ing). Institutionalization of the assessment process now requires that local health departments respond to local health priorities and maintain services in four basic areas (communicable disease, private sewage, private water, and food protection) rather than offer a standard set of 10 programs specified by the state. IDPH provides training and has developed a data system to better enable local health departments to conduct an effective assessment process.

In developing and implementing McPLAN, the McHenry County Department of Health has applied its experience over the past nine years in performance-based budgeting and community health needs assessment. These processes have been empowering for staff as well as community stakeholders. In the budgeting process, problem statements are developed based on local needs assessment, and indicators are selected to serve as markers for appropriate public health interventions. Staffing and other resources needed to address these problems plus an annual review of the health department's mission and goals become the basis for developing a program budget. Each quarter, a review of indicator status and resource utilization allows further refinement of staffing and resource needs. Under McPLAN, both staff and community representatives are active participants in the process through advisory committees and the Community Health Committee. The health priorities selected for the county through the first application of the McPLAN process were environmental health, unintentional injuries, and cardiovascular disease.

The performance-based budgeting process has been used to incorporate health assessment findings into local public health programming and other stakeholder organization initiatives. The use of such a process over the past nine years in McHenry County has (1) aided in the training, focus, confidence, and perspective of staff; (2) led to a clearer understanding of the roles of the Board of Health, County Board, and related community organizations; (3) allowed movement toward allocation of a more appropriate level of resources to address identified issues (grants, appropriate fees, etc.); (4) led to greater involvement and understanding of other community providers; and (5) resulted in community-wide efforts to address childhood immunizations, improve access to health care for the medically indigent, develop joint grant applications, and begin discussion about a community-wide human services needs assessment in McHenry County.

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