improve the health of the people in our community.*

The Eden Township Healthcare District lacks a clear vision of its future as a viable government agency. ETHD Response to Finding 16-14: Eden Township Healthcare District disagrees with the finding. Eden Township Healthcare District has established clearly that it seeks to improve the health of the community by increasing screening, early health care access and concentrating on underserved areas within the District (Ashland, Cherryland and South Hayward).

The execution of the Eden Township Healthcare District's mission is ineffective because it does not engage in advanced strategic planning practices. The district lacks information concerning the needs of its residents and fails to take steps to assess those needs. ETHD Response to Finding 16-15: Eden Township Healthcare District disagrees with the finding. The District regularly measures the health of the District's residents using the same data used by the Alameda County Health Care Services Agency and determines priorities and strategic planning based on this data.

The amount of resources devoted to the Eden Township Healthcare District's primary mission is only 12% of its total expenses. Although an improvement over the historical 5%, this ratio is an indication that the district's attention has been diverted away from its primary mission, which is to "improve the health of the people in our community." ETHD Response to Finding 16-16: Eden Township Healthcare District disagrees with the finding. Eden Township Healthcare District's healthcare mission includes providing access to care, which we do by providing medical office space for physicians in locations to provide access to patients. Measured in this way, 85% of our resources are committed to serving the community's health needs. 20400 Lake Chabot Road, Suite 303, Castro Valley, California 94546 • (510) 538-2031 • Fx (510) 582-4670 • www.ethd.org Eden Township Healthcare District (dba Eden Health District) Responses to Civil Grand Jury Report August 25, 2016

Survey data showing that district residents have little or no knowledge or opinion of ETHD's existence demonstrates ETHD's failure to deliver on its stated mission. ETHD Response to Finding 16-17: Eden Township Healthcare District agrees with the finding. However, the survey data was based on a 2012 survey conducted by the District. Since then, the District has spent resources and time communicating with more than 19,855 individuals in the District directly, and at health fairs. We have reached several hundred more through the District's community health educational programs.

Eden Township Healthcare District's current priorities lack concrete action plans, timelines, funding sources, or a rationale that would inform residents how and when plan priorities will be achieved. ETHD Response to Finding 16-18: Eden Township Healthcare District disagrees with the finding. Eden Township Healthcare District does have current priorities (areas and focus of health concerns, are the health of the residents in the Ashland and Cherryland areas, diabetes education and prevention, and mental health education). Informing residents when health care results will be achieved is a goal that even the Federal Government has been seeking to achieve for decades, without success. Even our most respected institutions have struggles with this issue. This is an unrealistic statement, especially for a small agency dealing with 350,000 people. Alameda County, with its much larger budget cannot show results in this area.

ETHD's stated priority to provide direct healthcare services to the community is unachievable under its current operating structure. This problem highlights the fact that the district has not aligned its strategic priorities with the reality of its operating structure. ETHD Response to Finding 16-19: Eden Township Healthcare District disagrees with this finding. This is just a statement of an unsubstantiated opinion: we can set up a clinic and deliver health care services directly. Also, when the District educates 100 people about how to live a healthier, productive life with diabetes, we ARE providing direct health care (not medical care, but "health" care) to people, some of whom do not get ill enough to get medical care because they are more aware of how to maintain good health.

The Eden Township Healthcare District's passive approach to planning has resulted in a lack of short- and long-term objectives. It reduces the organization to haphazardly funding its priorities on a reactionary or politically driven basis. ETHD Response to Finding 16-20: Eden Township Healthcare District disagrees with this finding. Eden Township Healthcare District believes this finding is absolutely off the mark! The District has set a goal of funding as much of our stated priorities that a given budget can provide and then fund those programs that meet those goals and monitor them. The District believes this is a far better approach than setting lofty goals with no money to follow through and get anything done.

There is little or no evidence of collaboration between Eden Township Healthcare District and the Alameda County Health Care Services Agency. Lack of collaboration is wasteful and detrimental to the community the district serves. Eden Township Healthcare District (dba Eden Health District) Responses to Civil Grand Jury Report August 25, 2016 ETHD Response to Finding 16-21: Eden Township Healthcare District disagrees with this finding. This is a matter of definition. Alex Briscoe, Director of the Alameda Health Care Services Agency came to the District and asked for help to keep St. Rose Hospital functioning. The District then made an emergency loan to St. Rose Hospital as a result. The District reviews the County's health assessment and works with them (sometimes funding County programs such as WIC), thereby disproving this statement. Responses to Recommendations: