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Public/Private Partnerships in Public Health – Lessons from MHRA

Public/Private Partnerships in Public Health – Lessons from MHRA. Ellen Rautenberg President & CEO Medical and Health Research Association of NYC, Inc. May 16, 2003. Bettering the Lives of All New Yorkers. Service  Research  Capacity Building  Advocacy.

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Public/Private Partnerships in Public Health – Lessons from MHRA

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  1. Public/Private Partnerships in Public Health – Lessons from MHRA Ellen Rautenberg President & CEO Medical and Health Research Association of NYC, Inc. May 16, 2003

  2. Bettering the Lives of All New Yorkers Service  Research  Capacity Building Advocacy Medical and Health Research Association of New York City, Inc.

  3. What is MHRA? • A Unique Public Health Resource in NYC • One of the Largest Non-Profits in NYC • Service Provider…Researcher/Evaluator… Contract Administrator…Technical Advisor…Advocate • Multidisciplinary program expertise coupled with sophisticated management services • Creative, flexible, accountable, objective, rapid response capability, and able to “go to scale”

  4. Our Original Mission: Established in 1957 as a 501(c)3 by NYC Health Commissioner Leona Baumgartner, to… “…assist in developing and increasing the facilities of the NYC Department of Health, other departments of the City and other institutions engaged in health research in New York City.”

  5. Our Mission Today MHRA is dedicated to improving the health of high-risk, underserved populations. It provides health and related services, conducts demonstration and research programs, and offers management services in order to improve community health and strengthen health policy. Working in partnership with government agencies, community organizations, and educational institutions, MHRA is committed to responding quickly and effectively to public health challenges.

  6. MHRA’s Critical Developmental Milestones: 1950’s - Established in 1957 as a “research foundation” by the NYC Department of Health. 1970’s - During the NYC fiscal crisis, the City DOH transferred two large service delivery programs to MHRA’s management: • Maternity Infant Care/Family Planning Projects (MIC-FPP) • Supplemental Nutrition Program for Women, Infants and Children (WIC)

  7. Developmental Milestones (cont’d): 1980’s – MHRA was asked by the State and City governments as well as local providers to begin re-granting some Title V and Title X funds. Later, Healthy Start, Tobacco Control, Healthy Heart and Asthma Surveillance were added to our re-granting portfolio 1990’s – At the initiation of Ryan White Title I in NYC, MHRA was asked to re-grant those funds.

  8. Developmental Milestones (cont’d): 1990’s - Increased work with community-based organizations led MHRA to develop two technical assistance programs: • information technology • organizational development with a focus on financial management

  9. Developmental Milestones (cont’d): 1990’s - A new strategic plan called for: • Initiative to “put the R (research) back in MHRA” • Revised governance plan • Greater attention to external communications and “branding” • Fundraising for unrestricted resources

  10. Developmental Milestones (cont’d): 2000’s – HIV prevention funding, both CDC and City Tax Levy, transferred to MHRA for re-granting. 2000’s – MHRA is asked by the City to serve as fiscal agent for emergency CDC bioterrorism funding.

  11. How We Grew… • From 56 employees in 1974 to more than 700 in the Year 2003 • From Research, to Direct Service Provider, to Re-granter, to Technical Assistance Provider, to Business Manager • In 2003, our annual budget is $194million.

  12. Number of Programs by Type Total Number of Projects = 75

  13. NYC Asthma Supplement3% ICHAP 4% MIC – Women’s Health Service 28% Central Office 7% Programs with < 8 FTEs (48) 11% EISC 14% Ryan White14% WIC 19% Staffing (FTE) by Program Total FTE = 755.57

  14. Program Areas by Revenue

  15. Revenue by Program Total Revenue = $194,078,100

  16. Funding Sources Total Funding: $194,078,100

  17. Is MHRA a Public Health Institute? • Created in 1957 as a PHI. • Since mid-70’s, the significant amount of direct delivery of public health services distinguishes it from a PHI. • Internally funded (through ICR) research, often tied to direct delivery of services, also distinguishes it from a PHI. • Work in collaboration with NYCDOH is one important “line of business” but there are others.

  18. MHRA Board of Directors The Board includes 3 ex. officio directors (who vote) and 22 elected directors. • The ex. officio directors are: • Commissioner of Health and Mental Hygiene • President of the NYC Health and Hospitals Corporation • NYC Chief Medical Examiner • The 22 elected directors are a mix of leaders in public health and health care practice, academia, civic affairs, and business.

  19. Core Organizational Structure

  20. Lessons from the MHRA Experience • Be flexible and creative • Think ahead – anticipate next PH challenge and $$ • Diversify funding sources for stability and growth • Be excellent in both the program and management aspects of what you do • Be able to respond quickly to new opportunities • Develop and nurture partnerships

  21. Partnerships = Be a Pretzel! Working relationships and business arrangements with DOHMH vary widely. For example: • Bioterrorism – Appointed as fiscal agent by NYCDOH to accept the CDC funds on behalf of the City. Arrangement includes a large MHRA contract to NYCDOH for all PS while MHRA does contracting, purchasing, and recruiting. • Ryan White – In 1991, because of “emergency” need for the funding, MHRA was given a sole source City contract. It has since been successful in two RFP competitions.

  22. Partnerships (cont’d) • All Kids Count (immunization registry) – Original grants (CDC and RWJ) received and work carried out by MHRA. The registry itself then transferred to NYCDOH. MHRA then awarded two competitive bids to do the physician outreach and training for registry. • Early Intervention – With grant funds, MHRA initiated establishment of citywide early intervention service coordination program for NYCDOH. MHRA is now reimbursed on a fee-for-service basis as do other EI providers who offer this service.

  23. Partnerships (cont’d) • Our partnerships with non-governmental partners are wide-ranging and highly varied. Some examples are: • Performance Measures in Family Planning • Bushwick Bright Start • Behavioral Science Training Program • CHAIN Study • And lots of grants/contracts with NYSDOH

  24. Concluding Thoughts • Relationships with government can be complicated and the dynamics change over time. • Must weigh actualizing the freedom of being an independent nonprofit vs. paralleling government requirements and structures. • Must weigh growing the intellectual capital within the nonprofit vs. symbiotic relationship with government. • Because of relationship to government, organizational identity is often confusing.

  25. For additional information about MHRA check our website: www.mhra.org

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