title: The use of memoranda of understanding in fostering inter-agency collaboration: a qualitative study of health services agencies serving vulnerable populations in Baltimore, USA.
abstract: BACKGROUND
  We examined whether mandated collaboration reflected in memoranda of understanding (MOUs) developed by health agencies to meet funder expectations is effective in fostering inter-agency collaboration.
  
  
  METHODS
  We conducted 22 semi-structured interviews from late 2010 to early 2012 in Baltimore, USA, with representatives of 17 HIV service agencies, three local health department units, and one agency that closed in 2008 (two interviews).
  
  
  RESULTS
  While there was no consensus, most respondents perceived MOUs negatively, mainly because the process of obtaining signed MOUs was time consuming; frontline staff was mostly unaware of MOUs, agencies did not necessarily work with agencies they signed MOUs with and MOUs were rarely evaluated after being signed. A few agencies reported that MOUs could keep agencies focused and set mutual expectations. The local health department acknowledged shortcomings in MOUs but emphasized that MOUs could help agencies plan for referring clients when their own capacity was full.
  
  
  CONCLUSIONS
  Although many agencies acknowledged the importance of collaboration, most respondents found that MOUs lacked practical utility. Grant-makers should consult sub-grantees to develop alternative means of fostering collaboration that would be perceived as relevant by both parties.
authors.affiliation: Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, USA khoslan@health.missouri.edu.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Khosla
authors.affiliation: Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, USA.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
authors.affiliation: Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Holtgrave
mesh_terms: D015142:Baltimore; D003299:Cooperative Behavior; D058016:Health Facility Administration / Q000379:methods*; D006801:Humans; D007373:Interinstitutional Relations; D007407:Interviews as Topic; D011635:Public Health Administration / Q000379:methods; D036301:Qualitative Research; D035862:Vulnerable Populations
keywords: HIV; United States; mandated inter-organizational collaboration; memoranda of understanding; qualitative methods; vulnerable populations