Achieving More with Less: Three Strategies for States to Obtain Public Health Accreditation

April 30, 2018|11:31 a.m.| Performance Improvement, Research, and Evaluation

As of April 2018, over 214 million Americans are benefiting from being served by a Public Health Accreditation Board (PHAB) accredited public health agency, including 30 states and the District of Columbia.   Accreditation has been identified as the gold standard in public health practice as it provides a data-driven framework for agencies to streamline processes, improve performance, and implement evidence-based strategies to advance the health of the populations they serve. Although the activities required to become accredited by PHAB were developed to ensure agencies are providing the 10 Essential Public Health Services, limited financial resources exist to support agencies on this meaningful endeavor. Resources are necessary for health agencies to complete the work to meet PHAB’s standards, prepare for accreditation, including documentation preparation, and to pay for the associated fees.  Initially, many states used CDC’s National Public Health Improvement Initiative for this funding; however, since the program’s termination in 2014, agencies are required to use innovative strategies to accomplish the work.

Outlined below are three such strategies that public health agencies can use to complete the programmatic and administrative activities required for accreditation.

1.  Increase your agency’s workforce and capacity, without hiring full-time staff.

Establishing mutually beneficial relationships with academic institutions and learning centers can increase an agency’s workforce and capacity to accomplish accreditation-related activities without hiring staff. Each summer, the Wisconsin Division of Public Health (WDPH) at the Wisconsin Department of Health Services works with the University of Wisconsin and the Wisconsin Area Health Education Centers to bring on two full-time interns within the division. For six weeks, interns work closely with staff to collect documentation for PHAB standards and measures, provide training, and develop communication mechanisms for accreditation activities. Susan Uttech, director of state public health accreditation for WDPH says, “the extensive communication efforts and products developed [with the assistance of interns] would have been hard to do without help in a timely manner.”

CDC’s Public Health Associate Program (PHAP), a competitive, two-year, paid training program offers a similar solution to hosting interns. Public health agencies seeking long-term assistance with accreditation activities may apply to become a host site for one or more PHAP associates. The Guam Department of Public Health and Social Services (DPHSS) was selected to host an onsite associate for two years. The associate works closely with Guam’s Performance Improvement Management Office to increase their capacity and prepare for accreditation, specifically with development of their accreditation roadmap, community health assessment, community health improvement plan, organizational strategic plan, quality improvement and performance management system. States, including New Mexico, Virginia, and Washington, have also utilized a PHAP to support their accreditation work. Increased capacity within the department, such as with WDPH and Guam DPHSS, can streamline processes and accelerate accreditation-related activities.

2.  Partner with others and work collaboratively to accomplish accreditation-related activities.

Due to the current public health funding landscape, state health agencies must come up with innovative approaches that are not only cost-effective, but also increase efficiency and productivity. The Ohio Department of Health (ODH) approached this via cross-jurisdictional resource sharing and collaboration by partnering with local health departments to develop several of the state’s key plans for accreditation. The collaboration is a result of the state’s recent push towards aligning state and local priorities, interest in expanding their partner networks, and support of state and local accreditation activities. This collaborative approach positively impacted several accreditation-related activities in Ohio, as well as their ability to better serve their community.

Other states are using similar collaborative approaches to partner with other entities, including non-governmental public health organizations, such as ASTHO, to advance health departments accreditation activities. Specifically, state and territorial health agencies can take advantage of ASTHO’s cost-free technical assistance (TA) through their CDC supported Accreditation Readiness and Performance Improvement Technical Assistance to States or Accreditation Support Initiatives. In addition, ASTHO offers opportunities to connect health agencies with tools, resources, and peers that are working towards or have achieved accreditation.

3.  Leverage new and/or existing funding opportunities.

Finally, recognizing that accreditation-related activities are cross-cutting, several states found creative ways to draw on new and/or existing funding opportunities for financial support. For example, several states have implemented a cost-sharing approach, allowing a portion of each program’s budget to help fund accreditation work. This approach can be used to fund staff time or purchases (such as performance management software) needed to complete accreditation-related activities.

In addition to cost-sharing, some states are utilizing existing resources, such as the Preventive Health and Health Services Block Grant and the Title V - Maternal and Child Health Block Grant to conduct and implement specific accreditation activities, such as a state health improvement plan (SHIP) and to pay the application and annual fees to PHAB. States can also consider opportunities to include accreditation-related activities in their new funding proposals, for example, using environmental health funds to meet preparedness-related standards. Through this approach, states are linking internal quality improvement initiatives to programmatic activities, and are finding opportunities to include programmatic priorities within the agency’s SHIP. This strategy efficiently allocates resources, reduces duplicative efforts across programs, and ensures buy-in and support from staff across the agency.

In summary, public health accreditation is extremely beneficial; however, the resources needed to undertake this effort should not be underestimated. States have found creative ways to meet their resource needs by increasing their workforce and capacity with the help of interns, peers, and organizations such as ASTHO. They have worked collaboratively within their agency and externally with local jurisdictions to align plans and activities, and they have identified creative ways to fund this important work.

This work was supported by funds made available from the Centers for Disease Control and Prevention, Center for State, Tribal, Local and Territorial Support (proposed). The content, findings, and conclusions shared are those of the authors and do not necessarily reflect the official position of or endorsement by the Centers for Disease Control and Prevention.

ASTHO is dedicated to increasing state health agency capacity to improve the performance and quality of the public health system. ASTHO does this by providing technical assistance and resources to states in the areas of accreditation preparation, national performance standards assessment, and quality improvement. If you would like more information, please contact

Jamie Ishcomer, MPH, MSWJamie Ishcomer, MPH, MSW is the Senior Analyst of Quality Improvement and Performance Management at ASTHO.  She supports initiatives related to state, territorial and freely associated state health agency’s performance management, quality improvement and public health accreditation activities. Ishcomer contributed to this article.