Disregarding any of the assessments will leave participants with an incomplete understanding of the factors that affect the local public health system and the health of the community.

Identifying and prioritizing strategic issues

During this step, participants use data to develop and prioritize a list of issues facing the community. Strategic issues are identified by exploring the convergence of the results of the data collection efforts, such as through the four MAPP Assessments, and determining how those issues affect the achievement of the shared vision. This is the fourth phase of the MAPP process.

Developing Goals, Strategies, and an Action Plan

During this step, participants take the strategic issues identified and formulate goals, strategies and an action plan related to those issues. The result is the development and adoption of an interrelated set of strategy statements and a plan of action including activities, timeframes, responsibility parties, and performance measures. This is the fifth phase of the MAPP Process.

Taking and Sustaining Action

The Action Cycle links three activities—Planning, Implementation, and Evaluation. Each of these activities builds upon the others in a continuous and interactive manner. This is the sixth phase of the MAPP process - While the Action Cycle is the final phase of MAPP, it is by no means the "end" of the process.

During this phase, the efforts of the previous phases begin to produce results, as the local public health system develops and implements an action plan for addressing priority goals and objectives. This is also one of the most challenging phases, as it may be difficult to sustain the process and continue implementation over time.

Models and frameworks

  • CDC Assessment and planning frameworks: CDC identifies common elements of assessment and planning frameworks and provides information about commonly used frameworks
  • Mobilizing for Action Through Planning and Partnerships: Mobilizing for Action through Planning and Partnerships (MAPP) is a community-driven planning process for improving community health. Facilitated by public health leaders, this framework helps communities apply strategic thinking to prioritize public health issues and identify resources to address them. MAPP is not an agency-focused assessment process; rather, it is an interactive process that can improve the efficiency, effectiveness, and ultimately the performance of local public health systems.
  • The Association for Community Health Improvement (ACHI) Community Health Assessment Toolkit: The ACHI Toolkit is a guide for planning, leading and using community health needs assessments to better understand -- and ultimately improve -- the health of communities. It presents a suggested assessment framework from beginning to end in six steps, and provides practical guidance drawn from experienced professionals and a variety of proven tools.
  • New York State DOH Community Health Assessment Development Page: The NYSDOH has identified 10 steps in the CHA development process by using planning models and frameworks. This website contains descriptions of the 10 steps along with actions and checklists for each.
  • Community Tool Box, Chapter Three: Assessing Community Needs and Resources: The Community Tool Box, created by the Work Group for Community Health and Development at the University of Kansas, provides information on how to build healthier and more equitable communities. Chapter Three of the tool box ("Assessing Community Needs and Resources") provides practical, step-by-step guidance on how to embark on the community health assessment process.
  • Guide and Template for Comprehensive Health Improvement Planning, Version 2.1: This guide, created by the Connecticut Department of Public Health, Planning and Workforce Development Section, provides a framework for the development of health improvement plans through approaches that are logical, systematic, and based on historically successful planning initiatives, and is easily adaptable for use by other governmental and community organizations.

Guidance on working with models and frameworks:

  • Community Health Improvement Process Models and Frameworks - Use this worksheet to ensure your community health improvement process considers certain aspects of a community health improvement process, regardless of your model/framework.
  • Training Presentation: Introduction to Models/Frameworks - Click here to access the presentation slides
  • Webinar Recording: Community Health Improvement Process Models/Frameworks: Finalizing Your Decisions and Considering Modifications - This two hour webinar includes information on how to critically reflect on the fit of a chosen model/framework to a particular community's situation, how to capitalize on strengths and address limitations of models/frameworks, and more. Watch the free archived recording of this webinar and Access the presentation slides.

NACCHO funded 12 local health department demonstration sites to engage in a robust community health improvement process that yielded: a community health assessment (CHA) and a community health improvement plan (CHIP).

Key features of this work included:

  1. Engaging community members and local public health system partners in a meaningful way; 
  2. Addressing the social determinants of health; and 
  3. Using quality improvement (QI) and quality planning techniques. Within the cohort of demonstration sites, NACCHO supported sites in completing several project-specific approaches, or collaborative models.

The CHAs and CHIPs below were developed by the 12 sites as a result of this project and serve as examples of high quality CHAs and CHIPs

Alachua County Health Department, FL

Austin/Travis County Health and Human Services Department, TX

Central Valley Health District, ND

East Central Kansas Public Health Coalition, KS

Gallatin City-County Health Department, MT

Healthy! Capital Counties, MI

Kittitas County Public Health Department, WA

New Orleans Health Department, LA

Norwalk Health Department, CT

Plumas County Public Health Agency, CA

San Francisco Department of Public Health, CA

Thomas Jefferson Health District, VA