The Component Model of Infrastructure: A Practical Approach to Understanding Public Health Program Infrastructure

摘要

Functioning program infrastructure is necessary for achieving public health outcomes. It is what supports program capacity, implementation, and sustainability. The public health program infrastructure model presented in this article is grounded in data from a broader evaluation of 18 state tobacco control programs and previous work. The newly developed Component Model of Infrastructure (CMI) addresses the limitations of a previous model and contains 5 core components (multilevel leadership, managed resources, engaged data, responsive plans and planning, networked partnerships) and 3 supporting components (strategic understanding, operations, contextual influences). The CMI is a practical, implementation-focused model applicable across public health programs, enabling linkages to capacity, sustainability, and outcome measurement. For decades, infrastructure has been promoted as the key to public health achievements. 1–3 General reports, models, and frameworks have intended to clarify infrastructure, including Baker et al. and Turnock, among others. 4–8 Historically, when public health infrastructure has been discussed in the literature, it has been in reference to the larger, societal system level. 1,2,4–8 This level of infrastructure provides the capacity to respond to threats to the nation’s health. 2 In this article, we focus on program infrastructure, which is distinct from, but an essential building block of, the larger system level of public health infrastructure. However, program infrastructure is still broadly described with abstract terms such as “platform” or “organizational capacity” and rarely operationalized in logic models or measured in the public health, intervention, or evaluation literatures. 9 There remains a lack of definition and few clear depictions of program-level infrastructure, making it difficult for public health programs attempting to design evaluations and build an evidence base for the role of infrastructure in achieving health outcomes. Program infrastructure is the foundation that supports program capacity, implementation, and sustainability. 9,10 Components of a functioning program infrastructure lead to capacity, which enables action (implementation) and is linked to outcomes and sustainability. Therefore, components of program infrastructure are best defined in a practical manner that lends itself to straightforward implementation and evaluation. 11 In previous work, we reviewed and discussed 1 model of oral health program infrastructure, the Ecological Model of Infrastructure (EMI), and assessed its applicability across a broader context of public health programs. 9 Although this model was a first step toward defining program infrastructure, additional work was necessary to fully construct a measurable model of public health program infrastructure. In particular, the EMI was lacking concrete examples and 2 vital elements: outcomes and sustainability. Moreover, the EMI’s narrow focus on state plans overlooked the planning process’s importance to program infrastructure, as well as the significance of other plans (e.g., evaluation, communication, sustainability plans), and did not consider the model as a complex system with connections across its core elements. Our new model of public health program infrastructure addresses the EMI’s limitations and defines infrastructure in a practical, actionable, and evaluable manner. It demonstrates how grant planners, evaluators, and program implementers can ultimately link infrastructure to capacity, measure success, and increase the likelihood of sustainable health achievements. The model contains core and supportive components that link to capacity, outcomes, and sustainability.