Government Booklet A

Local Public Health Governance
Performance Assessment Instrument

Version 2.0

U.S. Department of Health and Human Services
Centers for Disease Control and Prevention

OMB Control No. 0920-0580
Expires: August 31, 2010

THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS PROGRAM

Local Public Health Governance Performance
Assessment Instrument
Version 2.0
Public reporting burden of this collection of information is estimated to average 5 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to a collection of information unless it displays a currently
valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance
Officer, 1600 Clifton Road NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (0920-0580).

Program Partner Organizations

American Public Health Association
www.apha.org

Association of State and Territorial Health Officials
www.astho.org

Centers for Disease Control and Prevention
www.cdc.gov

National Association of County and City Health Officials
www.naccho.org

National Association of Local Boards of Health
www.nalboh.org

National Network of Public Health Institutes
www.nnphi.org

Public Health Foundation
www.phf.org

Governance

Table of Contents
Introduction........................................................................................................iv
Crosswalk of Model Standards...........................................................................vi
Performance Assessment Instrument
	
	

•	 Essential Service 1
Monitor Health Status to Identify Community Health Problems....................... 2

	
	

•	 Essential Service 2
Diagnose and Investigate Health Problems and Health Hazards..................... 5

	
	

•	 Essential Service 3
Inform, Educate, and Empower People about Health Issues........................... 8

	
	

•	 Essential Service 4
Mobilize Community Partnerships to Identify and Solve Health Problems...... 10

	 •	 Essential Service 5
	Develop Policies and Plans that Support Individual
and Community Health Efforts..................................................................... 13
	
	

•	 Essential Service 6
Enforce Laws and Regulations that Protect Health and Ensure Safety........ 16

	 •	 Essential Service 7
	Link People to Needed Personal Health Services
and Assure the Provision of Health Care when Otherwise Unavailable.......... 20
	
	

•	 Essential Service 8	
Assure a Competent Public and Personal Health Care Workforce................. 22

	 •	 Essential Service 9
	Evaluate Effectiveness, Accessibility, and Quality of Personal
and Population-Based Health Services......................................................... 25
	
	

•	 Essential Service 10
Research for New Insights and Innovative Solutions to Health Problems...... 27

Supplemental Questionnaires
Respondent Information Form.......................................................................... 29
Priority Questionnaire....................................................................................... 33

Local Public Health Governance Performance Assessment Instrument

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National Public Health Performance Standards Program
An Introduction to the Local Public Health Governance Performance Assessment Instrument
The National Public Health Performance Standards Program (NPHPSP) assessments are intended to help users answer questions
such as “What are the activities and capacities of our public health system?” and “How well are we providing the Essential Public
Health Services in our jurisdiction?” The dialogue that occurs in answering these questions can help to identify strengths and
weaknesses and determine opportunities for improvement.
The NPHPSP is a partnership effort to improve the practice of public health and the performance of public health systems.
The NPHPSP assessment instruments guide state and local jurisdictions in evaluating their current performance against a set
of optimal standards.
Three assessment instruments have been designed to assist state and local partners in assessing and improving their public
health systems or boards of health. These instruments are the:
• State Public Health System Performance Assessment Instrument,
• Local Public Health System Performance Assessment Instrument, and
• Local Public Health Governance Performance Assessment Instrument.
The three instruments were first released
in 2002 after a comprehensive developThe NPHPSP is a collaborative effort of seven national partners:
ment and testing process. Since the
NPHPSP began, 21 states and almost
• Centers for Disease Control and Prevention, Office of Chief
1,000 localities (over 750 local jurisdicof Public Health Practice (CDC/ OCPHP)
tions and almost 200 boards of health)
• American Public Health Association (APHA)
have used the instruments and submitted
data. One or more of the NPHPSP instru• Association of State and Territorial Health Officials (ASTHO)
ments have been applied in 30 states.
• National Association of County and City Health Officials
In late 2005, the NPHPSP partnership
(NACCHO)
initiated a collaborative effort to update
the instruments, in order to ensure the
• National Association of Local Boards of Health (NALBOH)
standards remain current and to seek
• National Network of Public Health Institutes (NNPHI)
opportunities for improving the tools.
Similar to the development process of the
• Public Health Foundation (PHF)
original instruments, the effort was guided
by three work groups of practitioners from
the field. Input from field test sites as well as subject matter experts on a variety of public health topics further informed the revisions. The “Version 2” instrument presented in this document is the result of this initiative.

About the Performance Assessment Instruments
Each of the three NPHPSP instruments is based on the framework of the ten Essential Public Health Services. The Essential
Services represent the spectrum of public health activities that should be provided in any jurisdiction. Therefore, the instrument
itself is divided into ten sections – one for each of the Essential Services.
Because many entities contribute to delivering the Essential Services, the NPHPSP addresses the important concept of the
“public health system.” A public health system includes all public, private, and voluntary entities that contribute to the delivery
of the Essential Public Health Services within a given jurisdiction.
The purpose for undertaking a performance assessment is to strengthen and improve the public health system. The standards
were set at the optimal level; for this reason, participating jurisdictions will likely see many differences between their own
performance and the “gold standard” presented in the instruments. System partners should seek to address these weaknesses
and also recognize and maintain areas in which they are strong.
The topics addressed within each of the three instruments are complementary and mutually-supporting, although each instrument
may be used independently of the other. To view how the instruments relate, a side-by-side comparison of the model standard
titles within each instrument follows this introduction. However, because the state public health system, local public health sys-

iv

Local Public Health Governance Performance Assessment Instrument

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tems, and boards of health play important and synergistic roles
in public health within a state, a coordinated application of all
three instruments within the same timeframe is considered ideal.
Findings from a coordinated use of multiple assessments may
more effectively guide statewide efforts to improve public health
practice and performance.

The Local Public Health Governance Performance
Assessment
The audience for this instrument is the local governing body.
Governing bodies have been defined as the individual, board,
council, commission, or other body with legal authority over the
primary governmental public health agency, usually defined
as the health department. The nature of this authority varies
from state to state, and even among jurisdictions within a state,
and may or may not include regulatory authority. In most cases,
however, the governing body assures that an infrastructure
exists within the public health system to protect and promote
health in the community. A governing board does this by assuring that the governmental public health agency and its local
public health system partners have the necessary legal authority,
resources, and policies to provide the Essential Services. The
Local Public Health Governance Instrument assists board
of health members in understanding these important roles and
determining how they can strengthen their ability to oversee
public health within the community. It serves as an educational,
orientation, and improvement tool for boards of health.

Essential Public Health Services
1.	Monitor health status to identify
community health problems.
2.	 D
 iagnose and investigate health problems
and health hazards in the community.
3.	Inform, educate, and empower people
about health issues.
4.	Mobilize community partnerships to identify and solve health problems.
5.	Develop policies and plans that support
individual and community health efforts.
6.	Enforce laws and regulations that protect
health and ensure safety.
7.	 L
 ink people to needed personal health
services and assure the provision of health
care when otherwise unavailable.
8.	Assure a competent public and personal
health care workforce.
9.	Evaluate effectiveness, accessibility and
quality of personal and population-based
health services.
10.	Research for new insights and innovative

This instrument is organized using only one model standard for
solutions to health problems.
each of the ten Essential Services, for a total of ten model
standards. The model standard relates to all aspects of the
governance and oversight activities for each of the Essential
Services. Throughout each of the ten model standards, there is consistent attention to resources and policies needed to support
each Essential Service, as well as the review and evaluation activities that must occur to ensure continuous quality improvement.
Through the assessment process, participants – primarily board of health members and senior local health department staff – will
have an opportunity to discuss and determine how they are performing in comparison to each of the ten model standards. Once
the assessment is completed, sites submit their data to the NPHPSP and receive a report summarizing their results within 24
hours. All of this information – the responses to the assessment questions, the NPHPSP report, and the comments shared during
the dialogue – should be used to improve and strengthen the governing body’s ability to provide oversight for local public health
services.
A variety of technical assistance and training resources are available to assist jurisdictions in undertaking the assessment and
post-assessment performance improvement activities. We encourage users to visit our website or contact the NPHPSP partners
to access these resources.

National Public Health Performance Standards Program Technical Assistance and Support
For general NPHPSP support and technical assistance resources, go to www.cdc.gov/od/ocphp/nphpsp/ or contact
1-800-747-7649 or phpsp@cdc.gov.
For support with the NPHPSP Local Public Health Governance Assessment, users may also contact NALBOH–
www.nalboh.org or 419-353-7714.

Local Public Health Governance Performance Assessment Instrument



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Crosswalk of Model Standards Within the Three NPHPSP Instruments

State Public Health System
Assessment

Essential Services
1. Monitor health status to
identify community health
problems.

2. Diagnose and investigate
health problems and health
hazards in the community.

1.1 Planning and Implementation

1.1 Population-Based
Community Health Profile

1.2 State-Local Relationships
1.3 Performance Management
and Quality Improvement

1.2 Current Technology to
Manage and Communicate
Population Health Data

1.4 Public Health Capacity and
Resources

1.3 Maintenance of Population
Health Registries

2.1 Planning and Implementation

2.1 Identification and Surveillance of Health Threats

2.2 State-Local Relationships

2.2 Investigation and
Response to Public Health
Threats and Emergencies

2.3 Performance Management
and Quality Improvement

3. Inform, educate, and
empower people about
health issues.

Local Public Health System
Assessment

2.4 Public Health Capacity and
Resources

2.3 Laboratory Support for
Investigation of Health
Threats

3.1 Planning and
Implementation

3.1 Health Education and
Promotion

3.2 State-Local Relationships

3.2 Health Communication

3.3 Performance Management
and Quality Improvement

3.3 Risk Communication

Local Public Health
Governance Assessment
1. Oversight for Community
Health Status Monitoring

2. Oversight for Public Health
Surveillance and Response

3. Oversight of Public Health
Information, Education and
Empowerment Activities

3.4 Public Health Capacity and
Resources
4. Mobilize community partnerships to identify and solve
health problems.

4.1 Planning and Implementation

4.1 Constituency Development
4.2 Community Partnerships

4.2 State-Local Relationships

4. Oversight for Constituency
Development and Partnership Building

4.3 Performance Management
and Quality Improvement
4.4 Public Health Capacity and
Resources
5. Develop policies and plans
that support individual and
community health efforts.

5.1 Planning and Implementation

5.1 Governmental Presence
at the Local Level

5.2 State-Local Relationships

5.2 Public Health
Policy Development

5.3 Performance Management
and Quality Improvement
5.4 Public Health Capacity and
Resources

5. Oversight of Public Health
Planning and Policy
Development

5.3 Community Health
Improvement Process
and Strategic Planning
5.4 Plan for Public
Health Emergencies

vi

Local Public Health Governance Performance Assessment Instrument

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Crosswalk of Model Standards Within the Three NPHPSP Instruments

Essential Services
6. Enforce laws and regulations that protect health and
ensure safety.

State Public Health System
Assessment
6.1 Planning and Implementation
6.2 State-Local Relationships
6.3 Performance Management
and Quality Improvement
6.4 Public Health Capacity and
Resources

7. Link people to needed
personal health services
and assure the provision of
health care when otherwise
unavailable.

7.1 Planning and
Implementation
7.2 State-Local Relationships
7.3 Performance Management
and Quality Improvement
7.4 Public Health Capacity
and Resources

8. Assure a competent public
health and personal health
care workforce.

8.1 Planning and
Implementation

Local Public Health System
Assessment
6.1 Review and Evaluation
of Laws, Regulations,
and Ordinances

Local Public Health
Governance Assessment
6. Oversight of Enforcement
of Public Health Laws and
Regulations

6.2 Involvement in the
Improvement of Laws,
Regulations, and
Ordinances
6.3 Enforcement of Laws,
Regulations, and
Ordinances
7.1 Identification of Personal
Health Service Needs
of Populations

7. Oversight for Public Health
Outreach and Linkage to
Personal Health Services

7.2 Assuring the Linkage
of People to Personal
Health Services

8.2 State-Local Relationships

8.1 Workforce Assessment,
Planning, and
Development

8.3 Performance Management
and Quality Improvement

8.2 Public Health Workforce
Standards

8.4 Public Health Capacity and
Resources

8.3 Life-Long Learning Through
Continuing
Education, Training,
and Mentoring

8. Oversight of Public Health
Workforce Issues

8.4 Public Health Leadership
Development
9. Evaluate the effectiveness,
accessibility, and quality
of personal and populationbased health services.

9.1 Planning and
Implementation

9.1 Evaluation of PopulationBased Health Services

9.2 State-Local Relationships

9.2 Evaluation of Personal
Health Services

9.3 Performance Management
and Quality Improvement
9.4 Public Health Capacity
and Resources

10. Research for new insights
and innovative solutions
to health problems.

9.3 Evaluation of the Local
Public Health System

10.1 Planning and
Implementation

10.1 Fostering Innovation

10.2 State-Local Relationships

10.2 Linkage with Institutions
of Higher Learning and/or
Research

10.3 Performance
Management and Quality
Improvement
10.4 Public Health Capacity
and Resources

9. Oversight and Evaluation for
Personal and Populationbased Health Services

10. Oversight of Public Health
Innovation and Research

10.3 Capacity to Initiate or
Participate in Research

Local Public Health Governance Performance Assessment Instrument

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Performance Assessment Instrument

Local Public Health Governance Performance Assessment Instrument



Governance

Essential Service #1: Monitor Health Status to Identify Community Health Problems
This service includes:
• Accurate, periodic assessment of the community’s health status, including:
- Identification of health risks, determinants of health, and determination of health service needs;
- Attention to the vital statistics and health status indicators of groups that are at higher risk than the total
population; and
	
- Identification of community assets that support the local public health system (LPHS) in promoting health and
improving quality of life.
	
	

• Utilization of appropriate methods and technology, such as geographic information systems (GIS), to interpret and
communicate data to diverse audiences.
• Collaboration among all LPHS components, including private providers and health benefit plans, to establish and use
population health registries, such as disease or immunization registries.

Governance Model Standard 1: Oversight for Community Health Status Monitoring
Community health status monitoring includes the identification of and access to community health data,
analysis of data, development of a community health profile, and maintenance of population health registries. The governing body provides oversight and support to assure that a collaborative and effective community health status monitoring process in place. Many entities, including but not limited to the local health
department, may contribute to the collection and monitoring of health status data.
To accomplish this, the governing body:
• Assesses and facilitates access to appropriate resources for community health status monitoring.
• Promotes broad-based participation and coordination among all entities active in collecting,
analyzing, and disseminating community health status data.
• Provides oversight and support for community health status monitoring efforts.
• Conducts a process for review and improvement of health status monitoring efforts.



Local Public Health Governance Performance Assessment Instrument

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Please answer the following questions related to Essential Service #1 from
the perspective of the Board of Health (BOH) or other governing body:
1.1 Does the BOH periodically assess the availability of resources necessary for
community health status monitoring?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

1.2 Does the BOH promote broad-based participation among individuals and
organizations active in collecting, analyzing, and disseminating community
health status data?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

1.3 Does the BOH support activities necessary for effective and broad-based
health status monitoring?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

1.1 Discussion Toolbox
In considering 1.1, does the BOH assess the availability
of resources, including:
q Financial resources?
q Personnel resources and expertise?
q Technological resources (e.g., geographic information systems)?

	

	
	

1.1.1 Does the BOH advocate for changes in resource allocation,
as appropriate, to support community health status monitoring?

1.3.1 Does the BOH support the establishment and/or adherence
to standards or guidelines for the local health department’s role
in data collection, sharing, and reporting?
1.3.2 Does the BOH encourage the use of a broad-based set of data
in developing a community health profile?

1.3.2 Discussion Toolbox
In considering 1.3.2, are the following data used:
q Community demographics characteristics?
q Community socioeconomic characteristics?
q Health resource availability data?
q Quality of life data for the community?
q Behavioral risk factors for the community?
q Community environmental health indicators?
q Social and mental health data?
q Maternal and child health data?
q Death, illness, and/or injury data?
q Communicable disease data?
q Sentinel events data for the community?

	

1.3.3 Does the BOH support the local health department’s role in maintaining
and/or contributing to population health registries?

Local Public Health Governance Performance Assessment Instrument



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1.4 Does the BOH review health status monitoring activities?
	
	
Does the BOH:
	
1.4.1 Periodically review reports (i.e., every 1-3 years) on the community’s
health (community health profile)?
	
1.4.2 Review and update, as appropriate, policies describing the
frequency or quality of community health status data collections?
	
1.4.3 Develop a written plan for the continuous improvement of community
health monitoring efforts?



NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

Local Public Health Governance Performance Assessment Instrument

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Essential Service #2: Diagnose and Investigate Health Problems and Health Hazards
in the Community
This service includes:
• Epidemiologic investigations of disease outbreaks, patterns of infections, chronic diseases, injuries, environmental hazards,
and other health threats.
• Active infectious disease epidemiology programs.
• Access to a public health laboratory capable of conducting rapid screening and high volume testing.

Governance Model Standard 2: Oversight for Public Health Surveillance and Response
The governing body is responsible for assuring that the community is adequately served by a public health
laboratory and an active infectious disease epidemiology program with the technical capacity sufficient
to conduct appropriate epidemiologic investigations.
To accomplish this, the governing body:
• Assesses and facilitates access to appropriate resources for public health surveillance and response.
• Establishes and oversees the implementation of policies to ensure the diagnosis and investigation
of health threats in the community, including public health emergency response.
• Promotes collaboration among all relevant groups for the diagnosis and investigation of health threats
to the community.
• Periodically reviews these activities and reports its conclusions and recommendations to the community.

Local Public Health Governance Performance Assessment Instrument



Governance

Please answer the following questions related to Essential Service #2 from
the perspective of the Board of Health (BOH) or other governing body:
2.1 Does the BOH assess the availability of resources for diagnosis and
investigation of health threats in the community?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

2.1 Discussion Toolbox
In considering 2.1, does the BOH assess the availability
of resources including:
q Appropriately licensed and/or accredited public health and
other laboratories?
q Appropriate epidemiologic expertise?
q Financial resources?
q Personnel resources?
q Technological resources?

	

2.1.1 Does the BOH advocate for changes in resource allocation,
as appropriate, for the diagnosis and investigation of health threats?

2.2 Does the BOH establish and oversee the implementation of policies that
support the diagnosis and investigation of health threats?
	

2.2.1 Are there policies for addressing efforts to diagnose and investigate
health threats?

2.2.1 Discussion Toolbox
In considering 2.2.1, do policies include:
q Guidelines for the collection of reportable disease
information from community health professionals?
q Establishment of a comprehensive surveillance system?
q Integration of surveillance systems with national and state
systems?
q Access to laboratory services?



Local Public Health Governance Performance Assessment Instrument

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2.2.2 Are there policies for addressing public health emergencies?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

2.2.2 Discussion Toolbox
In considering 2.2.2, do policies address:
q Individuals, agencies, and organizations that are authorized
to respond to public health emergencies?
q Maintenance of an up-to-date public health emergency
response plan?
qM
 aintenance of an up-to-date listing of those individuals,
agencies or organizations with current contact information?
q Review of the source of legal authority (e.g., regulatory code
section or contract provision) authorizing each individual,
agency, or organization to engage in emergency response
activities?

2.3 Does the BOH promote collaboration among individuals, agencies, and
organizations regarding issues of diagnosis and investigation of health threats?
2.4 Does the BOH periodically review (i.e., every 1-3 years) the adequacy
of laboratory services, infectious disease epidemiologic programs, and public
health surveillance and response capacity?
	

2.4.1 Does the BOH issue written reports on the current status and needed
improvements in these services, programs, and capacities?

Local Public Health Governance Performance Assessment Instrument



Governance

Essential Service #3: Inform, Educate, and Empower People about Health Issues
This service includes:
• Health information, health education, and health promotion activities designed to reduce health risk and promote better
health.
• Health communication plans and activities such as media advocacy and social marketing.
• Accessible health information and educational resources.
• Health education and health promotion program partnerships with schools, faith communities, work sites, personal care
providers, and others to implement and reinforce health promotion programs and messages.

Governance Model Standard 3: Oversight of Public Health Information, Education, and
Empowerment Activities
The informing, educating, and empowering of people about health issues depend on the governing body
assuring the implementation of appropriate health education and community-based health promotion
activities.
To accomplish this, the governing body:
• Assesses and facilitates access to national, state, and local resources that could be used in support
of these activities.
• Establishes and oversees the implementation of policies to support activities to inform, educate, and
empower people about public health issues.
• Reviews these activities in light of community needs, including assuring that all population subgroups
have an opportunity to provide input on community health issues.



Local Public Health Governance Performance Assessment Instrument

Governance

Please answer the following questions related to Essential Service #3 from
the perspective of the Board of Health (BOH) or other governing body:
3.1 Does the BOH assess the availability of national, state, or local resources
required for community health education and promotion programs?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

3.1 Discussion Toolbox
In considering 3.1, does the BOH assess the availability of:
q Financial resources?
q Personnel resources?
q Technological resources?

	

3.1.1 Does the BOH advocate for changes in resource allocation,
as appropriate, for community health education and promotion
programs?

3.2 Does the BOH establish and oversee the implementation of policies in support
of health education and promotion programs?
	
	
Does the BOH oversee the implementation of:
	
3.2.1 Policies or guidelines for health education and promotion programs?

3.2.1 Discussion Toolbox
In considering 3.2.1, do policies/guidelines assure that programs:
q Are appropriate for their intended audience (e.g., culture, age,
language, gender, race/ethnicity, socioeconomic status, sexual
orientation)?
q Are designed to reach their intended audience
in different settings (e.g., personal health care delivery
locations, work sites, schools, neighborhoods,
recreational facilities, places of worship, correctional facilities)?

	

3.2.2 Policies or guidelines for risk communication during public health
emergencies?

3.3 Does the BOH periodically review (i.e., every 1-3 years) public health
education and promotion activities?

3.3 Discussion Toolbox
In considering 3.3, does the BOH recommend that:
q Various types of mechanisms are used for gathering input
(email, websites, forums, annual meetings, etc.) on health
issues from the community?
q All population subgroups have an opportunity to provide input
and feedback?

Local Public Health Governance Performance Assessment Instrument



Governance

Essential Service #4: Mobilize Community Partnerships to Identify and Solve Health Problems
This service includes:
• Identifying potential stakeholders who contribute to or benefit from public health and increasing their awareness of the
value of public health.
• Building coalitions to draw upon the full range of potential human and material resources to improve community health.
• Convening and facilitating partnerships among groups and associations (including those not typically considered
to be health-related) in undertaking defined health improvement projects, including preventive, screening, rehabilitation,
and support programs.

Governance Model Standard 4: Oversight for Constituency Development and Partnership
Building
The governing body is responsible for creating a supportive environment that assures traditional and
non-traditional partnerships are nurtured in order to draw on the full range of potential human and material
resources in the cause of community health.
To accomplish this, the governing body:
• Assesses and facilitates access to resources for constituency development and partnership building
activities.
• Establishes and oversees the implementation of policies to support constituency development and
partnership building.
• Encourages constituency development and partnership building.
• Reviews these activities and provides relevant feedback to its constituents and the community at large.

10

Local Public Health Governance Performance Assessment Instrument

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Please answer the following questions related to Essential Service #4 from
the perspective of the Board of Health (BOH) or other governing body:
4.1 Does the BOH assess resources for constituency development and
partnership building activities?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

4.1 Discussion Toolbox
In considering 4.1, does the BOH assess the availability of:
q National resources?
q State resources?
q Local resources?

	
	

4.1.1 Does the BOH advocate for changes in resource allocation, as appropriate, to support constituency development and partnership building?
4.1.2 Does the BOH foster coordination of resources for these activities?

4.2 Does the BOH establish and oversee the implementation of policies in support
of public health constituency development or partnership building?

4.2 Discussion Toolbox
In considering 4.2, do policies support:
q Establishment of local or regional health improvement
coalitions?
q Maintenance of a publicly accessible and current
directory of organizations that comprise the local public
health system (LPHS)?
q Processes for identifying key constituents for population
-based health?

4.3 Does the BOH recognize and encourage community participation among
constituents?

4.3 Discussion Toolbox
In considering 4.3, does the BOH:
q Acknowledge constituents’ work?
q Participate in constituents’ meetings?
q Invite constituents to participate in Board meetings?
q Recognize LPHS partners for their commitment and role
in addressing public health goals and objectives?
q Identify and promote the participation of emerging
leaders?

Local Public Health Governance Performance Assessment Instrument

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Governance

4.4 Does the BOH periodically review (i.e., every 1-3 years) public health
constituency development and partnership building activities?
	
	
	
	

12

Does the BOH:
4.4.1 Provide feedback directly to LPHS partners on community
mobilization around health issues?
4.4.2 Recognize LPHS partners for their commitment and role
in addressing public health goals and objectives?
4.4.3 Review the effectiveness of partnership participation in solving
health problems?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

Local Public Health Governance Performance Assessment Instrument

Governance

Essential Service #5: Develop Policies and Plans that Support Individual and Community Health Efforts
This service includes:
• Effective local public health governance.
• Development of policy, codes, regulations, and legislation to protect the health of the public and
to guide the practice of public health.
• Systematic local public health system (LPHS) and state-level planning for health improvement in all jurisdictions.
• Alignment of LPHS resources and strategies with community health improvement plans.

Governance Model Standard 5: Oversight of Public Health Planning and Policy Development
Effective oversight in public health requires that individual members of the governing body within a local
jurisdiction understand, exercise, and advocate for the authority to improve public health within the
framework of a statutory charter, mission statement, or other similar strategic planning statement.
To accomplish this, the governing body:
• Maintains and annually assures the availability of appropriate documentation such as a statutory charter
describing its legal authority.
• Maintains and annually reviews documentation of its mission statement or other strategic planning
statement.
• Assesses and advocates for adequate resources and organizational support for the local health
department’s contributions to the provision of Essential Public Health Services.
• Supports planning processes for community health improvement and works to strategically align
community resources for these activities.
• Supports planning processes for all-hazards emergency response and works to strategically align
community resources for related activities.

Local Public Health Governance Performance Assessment Instrument

13

Governance

Please answer the following questions related to Essential Service #5 from
the perspective of the Board of Health (BOH) or other governing body:
5.1 Does the BOH have appropriate documentation (e.g., statutory charter)
describing its legal authority?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

5.1 Discussion Toolbox
In considering 5.1, does documentation include:
q A description of the legal responsibilities of the BOH?
q A description of the policy-making and oversight responsibilities of the BOH?
q A description of the rules and procedures of the BOH?
q A description of the duties and responsibilities of any boards
or committees appointed by the BOH?

	

5.1.1 Does the BOH periodically review and update, as appropriate, this
documentation?

5.2 Does the BOH have a mission statement or other similar strategic planning
statement (or other guidance appropriate for overseeing local health
department operations)?

5.2 Discussion Toolbox
In considering 5.2, do the materials include:
q Vision statement?
q Mission statement?
q Goals and objectives?
q Strategic plan?

	

5.2.1 Does the BOH annually review these materials?

5.3 Does the BOH assess the availability of adequate resources and organizational
support necessary to develop public health plans and policies?

5.3 Discussion Toolbox
In considering 5.3, does the BOH assess the availability of:
q Financial resources?
q Personnel resources?
q Technological resources?

	

14

5.3.1 Does the BOH advocate for changes in resource allocation,
as appropriate, to conduct planning and policy development?

Local Public Health Governance Performance Assessment Instrument

Governance

5.4 Does the BOH support a community health improvement process?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

5.4 Discussion Toolbox
In considering 5.4, does the BOH:
q Establish written policies supporting the community health
improvement process?
q Set goals and objectives in coordination with the local health
department for protecting and improving individual and
community health status?
q Encourage the local health department and its partners to use
a community health improvement process such as MAPP?
q Assure that all relevant individuals, agencies, and organizations
have the opportunity to participate in the community health
improvement process?
q Assure that the process leads to a strategic alignment
of resources to improve community health?

	

5.4.1 Does the BOH periodically review and update, as appropriate, the
community health improvement process?

5.5 Does the BOH support the establishment of an all-hazards emergency
response plan?

5.5 Discussion Toolbox
In considering 5.5, does the BOH oversee activities to:
q Describe the roles, functions and responsibilities of LPHS and
other entities in the event of a public health emergency?
q Establish a task force to develop and maintain an emergency
response plan?
q Test the plan at least every two years?

	

5.5.1 Does the BOH periodically review and update, as appropriate, the
all-hazards emergency response plan?

Local Public Health Governance Performance Assessment Instrument

15

Governance

Essential Service #6: Enforce Laws and Regulations that Protect Health and Ensure Safety
This service includes:
• Assurance of due process and recognition of individuals’ civil rights in all procedures, enforcement of laws and regulations,
and public health emergency actions taken under the board of health or other governing body’s authority.
• Review, evaluation and revision of laws and regulations designed to protect health and safety, reflect current scientific
knowledge, and utilize best practice for achieving compliance.
• Education of persons and entities obligated to obey and agencies obligated to enforce laws and regulations to encourage
compliance.
• Enforcement activities in a wide variety of areas of public health concern under authority granted by local, state and federal
rule or law including, but not limited to: abatement of nuisances, animal control, childhood immunizations and other
vaccinations, food safety, housing code, local sanitary code, on site wastewater disposal (septic systems), protection
of drinking water, school environment, solid waste disposal, swimming pool and bathing area safety and water quality,
tobacco control, enforcement activities during emergency situations, and vector control.

Governance Model Standard 6: Oversight of Enforcement of Public Health Laws and
Regulations
The governing body is responsible for assuring that public health laws, rules and regulations designed
to protect the health of the community are appropriately adopted, disseminated, evaluated, improved, and
enforced. All enforcement activities must be timely and complete.
To accomplish this, the governing body:
• Knows that appropriate legal authority exists for the adoption, dissemination, evaluation, improvement,
and enforcement of laws, rules, and regulations designed to protect the health of the community.
• Assures that its bylaws, rules, and procedures comply with local, state, and federal statutes and
regulations.
• Assesses and advocates for national, state, and local resources, including access to legal counsel, that
could be used for public health inspection and enforcement activities.
• Advocates for the enactment and retention of beneficial laws, rules, and regulations.
• Periodically reviews laws, rules, and regulations that include the participation of persons and groups that
benefit from particular legal requirements as well as those who are regulated and may oppose particular
legal requirements.

16

Local Public Health Governance Performance Assessment Instrument

Governance

Please answer the following questions related to Essential Service #6 from
the perspective of the Board of Health (BOH) or other governing body:
6.1 Is the BOH knowledgeable about the sources of authority (regulatory code
section, contract language, etc.) regarding laws, rules, and regulations
designed to protect the public’s health?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

6.2 Does the BOH have statutory authority to enact laws, rules, and regulations?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

	
	

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

	

6.1.1 Does the BOH understand the actions necessary to establish and
amend laws, rules, and regulations designed to protect the public’s
health?

6.1.1 Discussion Toolbox
In considering 6.1.1, does the BOH know the sources
of authority for:
q The enactment of laws, rules, and regulations?
q The dissemination of laws, rules, and regulations?
q The evaluation of laws, rules, and regulations?
q The improvement of laws, rules, and regulations?
q The enforcement of laws, rules, and regulations?

	

6.1.2 Does the BOH assure the existence of laws, rules, and regulations in
areas known to affect public health?

6.1.2 Discussion Toolbox
In considering 6.1.2, are laws, rules, and regulations
assured for:
q Abatement of nuisances?
q Animal control?
q Childhood immunizations and other vaccines?
q Food safety?
q Housing code?
q Local sanitary code?
q Septic systems?
q Protection of drinking water?
q School environment?
q Solid waste disposal?
q Swimming pools?
q Water quality?
q Vector control?

Does the BOH:
6.2.1 Periodically review its statutory authority?

Local Public Health Governance Performance Assessment Instrument

17

Governance

	

6.2.2 Assure that its bylaws, rules and procedures comply with local, state,
and federal statutes and regulations?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

6.2.2 Discussion Toolbox
In considering 6.2.2, does the BOH assure:
q Due process and civil rights protections for all who come
under the jurisdiction?
q The keeping of records of decisions and actions,
minutes of meetings, correspondence and other materials and
the timely provision of copies to members of the public upon
legal request?
q Compliance with open meeting laws?
q Proper conduct of public hearings, including posting,
conducting, and the reporting of decisions?

	

6.2.3 Understand the laws, regulations, and procedures applicable
in extraordinary or emergency situations?

6.2.3 Discussion Toolbox
In considering 6.2.3, is there a full understanding of laws,
regulations, and procedures applicable to:
q Quarantine?
q Compulsory treatment?
q Rationing of treatment?
q Civil commitment?
q Seizure, appropriation, entry into or condemnation
of private property?

	

6.2.4 Assure the enforcement of the laws, rules, and regulations under its
authority?

6.3 Does the BOH assess the availability of resources that could be used for the
inspection and enforcement activities designed to protect the health of the
community?

6.3 Discussion Toolbox
In considering 6.3, does the BOH assess the availability of:
q National resources?
q State resources?
q Local resources?

	
	

18

6.3.1 Does the BOH advocate for changes in resource allocation,
as appropriate, to conduct inspection and enforcement activities?
6.3.2 Does the BOH have access to legal counsel?

Local Public Health Governance Performance Assessment Instrument

Governance

6.4 Does the BOH routinely advocate for laws and regulations that protect health
and ensure safety?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

	

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

6.4.1 Does the BOH adopt written resolutions to this effect?

6.5 Does the BOH periodically review the laws, rules, and regulations designed
to protect the health of the community?
	
	
	

Does the BOH include in its review:
6.5.1 The participation of those that benefit from the laws, rules, and
regulations in the evaluation?
6.5.2 The participation of those who are being regulated by the laws, rules,
and regulations?

Local Public Health Governance Performance Assessment Instrument

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Governance

Essential Service #7: Link People to Needed Personal Health Services and Assure the Provision
of Health Care When Otherwise Unavailable
This service includes:
• Assuring the identification of populations with barriers to personal health services.
• Assuring identification of personal health service needs of populations with limited access to a coordinated system
of clinical care.
• Assuring the linkage of people to appropriate personal health services through coordination of provider services and
development of interventions that address barriers to care (e.g., culturally and linguistically appropriate staff and materials,
transportation services).

Governance Model Standard 7: Oversight for Public Health Outreach and Linkage to Personal
Health Services
The governing body works to assure a supportive environment for the coordination of outreach and
enabling services designed to facilitate access, service linkage, “care management,” transportation, and
information for the entire community, with special attention to those who experience barriers to care.
To accomplish this, the governing body:
• Identifies individuals, agencies, or organizations involved in, or responsible for, the coordination
of services.
• Assesses and advocates, as appropriate, for national, state, and local resources – public and private
– necessary to facilitate access to needed services for the entire community.
• Establishes and oversees the implementation of policies supporting outreach to vulnerable populations
and strategies for linking them to personal health services.
• Conducts periodic reviews of outreach and linkage activities with special attention to services for
vulnerable populations.

20

Local Public Health Governance Performance Assessment Instrument

Governance

Please answer the following questions related to Essential Service #7 from
the perspective of the Board of Health (BOH) or other governing body:
7.1 Does the BOH identify those individuals, agencies, and organizations
responsible for the coordination of needed outreach and linkage to personal
health services?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

7.2 Does the BOH assess the availability of resources necessary to facilitate
access to needed services for the entire community?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

	7.2.1 Does the BOH advocate for changes in resource allocation,
as appropriate, for needed personal health services?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

7.3 Does the BOH establish and oversee the implementation of policies supporting
resources for outreach and linkage to personal health services?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

7.2 Discussion Toolbox
In considering 7.2, does the BOH assess the availability of:
q National resources?
q State resources?
q Local resources?
q Private resources?
q Public resources?
q Resources to address vulnerable populations?

7.3 Discussion Toolbox
In considering 7.3, do policies exist concerning:
q Referral systems for needed care?
q Coordinated delivery of services (i.e., services that are
coordinated and co-located to optimize access)?
q Culturally and linguistically appropriate staff to assist
population groups?
q Culturally and linguistically appropriate materials?
q Transportation services for those with special needs?
q Prescription assistance programs?

7.4 Does the BOH periodically review (i.e., every 1-3 years) community
outreach efforts and linkage to personal health services?
	
Does the review:
	7.4.1 Include input and feedback from a wide spectrum of community participants?
	7.4.2 Consider the impact of these efforts on populations most in need within
the community?

Local Public Health Governance Performance Assessment Instrument

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Governance

Essential Service #8: Assure a Competent Public and Personal Health Care Workforce
This service includes:
• Education, training, and assessment of personnel (including volunteers and other lay community health workers) to meet
community needs for public and personal health services.
• Efficient processes for licensure of professionals.
• Adoption of continuous quality improvement and life-long learning programs that include determinants of health.
• Active partnerships with professional training programs to assure community-relevant learning experiences for all students.
• Continuing education in management and leadership development programs for those charged with administrative/
executive roles.

Governance Model Standard 8: Oversight of Public Health Workforce Issues
The governing body is responsible for assuring competence of the local health department workforce, the
availability of workforce training programs for both the workforce personnel and members of the governing
body, and the availability of leadership development programs for those charged with administrative and
executive roles.
To accomplish this, the governing body:
• Assures licensing and credentialing of local health department personnel, including both paid and
volunteer workers.
• Establishes and oversees the implementation of policies designed to assure improvements in workforce,
management, and leadership quality.
• Assesses and facilitates access to national, state and local resources available for workforce instruction,
leadership development and continuing education.
• Provides for the training and continuing education of the board or governing body.
• Reviews the current workforce, including attention to workforce training and education programs, and
workforce assessment.

22

Local Public Health Governance Performance Assessment Instrument

Governance

Please answer the following questions related to Essential Service #8 from
the perspective of the Board of Health (BOH) or other governing body:
8.1 Does the BOH assure compliance with licensure and credentialing requirements
for its public health workforce?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

8.2 Does the BOH establish and oversee the implementation of policies supporting
its public health workforce?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

	
	
	

Do these policies address:
8.2.1 The necessary knowledge, skills, and abilities needed by the public
health workforce?
8.2.2 Written job standard and/or position descriptions for all local health
department staff, including credentialing/licensing requirements?

8.2.1-8.2.2 Discussion Toolbox
In considering 8.2.1-8.2.2, do policies exist for:
q Cultural and linguistic competence?
q Understanding of the Essential Public Health Services?
q Understanding of the core public health competencies?

	
	
	

8.2.3 Activities related to annual performance evaluations of the local health
department staff?
8.2.4 Continuing education for local health department staff?
8.2.5 Leadership development for local health department staff?

8.3 Does the BOH assess the availability of resources that may be used for
workforce training, leadership development, or continuing education?

8.3 Discussion Toolbox
In considering 8.3, does the BOH assess the availability of:
q National resources?
q State resources?
q Local resources?
q Financial resources?
q Personnel resources?
q Technological resources?

	

8.3.1 Does the BOH advocate for changes in resource allocation,
as appropriate, to support these activities?

8.4 Does the BOH provide access to continuing training and education for all
board members?
	
	

8.4.1 Does the BOH routinely support the orientation of new members
of the governing body?
8.4.2 Does the orientation and/or training include information on the core
functions of public health?

Local Public Health Governance Performance Assessment Instrument

23

Governance

	

8.4.3 Does the orientation and/or training include information in governance
responsibilities?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

8.4.3 Discussion Toolbox
In considering 8.4.3, are theses areas addressed:
q Legal responsibilities and authorities?
q Knowledge of the jurisdiction?
q Development of policies?
q Monitoring and evaluation of policies and programs?

	

8.4.4 Does each board member receive written orientation or training
materials (e.g., a new member handbook or manual)?

8.5 Does the BOH review efforts to strengthen its public health workforce?
	
	
	
	

24

Does this include a review of:
8.5.1 Training and continuing education for local health department
personnel?
8.5.2 Leadership development activities for local health department
personnel?
8.5.3 Gaps related to workforce size and composition?

Local Public Health Governance Performance Assessment Instrument

Governance

Essential Service #9: Evaluate Effectiveness, Accessibility, and Quality of Personal and
Population-based Health Services
This service includes:
• Assurance of ongoing evaluation and critical review of health program effectiveness, based on analysis of health status and
service utilization data.
• Assurance of the provision of information necessary for allocating resources and reshaping programs.

Governance Model Standard 9: Oversight and Evaluation for Personal and Population-based
Health Services
The governing body is responsible for the overall quality of Essential Public Health Services provided to the
community, including the scope, timeliness, frequency, and cost-effectiveness of those services, and for
assuring that the results of evaluations are used to improve system performance.
To accomplish this, the governing body:
• Assesses and facilitates access to the necessary resources to conduct periodic evaluations, including
evaluations of the board of health or other governing body itself.
• Assures evaluations of personal and population-based services provided in its jurisdiction.
• Establishes and oversees the implementation of policies supporting evaluations of population-based and
personal health services.
• Encourages all public health constituents and partners within the local public health system (LPHS)
to provide input into evaluation processes.
• Reviews and utilizes evaluation results to improve system performance.

Local Public Health Governance Performance Assessment Instrument

25

Governance

Please answer the following questions related to Essential Service #9 from
the perspective of the Board of Health (BOH) or other governing body:
9.1 Does the BOH assess the availability of resources that could be used
to support evaluation?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

9.1 Discussion Toolbox
In considering 9.1, does the BOH assess:
q Financial resources?
q Personnel resources and expertise?
q Technological resources?
q National resources?
q State resources?
q Local resources?

	

9.1.1 Does the BOH advocate for changes in resource allocation,
as appropriate, to support evaluation activities?

	
9.2 Does the BOH support an evaluation plan for personal and population-based
services?

9.2 Discussion Toolbox
In considering 9.2, are plans developed to evaluate the:
q Scope of service delivery?
q Timeliness of service delivery?
q Frequency of service delivery?
q Cost-effectiveness of service delivery?
q Overall quality of service delivery?

9.3 Does the BOH establish and oversee the implementation of policies
supporting evaluation activities?
	

9.3.1 Does the BOH endorse the use of nationally recognized performance
standards applicable to local public health systems (e.g., National
Public Health Performance Standards Program Local Public Health
System Assessment)?

9.4 Does the BOH identify individuals, agencies, and organizations that should
participate in the evaluation activities?
	

9.4.1 Does the BOH encourage identified individuals, agencies, and
organizations to provide input into evaluation activities?

9.5 Does the BOH review the findings of the evaluations?
	
9.5.1 Does the BOH recommend changes based on evaluation results?
	9.5.2 Does the BOH use the findings in the development of their
strategic and operational plans?

26

Local Public Health Governance Performance Assessment Instrument

Governance

Essential Service #10: Research for New Insights and Innovative Solutions to Health Problems
This service includes:
• Local public health research activities:
- initiating research,
- participating in research by others,
- reporting results, and
- implementing policy based on these results.

	
	
	
	

Governance Model Standard 10: Oversight of Public Health Innovation and Research
The governing body is responsible for nurturing an environment within the community that will support and
encourage innovation ranging from practical field-based efforts that foster change in public health practice
to academic efforts that encourage the development of new topics to guide public health research.
The governing body is responsible for assuring the maintenance of continuous linkages with appropriate
research partners and the development of internal capacity to mount timely epidemiologic investigations
and economic analyses, and to conduct needed health services research.
To accomplish this, the governing body:
• Establishes and oversees the implementation of policies reflecting its commitment to public health
research and innovation activities.
• Encourages collaboration between academic (or other health-research) institutions and local public health
entities to carry out community-based research activities.
• Assesses and facilitates access to resources for research and identification of best practices.
• Encourages the incorporation of research results and best practices into policies and programs
to support the highest current standard of public health practice.

Local Public Health Governance Performance Assessment Instrument

27

Governance

Please answer the following questions related to Essential Service #10 from
the perspective of the Board of Health (BOH) or other governing body:
10.1 Does the BOH establish and oversee the implementation of policies
designed to foster and reward innovation?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

10.2 Does the BOH encourage collaboration between local health department
and academic or other research institutions for community-based research?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

10.3 Does the BOH assess the availability of resources for research and identification of best practices in its jurisdiction?

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

NO

MINIMAL

MODERATE

SIGNIFICANT

OPTIMAL

10.3 Discussion Toolbox
In considering 10.3, do resources include:
q Technical libraries?
q Distance learning?
q Online resources?
q Publication subscriptions?
q Membership to national and state organizations?
q Attendance at national and state conferences?

	

10.3.1 Does the BOH advocate for changes in resource allocation,
as appropriate, to support research and the identification of best
practices?

10.4 Does the BOH encourage appropriate use of research findings and best
practices in the implementation of public health policies and programs?

28

Local Public Health Governance Performance Assessment Instrument