Nearly three years into the coronavirus pandemic that burdened already-strained public health agencies across the country, the Baltimore City Health Department won a $8.4 million federal grant to modernize its technology and bolster its staff.

The money from the U.S. Centers for Disease Control and Prevention will not only help the department continue responding to this public health emergency, but help it prepare for the next one. That’s all while making improvements to everyday services, which include things such as restaurant inspections, disease testing and tracing, and health programs for new and expecting parents.

“Lack of investment in the department over time has meant that systems went without updates, and the work force, essential for core services we provide, was slashed and positions were reduced,” said Dr. Letitia Dzirasa, Baltimore health commissioner.

“With this money, we can really focus on work force and infrastructure,” she said. “Usually grants are program specific, but with this grant, we have some autonomy and flexibility to spend it where we’ve determined we need it. Whatever we’re facing, we can spend it that way. That’s a good thing.”

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The money is part of the $3.2 billion in funds allocated nationwide through a grant program created under the American Rescue Plan Act that’s specifically directed to public health infrastructure.

Dr. Rochelle Walensky, CDC director, said in a statement Nov. 29 when the program was announced that the pandemic strained public health agencies at all levels, but they were “weakened by neglect and underinvestment” for years prior to the first case.

“This grant gives these agencies critical funding and flexibility to build and reinforce the nation’s public health workforce and infrastructure, and protect the populations they serve,” she said.

That flexibility is unusual, and will be critical to rebuilding long neglected local systems, said Dr. Georges Benjamin, executive director of the American Public Health Association and a former Maryland health secretary.

Benjamin said the city can direct money where it’s needed, such as hiring or training workers, building new systems or boosting their preparedness work. He noted the CDC also funded three outside groups that can provide training and technical assistance to local jurisdictions, which can make Baltimore’s money go further.

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Since the funding lasts for only five years, he said all local agencies will have to figure out how they will maintain programs and pay workers in their normal budget. Baltimore’s health department has an annual budget of about $200 million, and a direct staff of about 740.

“Baltimore is a big city with a lot of challenges, but it has had a robust health department for some time. They’ve innovated with money they’ve gotten in the past,” he said. “In some ways this is a drop in the bucket when it’s all divided up, but almost $8.5 million over five years dedicated to public health infrastructure is not a bad idea.”

In Baltimore, officials say the agency plans to hire at least a dozen staffers — some to help with program administration — and fund recruitment and retention efforts. Dzirasa noted that the department stayed open continuously during the pandemic, providing guidance and coordinating testing and vaccination programs, which took a heavy toll on the workforce. Many workers had to learn new skills on the fly during the pandemic.

She said the grant provides an opportunity to get workers proper training that will both improve their job satisfaction and encourage them to continue working in public health, but also better serve the residents.

The department also plans to buy contract and grant management software, and implement a new electronic health records system, one used by most hospitals in the region. Many residents in underserved neighborhoods use city programs, and the new system will help the city coordinate care better and communicate.

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It will also allow staff to better track outbreaks from viruses or food poisoning. Dzirasa said the department still used spreadsheets and fax machines for some of that work when she arrived in 2019.

The department can also shift money when there is a new threat. Officials noted that when mpox cases began rising in the city, for example, they couldn’t use a specific pot of yet-to-be-spent money allocated for COVID-19.

Ultimately, Dzirasa said the department will need to sustain the focus on public health, which can be a challenge among policymakers, lawmakers and the public, she said. She noted that when public health systems are all working well, there are fewer people who are sick or harmed and the need for public health work seems to diminish.

Counties in Maryland will also receive funding, part of a $47 million CDC grant awarded to the Maryland Department of Health.

“Maryland is reviewing the award,” said Chase Cook, a department spokesman. “Per the federal grant stipulations, 40% of the workforce award will be distributed to local health departments.”

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Maryland Sens. Chris Van Hollen and Ben Cardin, along with the state’s seven Democratic House lawmakers, supported the funding and applauded the grants.

“Throughout the Covid-19 pandemic, our health care heroes have been navigating some of the most difficult public health challenges in this country’s history, exhausting their equipment, facilities and themselves,” said the lawmakers in a statement. “These federal dollars will allow our public health departments to fill staff vacancies and replenish equipment to better protect the health of all Marylanders.”