Genesee and Orleans County Cross Jurisdictional Sharing Project (GO Health)
Need: Two rural upstate New York counties struggled to provide necessary public health leadership and services amid a fluid environment with rising costs and funding limitations.
Intervention: The Genesee County and Orleans County health departments began a cross jurisdictional sharing relationship that integrated select functions and services, beginning with sharing a director and deputy director.
Results: By sharing personnel and functions, management personnel costs have been cut in half and both counties have saved over $1 million for the counties combined.
The state of New York passed legislation in 2011
that allows up to 3 county public health offices in
counties with a combined population of less than 150,000
to share staff and services under the management of one
public health director.
Genesee County and Orleans
County, two rural counties in western New York, were
struggling to provide mandated public health services
while facing budget restraints. In 2012, they entered a
2-year pilot project to study the feasibility of
combining some of their public health functions in order
to save money and work more collaboratively.
The aim of their Genesee and Orleans County Cross
Jurisdictional Sharing Project (GO Health) is to work
collaboratively while maintaining two distinctive health
departments with shared leadership and integrated service
delivery. Both departments are governed by their
respective legislatures and boards of health. Under the
agreement, they share the following personnel:
Public health director
Environmental health director
Community health services director
Emergency preparedness coordinator
Emergency preparedness assistant
Field staff as needed
Since 2015, the two counties have shared a commonly
appointed Board of Health. The counties also contract
together for medical and environmental engineering
consulting, share an early childhood transportation
provider, and share additional purchasing in some
programs. GO Health has developed common policies and fee
schedules for their community, environmental health
programs, and a common sanitary code for both counties.
Their joint community health assessment and community
health improvement plan (CHA/CHIP) will be used in
preparation for national accreditation.
By combining some resources, functions, and staff in
their health departments, the two counties
share services that enhance their role as public
health facilitators and educators in their respective
Public health education
Environmental engineering consulting
Community messaging and public information
Early childhood transportation
Sanitation and environmental health facility
Seasonal farm workers outreach program
Telehealth activities for Tuberculosis control
As a result of this collaboration, the 2 counties have
had a combined savings of over $1 million. In addition to
cost savings, the arrangement has helped the counties
identify and reduce duplications in tasks. Having just
completed 5 years of this arrangement, they have entered
into a long-term intermunicipal agreement extending CJS
sharing through 2020. Other results include:
Genesee County now pays only half as much for its
environmental health director (Orleans County previously
had no environmental health director).
Orleans County now pays less for medical,
environmental engineering, and transportation consultants
by joining Genesee County's contract for these services.
Savings have been achieved through process and policy
improvements, such as developing common policies and fee
schedules for septic inspections that allow sharing
sanitarians in both counties.
Additional savings have resulted from reduced staff
time costs when one staffer represents both health
departments at local, regional, or state meetings.
Administrative efficiency has increased: staff
meetings have been reduced to once a month, communication
is more streamlined, and goals more easily met.
Sharing staff and resources has aligned policies,
procedures, and the 2 public health office cultures. GO
Health has shared competencies and expertise across the 2
GO Health has become the single point of contact for
the 2 counties' healthcare providers and health systems.
Received approval for a public health associate from
the Center for Disease Control to participate in the
program's operations for 2 years. A joint county
application gave GO Health an advantage to being chosen
as a host site.
The GO Health director and deputy
director are participants in the
Kresge Foundation Emerging Leaders in Public Health
fellowship, a national program that is looking at role
transformation with a focus on cross jurisdictional
telehealth to improve access to care.
For more information about the program:
Bedard, B. A., Younge, M., Pettit, P., Mendoza, M.
(2017). Using Telemedicine for Tuberculosis Care
Management: a Three County Inter-Municipal Approach.
When first combining public health units, anxiety
levels were high among existing staffers who are
concerned that their positions may be cut if tasks become
shared and/or staff is integrated.
Although the state of New York allows public health
departments to combine services and share staff,
legislation still limits how far integration can go.
Managing 2 offices and 2 separate budgets has caused some
problems and restricted potential efficiencies that could
be realized with legislative changes.
New York law requires each county's public health
office to have their own board of health, but allows them
to be commonly appointed to the same board from each
county. GO Health created a common board that discusses
matters of both offices at one meeting and takes action
on behalf of both counties. A full merger of the boards
would allow for further efficiencies.
GO Health still lacks a synchronized information
technology (IT) system. Because each county's IT
department operated differently, it will take additional
time and effort to get the two synced.
Often, state funds administered to county services
can vary year to year. Through a CJS relationship, public
health units can leverage existing funds and cut down on
costs while delivering the same quality services to
Take adequate time to educate your boards and
legislators about the benefit of a CJS partnership. The
GO Health director spent a year talking with board
members and legislators and the state health department
about the benefits of a model like this.
Changing the culture by bringing 2 organizations and
counties together takes a methodical and thoughtful
approach, considering opportunities rather than forcing
change. Make sure staff have meetings in person together
and assign projects to staff from both offices, creating
opportunity for trusting relationships to grow.
An operation like this needs a strong buy-in from
both public health offices and communities. If one is
more committed than the other, the partnership will have
a much more difficult time thriving. Before combining
services, make sure commitment requirements and
expectations are clearly outlined.
Always be looking for new and innovative ways to
deliver public health services, especially in rural
areas. Prior to GO Health, Genesee and Orleans County had
multiple other joint projects and a collaborative
history, making the idea of a CJS partnership seem more
A successful partnership like this takes a leader who
has the interest of both public health offices and all
staff at the forefront of decisions and changes as well
as open communication with all staff, the board of
health, legislators, and stakeholders.
Combining services may free up funds to support
additional services. Be open to including new services,
for instance office of aging, a youth bureau, and mental
health, that would improve access for rural residents.
CSPHS contains research on best practices, case
studies, and toolkits for rural jurisdictions
considering or in the process of adopting CJS.
GO Health is one of the only public health cross
jurisdictional sharing project in the state. The public
health director regularly shares the model at state
conferences and encourages other counties to consider
Suggested citation: Rural Health Information Hub,
Genesee and Orleans County Cross Jurisdictional Sharing Project (GO Health) [online]. Rural Health Information Hub. Available at:
[Accessed 13 August 2022]
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.