HRSA Requirements for Strategic Planning

In the past 2-3 years, priorities for health centers have shifted dramatically, which for many resulted in putting goals and objectives within their strategic plan on hold. As Covid-19 becomes endemic and we are now moving into flu season, a lot of health centers are revisiting their strategic plan and looking at what that document means to them and their Board of Directors. Having a strategic plan is a program requirement; in fact, it can be found in Chapter 19-Board Authority, Element C, which requires “a long-range plan/strategic plan, but not limited to identifying health center priorities and adopting a three-year plan for financial management and capital expenditures”[1]. A three-year plan normally coincides with the Service Area Competition (SAC) application which health centers must complete to maintain federal funding. Having a plan that only addresses financial management and capital expenditures along with some health priorities may minimally meet the fulfillment of this part of the requirement, but it is not an industry best practice. Remember, the program requirements are the foundation, not the ceiling.

A strategic plan developed by the Board of Directors and health center staff works to create objectives and set goals for where the health center sees itself in the long-term. With goals and objectives established, having a plan allows a health center to work towards and achieve the goals set. It is essentially a road map to achieve goals and objectives that are based on documentation, such as needs assessments, focus groups, patient and staff surveys, etc.

To develop a strategic plan, a health center should:

  1. Complete or review a community needs assessment. This needs assessment should drive the strategic plan and identify issues. For example, if a health center doesn’t provide dental services in-house (only through a written referral arrangement), and the needs assessment demonstrates that patients must drive over 20 miles to the closest dentist that accepts uninsured/Medicaid patients, this may be a situation the health center wants to research.  The health center could complete a financial analysis and evaluate whether having a dental program in-house may be beneficial to the health center and decrease barriers in accessing care.
  2. Complete an environmental analysis. This can be completed through a SWOT analysis (Strengths, Weaknesses, Opportunities and Threats) which will help determine existing capabilities, challenges, and/or opportunities that a health center may want to pursue.
  3. Identifying recurring themes or opportunities can help identify the strategic direction of the organization and provide objectives and goals to add to the strategic plan. As an example, would adding services lines such as additional diabetic care, or hiring a diabetic educator help improve diabetic care to patients?
  4. Creating a strategic plan brings together the Board of Directors and health center staff to ensure that any goals and objectives developed are reasonable and achievable. It is imperative that SMART[2] goals are utilized. For example, if a health center wants to reach a goal of having 90-120 days cash on hand, this will take planning and specific tactics/steps to accomplish, and may be considered a long-term goal. In order words, by “Year 3, XXXX will have 90 days cash on hand”. The strategic plan will have to identify the steps needed to be taken to achieve 90 days cash on hand, who will be responsible for this goal, and how to reach this goal by the end of Year 3.
  5. The strategic plan shouldn’t be sitting on a shelf gathering dust; it should be a living document and updates should be provided to the Board of Directors and staff. Providing regular updates (such as quarterly) to the health center leadership and Board allows for any changes to be made to either the goal or objective.


Although the Health Center Program Requirements have provided a guide as to what should be included in a strategic plan, it is the responsibility of the health center to determine what is included in the plan. A strategic plan must be reasonable, clearly defined and not overstated. For more information, please visit :



[2] SMART goals are “Specific, Measurable, Attainable, Relevant and Time-based”

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