In the Central Valley, and just a few miles outside of Yosemite National Park, lies Madera County. A predominantly agricultural community, Madera is home to a large indigenous Mexican farmworker population that speaks languages such as Mixteco and Triqui, as well as a diverse group of lower income families working to make ends meet.

"We’re a small, tight-knit community,” said Sara Bosse, Director of Madera County’s Department of Public Health. “Every partner and community leader is at the table—they’re literally having lunch with one another—as are residents with lived experience in our priority issue areas. Together, they’re working strategically and changing systems.”

Despite its strong community bonds, Madera faces enormous challenges due to its geographic location and economy. With provider shortages and limited access to hospitals—all of which are located outside of the county—it is difficult to maintain an adequate health care system. Socioeconomic barriers further add to the community’s challenges.

Unfazed by these obstacles, community leaders came together in 2018 to establish Live Well Madera County, an Accountable Community for Health (ACH) coordinated by the Madera County Department of Public Health. Its first initiative was the publication of a Community Health Assessment, which provided a roadmap toward a stronger health care system and community.

COVID-19 interrupted the strategic elements of the plan, but ultimately tested the group’s mettle—trial by fire. Ending the pandemic with closer connections and a better understanding of each stakeholders’ priorities, needs and operations, the ACH has now developed its second Community Health Assessment and Community Health Improvement Plan.

This plan embeds equity and community voice into every decision and program, aligning with California's Future of Public Health initiative to strengthen public health infrastructure. ACH workgroups will focus on the community's top health priorities: access to care, growing healthy families, diabetes/heart disease prevention, and substance use disorder treatment.

Another key goal is to deeply involve impacted community members in developing new approaches and solutions. For example, "Resident Champions," funded by CalFresh Healthy Living, will be trained to conduct school-site assessments and will help lead projects to increase safe routes to schools.

"We're excited to work regionally to expand access to care,” said Bosse. "We're planning a landmark effort to assess gaps across the entire healthcare continuum and construct a model for what an optimal health care system would entail, from the bottom up. Instead of just saying we're struggling, we want to define exactly what we need and how to build the workforce and funding to get there. It's an innovative approach."

While the work ahead is substantial, Bosse is encouraged by the ACH's progress to date and growing resilience in the wake of COVID-19. “I’m proud of this group and its ability to maintain a high level of engagement and trust, and a strong drive to improve the community’s health.”In the Central Valley, and just a few miles outside of Yosemite National Park, lies Madera County. A predominantly agricultural community, Madera is home to a large indigenous Mexican farmworker population that speaks languages such as Mixteco and Triqui, as well as a diverse group of lower income families working to make ends meet.

"We’re a small, tight-knit community,” said Sara Bosse, Director of Madera County’s Department of Public Health. “Every partner and community leader is at the table—they’re literally having lunch with one another—as are residents with lived experience in our priority issue areas. Together, they’re working strategically and changing systems.”

Despite its strong community bonds, Madera faces enormous challenges due to its geographic location and economy. With provider shortages and limited access to hospitals—all of which are located outside of the county—it is difficult to maintain an adequate health care system. Socioeconomic barriers further add to the community’s challenges.

Unfazed by these obstacles, community leaders came together in 2018 to establish Live Well Madera County, an Accountable Community for Health (ACH) coordinated by the Madera County Department of Public Health. Its first initiative was the publication of a Community Health Assessment, which provided a roadmap toward a stronger health care system and community.

COVID-19 interrupted the strategic elements of the plan, but ultimately tested the group’s mettle—trial by fire. Ending the pandemic with closer connections and a better understanding of each stakeholders’ priorities, needs and operations, the ACH has now developed its second Community Health Assessment and Community Health Improvement Plan.

This plan embeds equity and community voice into every decision and program, aligning with California's Future of Public Health initiative to strengthen public health infrastructure. ACH workgroups will focus on the community's top health priorities: access to care, growing healthy families, diabetes/heart disease prevention, and substance use disorder treatment.

Another key goal is to deeply involve impacted community members in developing new approaches and solutions. For example, "Resident Champions," funded by CalFresh Healthy Living, will be trained to conduct school-site assessments and will help lead projects to increase safe routes to schools.

"We're excited to work regionally to expand access to care,” said Bosse. "We're planning a landmark effort to assess gaps across the entire healthcare continuum and construct a model for what an optimal health care system would entail, from the bottom up. Instead of just saying we're struggling, we want to define exactly what we need and how to build the workforce and funding to get there. It's an innovative approach."

While the work ahead is substantial, Bosse is encouraged by the ACH's progress to date and growing resilience in the wake of COVID-19. “I’m proud of this group and its ability to maintain a high level of engagement and trust, and a strong drive to improve the community’s health.”

For more information, visit maderacounty.com/cha.