The forgotten instrument: analysis of the national public health performance standards program governance instrument

This study examines the use of, and results from, the National Public Health Performance Standards Program Local Governance Instrument. It includes a compilation and analysis of 173 local governance instruments completed by local boards of health from 2003 to 2006. Only 24 of the 173 scored instruments are used because of exclusion of data from New Jersey. The study compares results from the instruments based upon demographic data reported by the local boards of health, and data on performance compiled by the National Public Health Performance Standards Program Local Public Health System Instrument. Local boards of health perform well on Essential Public Health Services #6 (78.85%), #2 (71.41%), and #7 (70.75%). Performance is far from optimal on Essential Public Health Services #10 (45.42%) and #9 (41.30%). Comparing groups based on demographic data yielded deviations too large and power too low to form any significant conclusions about local boards of health performance. It is important to note that individuals with varying levels of knowledge may have completed the governance instruments, and this may affect the results of any comparison between individual boards of health. Local boards of health need encouragement from national and state associations of local boards of health to complete the local governance instrument. This would allow local boards of health to use these data to compare performance with other boards around the nation. Identification of weak performing areas may lead to changes to improve service to the community. This instrument could also prove a useful tool in health department accreditation.