Comparing Types of Local Public Health Agencies in North Carolina

Markiewicz, Milissa; Moore, Jill; Foster, Johanna H.; Berner, Maureen; Matthews, Gene; Wall, Aimee

doi:10.1097/phh.0b013e318276e2a0

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…While standard measures of efficiency of service delivery are lacking for LHDs, variation in size of health department has been found to be a primary source of variation in levels of per capita spending in several studies ( 6 , 7 ). Cross-jurisdictional sharing is intended to increase quality of services ( 8 ), access to resources and efficiency of resource use, although benefits and challenges exist ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost

Humphries¹,

Hyde

Hahn

et al. 2018

Front. Public Health

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BackgroundForty one percent of local health departments in the U.S. serve jurisdictions with populations of 25,000 or less. Researchers, policymakers, and advocates have long questioned how to strengthen public health systems in smaller municipalities. Cross-jurisdictional sharing may increase quality of service, access to resources, and efficiency of resource use.ObjectiveTo characterize perceived strengths and challenges of independent and comprehensive sharing approaches, and to assess cost, quality, and breadth of services provided by independent and sharing health departments in Connecticut (CT) and Massachusetts (MA).MethodsWe interviewed local health directors or their designees from 15 comprehensive resource-sharing jurisdictions and 54 single-municipality jurisdictions in CT and MA using a semi-structured interview. Quantitative data were drawn from closed-ended questions in the semi-structured interviews; municipal demographic data were drawn from the American Community Survey and other public sources. Qualitative data were drawn from open-ended questions in the semi-structured interviews.ResultsThe findings from this multistate study highlight advantages and disadvantages of two common public health service delivery models – independent and shared. Shared service jurisdictions provided more community health programs and services, and invested significantly more ($120 per thousand (1K) population vs. $69.5/1K population) on healthy food access activities. Sharing departments had more indicators of higher quality food safety inspections (FSIs), and there was a non-linear relationship between cost per FSI and number of FSI. Minimum cost per FSI was reached above the total number of FSI conducted by all but four of the jurisdictions sampled. Independent jurisdictions perceived their governing bodies to have greater understanding of the roles and responsibilities of local public health, while shared service jurisdictions had fewer staff per 1,000 population.ImplicationsThere are trade-offs with sharing and remaining independent. Independent health departments serving small jurisdictions have limited resources but strong local knowledge. Multi-municipality departments have more resources but require more time and investment in governance and decision-making. When making decisions about the right service delivery model for a given municipality, careful consideration should be given to local culture and values. Some economies of scale may be achieved through resource sharing for municipalities <25,000 population.

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Section: Introductionmentioning

confidence: 99%

Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost

Humphries¹,

Hyde

Hahn

et al. 2018

Front. Public Health

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show abstract

“…North Carolina organizes LHDs at the county level; some are grouped into districts combining several health departments. [46][47][48] These are categorized in 10 larger public health regions. 46 Public health regions 1 and 2 represent 19 counties in the western end of NC.…”

Section: Nc Public Health Regionsmentioning

confidence: 99%

Hepatitis C and HIV Screening, Testing, and Risk Perceptions among South-Central Appalachian County Health Department Staff

Harless¹,

Lugo²,

Ostrach³

2022

Southern Medical Journal

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Objectives: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV. Gaps persist in LHD resources for meeting these demands, especially in Appalachia and the US South.Methods: To explore HCV/HIV screening, testing, and treatment approaches and perspectives in south-central Appalachian North Carolina, structured telephone questionnaires were administered to communicable disease nurses and other health department staff directly involved in screening and testing. Mixed-methods data analyses were conducted and triangulated with stakeholders.Results: Eighteen participants representing 19 counties completed the questionnaire, achieving a saturation sample. Participants reported barriers to screening and testing, including housing insecurity, lack of transportation and insurance, unemployment, and the isolation of living in a rural area. Divergence in perceptions of barriers between public health regions emerged, as did perceptions of who is at risk and use of stigmatizing language about people at risk for HCV/HIV.Conclusions: This study highlights the impact of LHD behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.

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Comparing Types of Local Public Health Agencies in North Carolina

Cited by 2 publications

References 8 publications

Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost

Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost

Hepatitis C and HIV Screening, Testing, and Risk Perceptions among South-Central Appalachian County Health Department Staff

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