21C Learning Community

Public health transformation cannot happen in isolation; innovation, collaboration, and learning together are essential to drive the changes we need to meet current and future public health needs. Since 2015, PHNCI at PHAB has been home to the 21st Century Learning Community (21C), a group of states focused on intentional state-wide public health system transformation; these states are driving transformation in their state and generating a knowledgebase for the field. 21C states are leaders in developing an understanding of a state’s approach to transformation, conducting capacity and costing assessments, making the case for sustainable funding for core public health, advancing equity, and exploring various models for workforce and service sharing. Through 21C, PHNCI will drive transformation and modernization.

PHNCI expanded 21C to include states intentionally transforming their governmental public health systems, modernizing, and advancing equity, through a variety of models/strategies including, but not limited to using, the FPHS model. Learn more about our transformation efforts here.

To achieve these goals, PHNCI will:

  • Actively recruit and onboard new states engaged in state-wide public health transformation – states must be taking a system-wide approach to transformation and have a vision and strategy for their work;
  • Engage a subset of states in examining and implementing recommendations from RWJF’s National Commission to Transform Public Health Data Systems
  • Define public health transformation and what a reimagined public health system could look like on a state-by-state basis;
  • Provide opportunities for 21C members to engage in learning, communication, and sharing of emerging practices with peers. Events will include deep dives on topics such as data modernization, service sharing, workforce, equity, costing/assessment, and more;
  • Provide technical assistance and access to subject matter experts;
  • Ensure coordination across various national and regional initiatives focused on public health transformation and modernization to share practices, data, and align efforts as appropriate.

Through the expanded 21C, PHNCI will support states in strategic positioning and engagement with key state stakeholders to leverage short term federal funding to set up long term gains and shape the public health system of the future.

Thank you to the Robert Wood Johnson Foundation for their continued support of these efforts.

Beginning in January 2022, PHNCI will increase efforts to advance public health transformation and modernization through expanding 21C to include new states.

21C offers participating states additional, no cost, support on their transformation journey. Through December 2023, states participating in 21C will:

    • Engage in peer networking and learning through up to three in-person and/or virtual convenings (cost covered by PHNCI) and through quarterly virtual meetings. We will have a kick-off in-person or virtual convening in spring 2022.
    • Have access to enterprise-wide and customized technical assistance and subject matter expertise. Possible areas for deeper focus include use of federal funding, workforce, service sharing, policy, data modernization, and more.
    • Contribute to building the knowledge base around public health transformation and modernization to support cross-state learning and national conversations through requests for information, sharing stories, presenting at conferences, and more.

To apply, your state must be:

    • Taking a state-wide systems approach (i.e., state, local, Tribal) towards governmental public health modernization and transformation of infrastructure and systems. Participating stakeholders may include health departments, SACCHOs, and other entities engaged in efforts.
    • Focusing on developing equitable public health systems and communities.
    • Developing and implementing a vision and strategy to engage in and accelerate transformation and modernization that has been or is in the process of being conceptualized across key public health stakeholders across the state. With this expansion, we are open to various models and strategies for these efforts, including, but not limited to, using the FPHS.

Is your state interested in joining? Or interested but not yet ready to apply? Please follow the details below:

    • Review the above information and criteria for participating in 21C and email Reena Chudgar at rchudgar@phnci.org to express your interest. You’ll then get access to the application details.
      • Applications consist of an online application form and 60-minute recruitment call with PHNCI staff to discuss the Learning Community and your state’s work. The online application form will be accepted on a rolling basis – however, to be eligible to participate in the spring 2022 kick-off meeting, applications must be received by February 25, 2022. Recruitment calls may occur prior to or after submission of the online application form.
      • Applications should be submitted on behalf of the state-based effort (not an individual agency focused on transformation). Submissions may be from health departments, SACCHOs, public health associations, etc.
      • Review application questions here – note that this is for review purposes only and only submissions via the online form will be accepted.
    • If selected, your state will be invited to join 21C and receive an onboarding package that will include the 21C Charter, a template to describe your efforts, TA needs assessment, and more.

Across the country, 11 states are working to transform their governmental public health system by adopting and implementing the Foundational Public Health Services (FPHS) framework. The framework specifies the suite of skills, programs and activities that must be available in state and local health departments everywhere for the health system to work anywhere.

PHNCI supports these states, each at various stages of adopting the FPHS framework, through 21C. PHNCI has collected a host of materials generated by learning community members, and they have been categorized as those that have helped set the stage for FPHS, FPHS frameworks that define core services, models to deliver FPHS, assessments of existing and needed capacity to fully implement FPHS, financing and implementation strategies, and accountability metrics. The chart below indicates the category of materials available from each state to access these and other resources available, such as additional reports, legislation, and websites. The links at the bottom of the page allow you to view all items available by category.


Setting the Stage

State-Specific FPHS Framework

FPHS Delivery Model

Public Health System Assessment

Financial and Implementation Strategies


Legislation & Impact








North Carolina




Setting the Stage

Transforming public health is a multi-year effort that requires commitment and buy-in from individuals who work within the system and others who are critical to achieving this far-reaching goal.

State-Specific FPHS Frameworks

The nationally-developed FPHS framework reflects the consensus of public health and health care leaders across the country of the suite of skills, programs and activities that must be available in state and local health departments everywhere for the health system to work anywhere, and for which costs could be estimated.

FPHS Service Delivery Models

Local health department capacity and resources historically have varied widely both within and between states across the country.

Public Health System Assessment

Conducting an analysis of the gap between current investments and capacity and what is needed for implementation of the FPHS framework provides a critical foundation for developing cost estimates and planning implementation strategies.

Financing and Implementation Strategies

Transitioning to a modernized public health system requires carefully designed changes to financial and operational practices.


Performance metrics measure progress toward implementation of the FPHS framework, and are also an important accountability tool for policy makers, particularly if additional funding is allocated to the governmental public health system.

Legislation & Impact

Legislation has been enacted in several states to guide transformation efforts.