State and local collaboration is a critical element in restructuring the way public health is practiced in any state. In a state as diverse as Louisiana, the needs of specific communities cannot be approximated from the state level. Working closely with local partnerships allows for local community assets to be explored and utilized, assets that might not have otherwise come to the attention of the state partners. Thus, the Louisiana Turning Point Partnership has made extensive efforts to assure that there is local representation on all statewide committees and working groups.

However, the local Turning Point partnerships are not merely extensions of the state partnership, but rather independent entities with their own governance structure. This egalitarian organizational structure, as well as the resulting linkages created between the local and state partnerships, ensures that the local partnerships have a strong voice at the state level.

Local Partnership Are Represented at the State Level

Two representatives from each of the three local Turning Point partnerships serve on the state Turning Point Steering Committee, which brings the local perspective to state activities and ensures collaboration and coordination between state and local efforts. The Steering Committee guides the larger perspective of the Turning Point initiative statewide. B.J. Foch, Chair of the Southwest Louisiana Turning Point Partnership, comments that having representatives on the state Steering Committee allows the local partnerships to participate in setting the direction for, and monitoring the process of the state partnership.

Furthermore, a local liaison from each partnership serves on the planning group that is charged with overseeing the development of the statewide public health improvement plan. The local liaisons that serve on this committee are also involved in developing their own community's health improvement plans. Their participation on the statewide committee further allows for the inclusion of the local perspective in the state plan.

In order to develop a detailed, meaningful public health improvement plan, four statewide workgroups were established, with each workgroup focusing on one of four core functions of the public health system: prevention and health promotion; assurance ( e.g., access and quality); assessment (e.g., information and communication); and policy development. In addition, there is a marketing and communication advisory group that provides additional support to the workgroups. At least one representative from each of the local partnerships serves as a member of each group. This is especially critical since the workgroups dually focus on the assets of the community as well as on the needs of the community.

State Technical Assistance Complements Local Partnerships' Agendas

The state partnership offers guidance to the local partnerships in the development of their community health improvement plans by providing various forms of resources and technical assistance. For example, the Tools for Change program is a series of true working sessions addressing very specific topics, with technical assistance and tangible tools provided by nationally renowned consultants. The sessions do not rely on didactic presentations, but rather on active brainstorming and problem-solving. These sessions have become a forum for sharing ideas and learning from other partnerships, creating a true statewide learning community, where partnerships can build upon what others have learned. According to B.J. Foch, some of the most beneficial discussions held during the Tools for Change 1998 sessions included stakeholder identification, coalition governance, shared vision development, and systems change planning. Linda Holyfield, the Co-Chair of the Northeast Louisiana Regional Partnership for Community Health sums up the impact of the networking opportunities among the state and local partnerships: "Tools for Change has been the best opportunity to learn from and meet so many people involved in other local partnerships in the state."

Another resource that was fully appreciated by the Northeast Loiusiana Regional Partnership was the Turning Point Coalition Effectiveness Survey, a resource provided by the state partnership and conducted by Robert Goodman, Ph.D., from the Tulane School of Public Health and Tropical Medicine. This diagnostic tool allowed the Northeast Louisiana Regional Partnership to understand better the anatomy of its coalition and to establish a platform for aiding in the partnership's strategic planning process.

Furthermore, the state partnership holds technical assistance site visits in each of the local partnerships' regions. The topics for these site visits are determined by each local partnership, in response to their particular needs.

Successes to Date

As a result of these strong linkages between the state and local partnerships, the Louisiana Turning Point Partnership has experienced several successes to date.

• The collaboration between the state and local partnerships has resulted in the development of a statewide learning community and creation of dialogue among key stakeholders regarding the aforementioned core functions of the public health system. This is critical, since until now, there was very little collaboration or dialogue among different sectors that were working independently toward the common goal of positively impacting the public's health.

• In conjunction with the above success is the improvement in the communication and coordination between state and local public health efforts, particularly in health systems planning.

• The linkages between the state and local partnerships have resulted in the creation of new products and processes, such as a tool for assessing the capacity and competency of a community health system and a process for engaging public input into state and local health planning efforts.

• A proposal is in development for a Community Change curriculum for a four-state workforce development program based on the lessons learned from Turning Point.

• Collaborative efforts between the state and local partnerships have created the ability to attract and leverage additional funding for other health improvement efforts as a result of Turning Point and its successes to date.

As the Turning Point initiative evolves over time, it is becoming clear that there are no experts in this new and uncharted territory. Thus, it is ever more critical for intensive and extensive collaboration and dialogue among state and local partnerships. Everyone brings his or her own unique perspectives and experiences to the Turning Point initiative. The value of respecting these different perspectives lies in the fact that no sector, organization, or even health program exists in a vacuum - there is a strong need to collaborate, form coalitions and partnerships, share resources and ideas, and, crucially, not to duplicate efforts. In a time of budget restraints, being efficient and effective necessitates that public health, via the Turning Point initiative, must lead the way in changing how healthcare delivery is viewed and practiced.

Vaishali (Shelly) Mane is Program Coordinator of the state-level Turning Point partnership in Louisiana.