Formula Grants Research Articles

The effects of anticipated funding changes on maternal and child health projects: a case study of uncertainty.

A questionnaire survey of Title V special projects--Maternal and Infant Care (M&I), Comprehensive Care for Children and Youth (C&Y), Neonatal Intensive Care and Children's Dental Care--indicated that the anticipated change from federal project grants to state formula grants caused anxiety among project directors, low morale and high turnover in project staff, difficulty in filling staff positions, and anticipation of service reductions. These effects were much more prevalent and severe in projects which could realistically be expected to suffer budget cuts as a result of the shift in funding method. Despite the widespread anxiety, low morale and adverse effects reported by program directors, there was no reduction in the number of patients served, the scope of services offered, or the number of staff employed.

Congress Votes `Yes' on Health Services Bill; Family Planning Legislation Extended to FY 1977

Congress overrode the Presidents veto of the Health Revenue Sharing and Health Services Bill (S.66) the omnibus bill authorizing 6 health services programs including family and population research through June 30 1977. Title 2 of S.66 retains virtually all of the essential features of the Family Planning Services and Population Research Act of 1970. S.66 extends the requirements another 5 years and stipulates that the Department of Health Education and Welfare must maintain a systematic reporting system. The original act also authorized funds support 5 different types of family and population research activities: 1) project grants and contracts the provision of family services by public and/or private nonprofit organizations; 2) formula grants the states planning establishing monitoring coordinating and evaluating family services; 3) grants and contracts the training of the personnel necessary to carry out family service programs; 4) grants and contracts for family and population growth information; and 5) grants and contracts population and human reproduction research and research training. All except the formula program grants state health agencies that the administration has consistently refused fund are continued by the new law 2 more years. S.66 requires that the Secretary of DHEW in promulgating definitions of low income must do this so as ensure that economic status shall not be a deterrent participation in the programs assisted under this Title. S.66 has added language that reiterates the policy of providing a variety of medically approved family methods which include the rhythm method. Reviewed here along with patient income and access services and scope of services are consolidation and the rights of project applicants voluntary participation research funding policies and federal matching share.

State Administration and Financing of Family Planning Services

A 1971 survey by the Center for Family Planning Program Development consisted of a questionnaire mailed to health and welfare directors in 50 states and 5 federal jurisdictions concerning their family planning policies and administrative practices. 52 agencies responded; Guam, Mississippi, and Louisiana did not. The major funding for state health agencies was allocated by HEW and by maternal and child health (MCH) formula grants under Title 5 of the Social Security Act. 11 states made additional expenditures of $1.7 million for a variety of purposes. 21 states required local welfare departments to purchase services under the Medicaid program established by Title 19 of the Social Security Act. Administration was assigned to specific organizations within the state health agencies. 31 states reported a total of 128 full-time professional personnel, with 90 assigned at state headquarters level. In general, on a state-by-state basis, the full-time staff does not correspond to the size of the appropriations. Survey findings were useful measures of resource commitments to family planning services by state health and welfare agencies and provided data on future levels of resource requirements.

Formula grants to schools of public health.

The Editor is pleased to find a dean of a school of public health willing to present so forthrightly the problems now facing educators of public health personnel.

Federal Support of Schools of Public Health

T HE UNITED STATES has 12 accredited schools of public health, 6 public and 6 private. Each is part of a university that operates a medical school. The six public schools are at the Universities of California at Berkeley and Los Angeles and the Universities of Michigan, Minnesota, North Carolina, and Puerto Rico>. The six private school's are at Columbia, Harvard, Johns Hopkins, Pittsburgh, Tul,ane, and Yale Universities. All six of the private schools were included in this study but only five of the public schools. The school of public health of the University of California, Los Angeles, was not included because it first became a separate, accredited school during the period covered by this study and its sources of support were not comparable to those of the other schools. Schools of public he.alth have a unique public service function in that their major responsibility is to give advanced training to physicians, nurses, and other health workers who are preparing for or are engaged in public service in Federal, State, and local health agencies, or in public health services in other countries. Since the number of schools is so small, each of the 12 accredited schools has a regional, or indeed a national, role. In addition to training students for work in many geographic areas', the schools through their faculties perform a variety of advisory and service functions for public healtl and related agencies. Enrollment in the schools of public health has increased substantially in the past 4 years. Between 1957 and 1961 enrollment increased by 13 percent, with a rise in graduate enrollment of 28 percent. Despite this increase, however, output of the schools falls far short of meeting the demand for trained public health workers. As new areas of public health responsibility emerge, the problem of providing adequate training to meet the manifest public need increases in urgency. The major teaching emphasis and operational cost in these schools relate to graduate education of professional personnel-the most costly level of education. In 1961 the 11 schools in full operation had 1,257 full-time equivalent graduate and special students, of whom 751, or 60 percent, were federally sponsored (table 1). Two part-time students are counted as equivalent to one full-time student. The figure 1,257 was derived from the total of 1,489 full-time and part-time graduate and special students reported by the schools of public health and is very close to the number of equivalent full-time students reported in computations for formula grants from the Public Health Service. Seven percent of the graduate and special students were sponsored by international agencies and foreign governments. These proportions were much the same in the public and private schools. In addition to the training of graduate students, the five public schools provide undergraduate training which is largely public health training for nurses. About a quarter of the undergraduate students were federally sponsored. Of the total enrollment, 52 percent were sponsored by Mrs. West is chief of the Health Service Requirements Branch, Division of Public Health Methods, Public Health Service. Dr. Gooch and Miss Raup are members of the staff of that branch. Data on students and sources of funds were obtained from the schools of public health in November 1961 by means of a mailed questionnaire.