Designing Countywide Framework to Optimize Public Health Investments

Designing a Countywide Framework to Optimize Public Health Investments

Fresno County is working to strengthen the efficiency and equity of its public health services by aligning investments with measurable outcomes. The FUSE Executive Fellow will design and pilot a countywide return‑on‑investment (ROI) framework that connects spending to impact, improves data‑driven decision‑making, and guides equitable resource allocation. Ultimately, this project will enhance accountability, expand access to quality care, and improve long‑term health outcomes for communities across Fresno County.

Fellowship Dates:
April 27, 2026 – April 23, 2027

Salary: Executive Fellows are FUSE employees and receive an annual base salary of $95,000. Fellows can also access various health, dental, and vision insurance benefits. Compensation for this year of public service is not intended to represent market‑rate compensation for the experienced professionals in our program.

FUSE is a national nonprofit working to expand social and economic opportunities, particularly for communities that have been limited by a history of systemic and institutionalized racism. FUSE partners with local governments and communities to more effectively address pressing challenges by placing experienced professionals within city and county agencies. These FUSE Executive Fellows lead strategic projects designed to advance racial equity and accelerate systems change.

Since 2012, FUSE has led over 250 projects in 40 governments across 20 states, impacting the lives of 25 million people.

When designing each fellowship project, FUSE works closely with government partners and local stakeholders to define a scope of work that will achieve substantive progress toward regional priorities. FUSE then conducts an individualized search for each project to ensure that the selected candidate has at least 15 years of professional experience, the required competencies for the role, and deep connections to the communities being served.

They are data‑driven and results‑oriented and able to effectively manage complex projects by developing actionable roadmaps and monitoring progress to completion.

Executive Fellows are hired as FUSE employees and embedded in government agencies for at least one year of full‑time work. Throughout their fellowships, they receive training, coaching, and professional support from FUSE to help achieve their project goals. FUSE Executive Fellows bring diverse perspectives and new approaches to their projects. They build strong relationships with diverse arrays of stakeholders, foster alignment within.

Improving the effectiveness and equity of public health services such as maternal and child health programs is essential to advancing community well‑being and ensuring that all residents benefit from quality care. In Fresno County, CA, while individual families who receive county services frequently experience positive outcomes, these results often fail to translate into broader, population‑level improvements. For instance, African American residents continue to experience the highest rates of infant mortality and preterm births, and Latino and Southeast Asian families, who represent a growing share of births, continue to have limited access to culturally responsive services.

At the same time, ongoing reductions in federal and state public health funding have forced the Department of Public Health (DPH) to make difficult decisions about how to allocate limited resources. A clear understanding of which investments deliver the strongest returns is vital for Fresno to reduce health burden and improve health outcomes for its most vulnerable populations.

To address this challenge, Fresno County DPH has strengthened its data collection systems, refined charting processes, and built capacity to link financial data with health outcomes. The department maintains strong fiscal tracking tools and is working to improve its ability to analyze the relationship between public health spending and community impact. Further, DPH is collaborating with the California Department of Public Health (CDPH) and the…