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Honoré PA, Zometa C, Thomas C, Edmiston A. The Public Health Uniform National Data System (PHUND$): A Platform for Monitoring Fiscal Health and Sustainability of the Public Health System. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:366-372. [PMID: 31136510 DOI: 10.1097/phh.0000000000000838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Leaders of government agencies are responsible for stewardship over taxpayer investments. Stewardship strengthens agency performance that is critical to improving population health. Most industries, including health care, and public enterprises, such as education, have policies for uniform data reporting and financial systems for the application of theoretical analytical techniques to organizations and entire systems. However, this is not a mainstreamed practice in local and state government public health. PROGRAM The Public Health Uniform National Data System (PHUND$) is a financial information system for local health departments that advances the application of uniform practices to close financial analytical gaps. A 10-year retrospective overview on the development, implementation, and utility of PHUND$ is provided and supported by documented program and agency improvements to validate the analytical features and demonstrate a best practice. RESULTS Benefits found from utilizing PHUND$ included reducing financial risks, supporting requests for increased revenues, providing comparative analysis, isolating drivers of costs and deficits, increasing workforce financial management skills, enhancing decision-making processes, and fostering agency sustainability to support continuous improvements in quality and population health. The PHUND$ financial data definitions in the data dictionary provided the structure needed for standardized data collection and confirmed the feasibility of a standardized public health chart of accounts. CONCLUSION PHUND$ analysis provided evidence on the relationship between financial and operational performance, as well as informing strategies for managing risks and improving quality. Such analysis is critical to identifying financial and operational problems and essential to mitigating financial crisis, avoiding disruption of services, and fostering agency sustainability. PHUND$ additionally serves as an instrument that can guide development of standards that measure for agency sound financial management systems.
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Affiliation(s)
- Peggy A Honoré
- Louisiana State University Health Sciences Center School of Public Health & School of Medicine, New Orleans, Louisiana (Dr Honoré); Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Zometa and Thomas); and National Association of County & City Health Officials, Washington, District of Columbia (Ms Edmiston)
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Allen P, Jacob RR, Parks RG, Mazzucca S, Hu H, Robinson M, Dobbins M, Dekker D, Padek M, Brownson RC. Perspectives on program mis-implementation among U.S. local public health departments. BMC Health Serv Res 2020; 20:258. [PMID: 32228688 PMCID: PMC7106610 DOI: 10.1186/s12913-020-05141-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health resources are limited and best used for effective programs. This study explores associations of mis-implementation in public health (ending effective programs or continuing ineffective programs) with organizational supports for evidence-based decision making among U.S. local health departments. METHODS The national U.S. sample for this cross-sectional study was stratified by local health department jurisdiction population size. One person was invited from each randomly selected local health department: the leader in chronic disease, or the director. Of 600 selected, 579 had valid email addresses; 376 completed the survey (64.9% response). Survey items assessed frequency of and reasons for mis-implementation. Participants indicated agreement with statements on organizational supports for evidence-based decision making (7-point Likert). RESULTS Thirty percent (30.0%) reported programs often or always ended that should have continued (inappropriate termination); organizational supports for evidence-based decision making were not associated with the frequency of programs ending. The main reason given for inappropriate termination was grant funding ended (86.0%). Fewer (16.4%) reported programs often or always continued that should have ended (inappropriate continuation). Higher perceived organizational supports for evidence-based decision making were associated with less frequent inappropriate continuation (odds ratio = 0.86, 95% confidence interval 0.79, 0.94). All organizational support factors were negatively associated with inappropriate continuation. Top reasons were sustained funding (55.6%) and support from policymakers (34.0%). CONCLUSIONS Organizational supports for evidence-based decision making may help local health departments avoid continuing programs that should end. Creative mechanisms of support are needed to avoid inappropriate termination. Understanding what influences mis-implementation can help identify supports for de-implementation of ineffective programs so resources can go towards evidence-based programs.
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Affiliation(s)
- Peg Allen
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA.
| | - Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Renee G Parks
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Hengrui Hu
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Mackenzie Robinson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, Ontario, L8P 0A1, Canada
| | - Debra Dekker
- National Association of County and City Health Officials (NACCHO), 1201 Eye Street, NW, 4th Floor, Washington, DC, 20005, USA
| | - Margaret Padek
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, 4921 Parkview Place, St. Louis, MO, 63110, USA
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Criteria-Based Resource Allocation: A Tool to Improve Public Health Impact. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 22:E14-20. [PMID: 26247802 DOI: 10.1097/phh.0000000000000319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Resource allocation in local public health (LPH) has been reported as a significant challenge for practitioners and a Public Health Services and Systems Research priority. Ensuring available resources have maximum impact on community health and maintaining public confidence in the resource allocation process are key challenges. A popular strategy in health care settings to address these challenges is Program Budgeting and Marginal Analysis (PBMA). This case study used PBMA in an LPH setting to examine its appropriateness and utility. DESIGN The criteria-based resource allocation process PBMA was implemented to guide the development of annual organizational budget in an attempt to maximize the impact of agency resources. Senior leaders and managers were surveyed postimplementation regarding process facilitators, challenges, and successes. SETTING Canada's largest autonomous LPH agency. RESULTS PBMA was used to shift 3.4% of the agency budget from lower-impact areas (through 34 specific disinvestments) to higher-impact areas (26 specific reinvestments). Senior leaders and managers validated the process as a useful approach for improving the public health impact of agency resources. However, they also reported the process may have decreased frontline staff confidence in senior leadership. CONCLUSIONS In this case study, PBMA was used successfully to reallocate a sizable portion of an LPH agency's budget toward higher-impact activities. PBMA warrants further study as a tool to support optimal resource allocation in LPH settings.
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Leider JP, Resnick B, Bishai D, Scutchfield FD. How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels. Annu Rev Public Health 2018; 39:471-487. [PMID: 29346058 DOI: 10.1146/annurev-publhealth-040617-013455] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The United States has a complex governmental public health system. Agencies at the federal, state, and local levels all contribute to the protection and promotion of the population's health. Whether the modern public health system is well situated to deliver essential public health services, however, is an open question. In some part, its readiness relates to how agencies are funded and to what ends. A mix of Federalism, home rule, and happenstance has contributed to a siloed funding system in the United States, whereby health agencies are given particular dollars for particular tasks. Little discretionary funding remains. Furthermore, tracking how much is spent, by whom, and on what is notoriously challenging. This review both outlines the challenges associated with estimating public health spending and explains the known sources of funding that are used to estimate and demonstrate the value of public health spending.
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Affiliation(s)
- Jonathon P Leider
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205, USA; ,
| | - Beth Resnick
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205, USA; ,
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland 21205, USA;
| | - F Douglas Scutchfield
- Department of Health Services Management, University of Kentucky, Lexington, Kentucky 40536-0003, USA;
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Johnson BL, Tesoriero J, Feng W, Qian F, Martin EG. Cost Analysis and Performance Assessment of Partner Services for Human Immunodeficiency Virus and Sexually Transmitted Diseases, New York State, 2014. Health Serv Res 2017; 52 Suppl 2:2331-2342. [PMID: 28799163 DOI: 10.1111/1475-6773.12748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the programmatic costs of partner services for HIV, syphilis, gonorrhea, and chlamydial infection. STUDY SETTING New York State and local health departments conducting partner services activities in 2014. STUDY DESIGN A cost analysis estimated, from the state perspective, total program costs and cost per case assignment, patient interview, partner notification, and disease-specific key performance indicator. DATA COLLECTION Data came from contracts, a time study of staff effort, and statewide surveillance systems. PRINCIPAL FINDINGS Disease-specific costs per case assignment (mean: $580; range: $502-$1,111), patient interview ($703; $608-$1,609), partner notification ($1,169; $950-$1,936), and key performance indicator ($2,697; $1,666-$20,255) varied across diseases. Most costs (79 percent) were devoted to gonorrhea and chlamydial infection investigations. CONCLUSIONS Cost analysis complements cost-effectiveness analysis in evaluating program performance and guiding improvements.
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Affiliation(s)
- Britney L Johnson
- Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Brookhaven, GA, 30329
| | - James Tesoriero
- New York State Department of Health, AIDS Institute, Albany, NY
| | - Wenhui Feng
- Rockefeller Institute of Government, Albany, NY.,Rockefeller College of Public Affairs & Policy, University at Albany, State University of New York, Albany, NY
| | - Feng Qian
- University at Albany School of Public Health, State University of New York, Rensselaer, NY
| | - Erika G Martin
- Rockefeller Institute of Government, Albany, NY.,Rockefeller College of Public Affairs & Policy, University at Albany, State University of New York, Albany, NY
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Taking a Step Forward in Public Health Finance: Establishing Standards for a Uniform Chart of Accounts Crosswalk. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016. [PMID: 26214536 DOI: 10.1097/phh.0000000000000283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In its 2012 report on the current and future states of public health finance, the Institute of Medicine noted, with concern, the relative lack of capacity for practitioners and researchers alike to make comparisons between health department expenditures across the country. This is due in part to different accounting systems, service portfolios, and state- or agency-specific reporting requirements. The Institute of Medicine called for a uniform chart of accounts, perhaps building on existing efforts such as the Public Health Uniform National Data Systems (PHUND$). Shortly thereafter, a group was convened to work with public health practitioners and researchers to develop a uniform chart of accounts crosswalk. A year-long process was undertaken to create the crosswalk. This commentary discusses that process, challenges encountered along the way and provides a draft crosswalk in line with the Foundational Public Health Services model that, if used by health departments, could allow for meaningful comparisons between agencies.
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McCullough JM, Leider JP, Riley WJ. Local Fiscal Allocation for Public Health Departments. Am J Prev Med 2015; 49:921-9. [PMID: 26165198 DOI: 10.1016/j.amepre.2015.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/25/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We examined the percentage of local government taxes ("fiscal allocation") dedicated to local health departments on a national level, as well as correlates of local investment in public health. METHODS Using the most recent data available--the 2008 National Association of City and County Health Officials Profile survey and the 2007 U.S. Census Bureau Census of Local Governments-generalized linear regression models examined associations between fiscal allocation and local health department setting, governance, finance, and service provision. Models were stratified by the extent of long-term debt for the jurisdiction. Analyses were performed in 2014. RESULTS Average fiscal allocation for public health was 3.31% of total local taxes. In multivariate regressions, per capita expenditures, having a local board of health and public health service provision were associated with higher fiscal allocation. Stratified models showed that local board of health and local health department taxing authority were associated with fiscal allocation in low and high long-term debt areas, respectively. CONCLUSIONS The proportion of all local taxes allocated to local public health is related to local health department expenditures, service provision, and governance. These relationships depend upon the extent of long-term debt in the jurisdiction.
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Affiliation(s)
- J Mac McCullough
- School for the Science of Health Care Delivery, Arizona State University, Phoenix, Arizona.
| | | | - William J Riley
- School for the Science of Health Care Delivery, Arizona State University, Phoenix, Arizona
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Corso PS, Ingels JB, Taylor N, Desai S. Linking costs to health outcomes for allocating scarce public health resources. EGEMS 2014; 2:1128. [PMID: 25848629 PMCID: PMC4371394 DOI: 10.13063/2327-9214.1128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction: Resources for public health (PH) are scarce and policymakers face tough decisions in determining their funding priorities. The difficulty of making these decisions is compounded by current PH accounting systems, which are ill-equipped to link fiscal resources to PH outcomes. This paper examines the types of revenues and expenditures, health services, and health outcomes that are being tracked at the local and state PH levels. The authors provide recommendations for strengthening the ability of local and state governments to link expenditures to PH outcomes, both within and across jurisdictions. Framework and Next Steps: The source of revenue data for most local jurisdictions is the accounting systems used for the budgeting and auditing of fiscal activities, and these are primarily linked to specific PH programs. In contrast, expenditure data are mostly generic and typically span multiple PH programs with no link to specific PH activities. Many challenges exist to then link PH activities to health outcomes data, which are often collected through separate reporting systems at the local, state, and national levels. Policy change at the state level and implementation strategies that are standardized across local health departments are required to assess the costs and health outcomes of PH activities. Conclusion: Information linking PH expenditures to health outcomes of PH services could greatly inform the decision-making process. This information will allow investments in PH to be better understood and will provide a strong foundation for the PH services and systems research community to understand variation and drive improvement. Ultimately, these data could be used to improve accountability at the local and state PH department levels.
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Can Voter-Approved Tax Levies Provide Fiscal Advantages and Stability for Local Public Health Agencies? JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:E14-9. [DOI: 10.1097/phh.0b013e31825b8a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brownson RC, Allen P, Duggan K, Stamatakis KA, Erwin PC. Fostering more-effective public health by identifying administrative evidence-based practices: a review of the literature. Am J Prev Med 2012; 43:309-19. [PMID: 22898125 PMCID: PMC3990249 DOI: 10.1016/j.amepre.2012.06.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CONTEXT The aim of evidence-based decision-making in public health involves the integration of science-based interventions with community preferences to improve population health. Although considerable literature is available on the development and adoption of evidence-based guidelines and barriers to their implementation, the evidence base specific to public health administration is less developed. This article reviews the literature from public health and related disciplines to identify administrative evidence-based practices (A-EBPs; i.e., agency-level structures and activities that are positively associated with performance measures). EVIDENCE ACQUISITION A "review of reviews" was carried out to assess the evidence for the effectiveness of A-EBPs covering the time frame January 2000 through March 2012. The following steps were used: (1) select databases; (2) determine search parameters and conduct the search; (3) screen titles and abstracts; (4) obtain selected documents; (5) perform initial synthesis; (6) abstract data; and (7) synthesize evidence. EVIDENCE SYNTHESIS In both the reviews and original empiric studies, the most common outcome reported was performance of the local health department or local public health system. On the basis of a synthesis of data from 20 reviews, a total of 11 high-priority A-EBPs were identified (i.e., practices that local public health systems potentially can modify within a few years). The A-EBPs covered five major domains of workforce development, leadership, organizational climate and culture, relationships and partnerships, and financial processes. CONCLUSIONS As the body of practice-based research continues to grow and the ability to measure administrative evidence-based practices improves, this initial list can be further developed and improved.
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Affiliation(s)
- Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri 63110, USA.
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Decision science: a scientific approach to enhance public health budgeting. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 16:98-103. [PMID: 20150789 DOI: 10.1097/phh.0b013e3181c87ace] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The allocation of resources for public health programming is a complicated and daunting responsibility. Financial decision-making processes within public health agencies are especially difficult when not supported with techniques for prioritizing and ranking alternatives. This article presents a case study of a decision analysis software model that was applied to the process of identifying funding priorities for public health services in the Spokane Regional Health District. Results on the use of this decision support system provide insights into how decision science models, which have been used for decades in business and industry, can be successfully applied to public health budgeting as a means of strengthening agency financial management processes.
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Honoré PA, Wright D, Berwick DM, Clancy CM, Lee P, Nowinski J, Koh HK. Creating a framework for getting quality into the public health system. Health Aff (Millwood) 2011; 30:737-45. [PMID: 21471496 DOI: 10.1377/hlthaff.2011.0129] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The US health care system has undertaken concerted efforts to improve the quality of care that Americans receive, using well-documented strategies and new incentives found in the Affordable Care Act of 2010. Applying quality concepts to public health has lagged these efforts, however. This article describes two reports from the Department of Health and Human Services: Consensus Statement on Quality in the Public Health System and Priority Areas for Improvement of Quality in Public Health. These reports define what is meant by public health quality, establish quality aims, and highlight priority areas needing improvement. We describe how these developments relate to the Affordable Care Act and serve as a call to action for ensuring a better future for population health. We present real-world examples of how a framework of quality concepts can be applied in the National Vaccine Safety Program and in a state office of minority health.
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Affiliation(s)
- Peggy A Honoré
- Public Health Systems, Finance, and Quality Program in the Office of Healthcare Quality/Office of the Assistant Secretary for Health, Department of Health and Human Services (HHS), Washington, DC, USA.
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Suarez V, Lesneski C, Denison D. Making the case for using financial indicators in local public health agencies. Am J Public Health 2011; 101:419-25. [PMID: 21233438 DOI: 10.2105/ajph.2010.194555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The strength of the public health infrastructure determines the ability of local public health agencies to respond to emergencies and provide essential services. Organizational and systems capacity measures and assessments are important components of the public health infrastructure. Hospitals and governments have a long tradition of using financial indicators to assess fiscal and operational activities. We reviewed the literature on how hospitals use financial indicators to monitor financial risk, promote organizational sustainability, and improve organizational capacity. Given that financial indicators have not generally been employed by public health practitioners, we discuss how these measures can be applied to local public health agencies to improve their organizational capacity.
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Affiliation(s)
- Virginia Suarez
- Department of Clinical Quality Assurance, Celgene, Durham, NC, USA
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Van Wave, TW, Scutchfield FD, Honoré PA. Recent Advances in Public Health Systems Research in the United States. Annu Rev Public Health 2010; 31:283-95. [DOI: 10.1146/annurev.publhealth.012809.103550] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Timothy W. Van Wave,
- Office of the Chief of Public Health Practice, Centers for Disease Control and Prevention, Atlanta, Georgia 30333,
| | - F. Douglas Scutchfield
- Department of Health Services Research and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky 40536-0003;
| | - Peggy A. Honoré
- College of Health, University of Southern Mississippi, North Potomac, Maryland 20850;
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Abstract
The absence of appropriate financial management competencies has impeded progress in advancing the field of public health finance. It also inhibits the ability to professionalize this sector of the workforce. Financial managers should play a critical role by providing information relevant to decision making. The lack of fundamental financial management knowledge and skills is a barrier to fulfilling this role. A national expert committee was convened to examine this issue. The committee reviewed standards related to financial and business management practices within public health and closely related areas. Alignments were made with national standards such as those established for government chief financial officers. On the basis of this analysis, a comprehensive set of public health financial management competencies was identified and examined further by a review panel. At a minimum, the competencies can be used to define job descriptions, assess job performance, identify critical gaps in financial analysis, create career paths, and design educational programs.
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