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  1. Watts, Theresa MPH, RN
  2. Zahner, Susan DrPH, RN
  3. Mrochek, Tracy MPA, RN


Background: Cross-jurisdictional sharing is a resource management strategy increasingly being used by local health departments to provide essential and mandated public health services. Cross-jurisdictional shared service agreements (CJSSAs) are the legal documents that govern cross-jurisdictional sharing arrangements. Information on the financial and legal characteristics of CJSSAs is limited.


Objective: This study described the financial and legal elements of a set of formal, written CJSSAs in one state to offer guidance to practitioners on how to structure the financial and legal elements in CJSSAs.


Design: CJSSAs, which included a written statement about the financial commitment governed by the agreement (n = 63), were analyzed. Data collection occurred through 2 structured data extraction tools and structured telephone interviews conducted with local and tribal health department directors. Descriptive statistics of all variables and a single predictor linear regression were performed.


Results: The higher population partner to the CJSSA more often provided the public health service and received payment (n = 41; 65%). Financial statements were found to vary by CJSSA characteristic. CJSSAs were more likely to be legally complete when a legal counsel was involved in creating them (odds ratio = 2.74; 95% confidence interval, 2.19-3.29; P <= .001). Yet, only 2 (3%) of the CJSSAs described all the legal elements and were considered legally complete.


Conclusion: Clearly identifying and including necessary fiscal and legal elements when creating and managing CJSSAs may strengthen agreements and reduce local health department legal and fiscal vulnerabilities. Local health department capacity for planning, coordination, budgeting, management, and evaluation is essential when creating CJSSA. Careful consideration of cost-sharing and consulting with legal counsel could strengthen the CJSSA.