MOJ Public Health Public Health Delivery Systems and the Provision of Maternal and Child Health Preventive Services Submit Manuscript | http://medcraveonline.com and 21% were maternal child health programs [3]. In early 2014, 28 percent of LHDs across the nation reported additional cuts to their budgets, which limits their ability to address the health needs especially among the most vulnerable populations, women and children [3]. To minimize the effects of program and service cuts, LHDs have begun to collaborate with other agencies to increase the reach of maternal and child health services. However, LHDs have faced many challenges in developing and sustaining collaborative capacity over the last decade [3]. One challenge is how to develop and maintain collaborations in light of changes over time including changes in relationships through joint production, core membership, and number of collaborators (i.e. partnerships). One possible approach to addressing the challenge may be to study the changes of LHD collaborative capacity and joint production (i.e. ability to perform services with other organizations) to enhance and coordinate services targeted at assuring healthy women, infants, and children through public health delivery systems (PHDS). PHDS include public and private organizations that contribute to the delivery of public health services for a given population. The inter-organizational theory is useful for studying collaborative efforts of PHDS by addressing change and examining how organizations work together [4,5]. It suggests that studying and understanding PHDS may lead to a more comprehensive and coordinated approach to addressing complex issues beyond a single organization’s domain [4,6]. Additionally, the theory suggests that defining a useful foundation for understanding and mobilizing PHDS enhances the ability to address a range of public health issues, such as infant mortality. By working together, PHDS may be able to provide a comprehensive coordinated approach and useful foundation to increase the reach of maternal and infant services and ultimately reduce infant mortality. The existing literature provides some evidence of the benefit of PHDS. For example, a recent study found that PHDS varied widely in organizational structure but offer a broader scope of services and engage with a wider range of organizations [7]. Another study found that partnerships among public health systems were a partial mediator between resources and service provision [8]. In a mediating role, these partnerships reduce differences in service provision among rural, suburban, and urban LHDs [8]. A social network analysis study found an association between central and dense PHDS and improved health status [9]. Also, a few studies have suggested that joint production, or collaboration through PHDS, is motivated by cost reduction and resource scarcity [11,12]. Taken together, these studies suggest that joint production is a strategic way of gaining access to crucial knowledge while developing fast, effective, and efficient means for acquiring the appropriate skills and resources needed to deliver services to communities of need. Research has focused mainly on collaboration processes, interactions, and health outcomes and less on how the changes in partnerships and joint production over time may influence their ability to deliver superior maternal and child health (MCH) services. It is important to understand that PHDS joint production cannot be measured by partnerships alone but there is a need to understand the mutual responsibilities and benefits of working collaboratively to deliver maternal and child health services. We used two measures of social network analysis, density and centrality, to understand the relationship between PHDS partnership and joint production and maternal and child service provisions and over time. Density is the number of delivery systems partners and centrality is the number of organizations that jointly produce services. Therefore, we hypothesized that joint production among a large number of PHDS partners is associated with a broader larger scope of maternal and child health services. The current study tests this hypothesis Volume 5 Issue 3 - 2017 1 Preventive Medicine and Public Health, University of Kansas School of Medicine, USA 2 Department of Health Policy and Management, University of Arkansas for Medical Sciences, USA 3 Department of Health Management & Policy, The University of Kentucky, USA *Corresponding author: Sharla Smith A, Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita, USA, Email: Received: February 02, 2015 | Published: March 03, 2017 Research Article MOJ Public Health 2017, 5(3): 00128 Keywords: Hispanics; LHD;PHD; MCH; NLSPHA; Joint production; Prenatal; Obstetric; NACCHO; Tobacco use Introduction Despite major advances in medical care, critical threats to maternal, infant, and child health exist in the United States [1]. Among the nation’s most pressing challenges are reducing infant mortality, which in 2015 remained higher among non-white Hispanics, 5.22 deaths per 1,000 live births, and non-Hispanic blacks, 11.11 deaths per 1,000 live, compared to non-Hispanic whites, 4.93 per 1,000 live births [1]. One approach for addressing the pressing challenge of reducing the infant mortality rate is optimizing the health of the mother prior to and during pregnancy to create the best opportunity for a fetus to develop in a healthy manner [2]. Despite the emerging need to improve maternal and infant health, budget cuts to local health department’s (LHD) have forced a reduction or elimination of preventive programs and services aimed to promote healthy women and infants [3]. In 2011, 57% of LHDs reduced or eliminated at least one program