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.

ABOUT THE FUSE EXECUTIVE FELLOWSHIP

FUSE is a national nonprofit dedicated to increasing the capacity of local governments to work more effectively for communities. We embed private sector executives in city and county agencies to lead projects that improve public services and accelerate systems change. Since 2012, FUSE has led over 400 projects in 58 governments across 26 states, impacting a total population equivalent to 1 in 10 Americans.

When designing each fellowship project, FUSE works closely with government partners and community stakeholders to define a scope of work that will achieve substantive progress toward high-priority local needs. Projects address today’s most pressing challenges and opportunities, including affordable housing, economic mobility, climate resilience, public safety, infrastructure, technology, and more.

FUSE conducts a full executive search for each individual 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 community being served.

Executive Fellows are embedded in government agencies working with senior leaders for at least one year of full-time work. Prospective responsibilities may include thorough data analytics and research, developing enhanced operations and financial models, building change management and strategic planning processes, and/or building broad coalitions to support project implementation efforts. Executive Fellows are data-driven and results-oriented and able to effectively manage complex projects. They build strong relationships with a broad array of stakeholders, foster alignment within and across various layers of government, and build partnerships between governments and communities.

Throughout the fellowships, Executive Fellows receive training, coaching, and professional support to help achieve their project goals.

PROJECT CONTEXT

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 University of California, Merced to identify best practices for measuring the return on investment (ROI) of its public health programs such as how the county can balance professional and paraprofessional staffing (e.g., nurses vs. health education staff) to serve more families effectively. However, no standardized ROI methodology currently exists in California. This lack of replicable framework limits the ability of counties to evaluate program performance, compare service models, or make data-driven decisions about resource allocation.

Fresno County will partner with FUSE to design and pilot a countywide ROI methodology that improves the efficiency and impact of health services delivery. The FUSE Executive Fellow will: conduct a comprehensive listening tour and landscape analysis of existing program and financial data; review best practices and literature on public health ROI models; collaborate with stakeholders to develop a robust ROI framework; and pilot test the model to assess cost-effectiveness, outcomes, and scalability. Ultimately, this work will enable Fresno County to allocate resources more strategically, strengthen accountability, and expand access to high-quality public health services. By establishing a replicable methodology, the county will also help set a precedent for data-driven decision-making that can improve health outcomes and promote greater healthcare access across California.

PROJECT SUMMARY

Beginning in May 2026, the FUSE Executive Fellow will partner with the Fresno County Department of Public Health (DPH) to develop and pilot a data-driven methodology that measures the return on investment (ROI) of public health programs.

The fellow will begin by conducting a comprehensive listening tour with internal and external stakeholders such as DPH leadership and staff, the California Department of Public Health (CDPH), the University of California, Merced, and other local partners. These conversations will capture insights into current health service delivery models, data management systems, and financial processes, as well as identify barriers that limit the department’s ability to evaluate the cost-effectiveness of its programs.

The fellow will conduct a detailed landscape analysis of Fresno County’s program and financial data, with a focus on maternal and child health services. They will also review best practices from other jurisdictions that have implemented ROI methodologies for public health and related sectors. The fellow will then develop a set of specific project goals and deliverables for DPH and CDPH leadership to review and approve before continuing with the next phase of the fellowship.

Using these collected insights, the fellow will design and test a comprehensive ROI framework that connects financial investments with population health outcomes. The fellow will work closely with DPH’s finance, data analytics, and program evaluation teams to create models that assess the effectiveness of different service delivery structures, such as the use of nurses versus health education staff. The fellow will collaborate with UC Merced researchers and CDPH partners to ensure that the framework is scientifically sound, scalable, and aligned with statewide evaluation standards. As time allows, the fellow will execute pilot tests of the model to assess cost-effectiveness, outcomes, and scalability.

The fellow will deliver a validated ROI methodology, an analytical toolkit, and a set of actionable recommendations for how Fresno County can integrate ROI analysis into its budget planning and resource allocation processes. This will include identifying and refining key metrics for measuring impact, including preterm birth rates, infant mortality, and other population health indicators, with a focus on scaling to health burdened populations. Throughout this process, the fellow will facilitate knowledge-sharing sessions and capacity-building workshops with DPH staff to strengthen their ability to use ROI tools for ongoing performance monitoring and data-informed decision-making.

The fellow will produce a final comprehensive report detailing findings, methodologies, and data templates, as well as a five-year cost-benefit analysis of key public health programs. To ensure sustainability, the fellow will develop a training and implementation plan that enables DPH staff to maintain and adapt the framework across other divisions. Ultimately, this project will equip Fresno County with a powerful, evidence-based tool to improve fiscal efficiency, strengthen accountability, and promote equitable health outcomes across all communities.

PROJECT DELIVERABLES

By April 2027, the Executive Fellow will have produced the following:

  • Developed Countywide ROI Methodology and Framework – Designed and piloted a comprehensive return-on-investment (ROI) model that links Fresno County’s public health expenditures to measurable outcomes such as birth outcomes, infant mortality, and service reach, providing a standardized approach to evaluate cost-effectiveness.
  • Created Analytical Toolkit and Data Templates – Built practical tools, dashboards, and templates that enable DPH staff to integrate financial and programmatic data, conduct ongoing ROI analyses, and apply results to inform budget planning and resource allocation decisions.
  • Produced Strategic Recommendations for Policy and Resource Allocation – Delivered actionable recommendations for how Fresno County can apply ROI findings to guide future funding priorities, staffing structures, and program design to promote fiscal accountability and addressing health burdened populations.
  • Completed Five-Year Cost-Benefit Analysis Report – Conducted an in-depth evaluation of maternal and child health programs, assessing cost drivers, population impacts, and opportunities to improve service efficiency and reach more families countywide.
  • Established Capacity-Building and Sustainability Plan – Developed a training and implementation roadmap to institutionalize ROI practices within DPH, ensuring that staff can maintain, adapt, and expand the framework across other divisions beyond the fellowship period.

KEY STAKEHOLDERS

  • Executive Sponsor – Joe Prado, Interim Director, Fresno County DPH
  • Project Supervisor – Chashua Lor, Senior Staff Analyst, Fresno County DPH

QUALIFICATIONS

  • Synthesizes complex information into clear and concise recommendations and action-oriented implementation plans.
  • Develops and effectively implements both strategic and operational project management plans.
  • Generates innovative, data-driven, and result-oriented solutions to complex challenges.
  • Respond quickly to changing ideas, responsibilities, expectations, trends, strategies, and other processes.
  • Communicates effectively verbally and in writing and excels in active listening and conversing.
  • Fosters collaboration across multiple constituencies to support more effective decision-making.
  • Establishes and maintains strong relationships with diverse stakeholders, both inside and outside of government, particularly community-based relationships.
  • Embraces differing viewpoints and implements strategies to find common ground.
  • Demonstrates confidence and professional diplomacy while effectively interacting with individuals at all levels of various organizations.

FUSE is an equal-opportunity employer with core values of diversity, equity, and inclusion. We encourage candidates from all backgrounds to apply for this position.