Public Health Performance Standards and the Accreditation of State and Local Health Departments

Performance measurement has become an essential tool for guiding quality improvement efforts and for holding organizations in the public and private sectors accountable for meeting specified responsibilities. The National Public Health Performance Standards Program (NPHPSP), initiated in 1998, is an effort to use the ideas of performance measurement to promote the organization of state and local public health practice around delivery of the essential public health services (see Box 3–4).

In a national partnership, CDC, ASTHO, NACCHO, NALBOH, APHA, and PHF are working together to establish measurable performance standards for state and local public health systems, to develop tools to assess performance against these standards, and to create incentives for states and localities to use such tools. Some of these measures could be used in a “report card” or as standards in a national program that accredits public health agencies.

The performance standards effort is seen as one way to help move the state and local components of the nation’s public health system closer to the system envisioned in The Future of Public Health (IOM, 1988). Separate sets of tools for governance have been developed and tested. The instruments are available via CDC’s NPHPSP website (, the ASTHO website for the state instrument ( (ASTHO, 2001d), the NACCHO website for the local instrument ( (NACCHO, 2001f), and the NALBOH website for the governance instrument ( (NALBOH, 2001). Although the program is aimed at assessing the performance of the public health system as a whole, it recognizes that governmental public health agencies have key responsibilities for leading, coordinating, and supporting the efforts of various contributors.

The interest in measuring the performance of the public health system extends to the possibility of establishing a formal process of accreditation to certify that governmental public health agencies are meeting specified levels of performance. Several states have developed or are developing state-specific performance requirements for local governmental public health agencies, but interest has also emerged in the development of nationally standardized, systematic performance evaluations for state and local public health agencies.

No agreement has been reached on the appropriate criteria or process for accreditation. One of the key challenges is to create a system that is flexible enough to accommodate the wide variety of public health department structures and circumstances across states. Given the resource constraints that state and local governmental public health agencies currently face, it is unclear how performance standards can be met or accreditation

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