21C Learning Community

Across the country, a number of 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 the 21st Century (21C) learning community, a group of states in various stages of adopting the FPHS framework, from initial conceptualization to implementation. 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











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.