of the Association of State and Territorial Health Officials (ASTHO, 1995a, b, c) and the National Association of County and City Health Officials (NACCHO, 1994), and a previous IOM committee (IOM, 1988). Many state and local governments have already addressed some or many of the responsibilities outlined above; the committee, however, believes that state and local government efforts generally need to be more consistent, more innovative, and better supported.

The monitoring and assessment role of government agencies requires them to monitor the prevalence of STDs in the community, identify high-risk populations or communities, and assess the adequacy of treatment and prevention efforts. This role also requires these agencies to monitor and ensure compliance with minimum standards of quality and accessibility of services. Effective performance of these roles requires collaborative relationships among local health departments and community-based health services, private sector health care professionals, health plans, laboratories, and others in the community. STD services and programs in most local health departments currently are relatively isolated from other providers in the community. Such isolation reduces opportunities for collaborative efforts, such as sharing of disease surveillance data, to improve STD prevention. The performance of local and state government agencies in ensuring and improving STD-related services should be monitored by consumer groups, elected officials, health professional organizations, and the federal government as appropriate (IOM, 1997).

Catalyzing Change Through Partnerships

The barriers to an effective national system for STD prevention are found in government, private sector organizations, and political factors and social norms. Overcoming these barriers is a challenge that requires the active participation of all levels of government, the private health care sector, businesses, labor leaders, the mass media, schools, and many community-based organizations. Many of the committee's recommendations regarding health agencies and private sector organizations involve sharing of responsibility and technical expertise and information; coordination of programs; and forming partnerships both within agencies and organizations and between the public and private sectors. In developing and implementing a national system for STD prevention, it is important that stakeholders be involved in all steps of the process; however, a formal mechanism for collaboration among agencies and organizations does not exist. Therefore, a neutral forum is needed to maximize the range of participants and to catalyze the collaborative process.

To establish an effective national system for STD prevention, the committee believes that a long-term national Roundtable for public agencies and private sector organizations is needed to catalyze the development and implementation of a comprehensive system of STD prevention in the United States. Independence



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