Association Between Local Boards of Health Authority Over Budgets and PHAB Accreditation Standard Score

Area of Science:

• Public Health Administration
• Health Policy
• Organizational Management

Background:

• Local health departments (LHDs) operate under various governance structures.
• The authority of local boards of health (LBOH) over LHD budgets is a key factor in operational capacity.
• Assessing the impact of LBOH authority on LHD performance is crucial for public health system improvement.

Purpose of the Study:

• To examine the relationship between LBOH authority over LHD budgets and LHD performance scores.
• To investigate the influence of different governance structures on this relationship.
• To understand how budget-related activities mediate the impact of LBOH authority on accreditation outcomes.

Main Methods:

• Utilized data from 250 LHDs, combining Public Health Accreditation Board (PHAB) data with the 2016 National Association of County and City Officials (NACCHO) Profile Survey.
• Employed multilevel regression analysis to assess the association between LBOH budget authority and LHD budget-related activities.
• Used governance structure as a group-level variable in the analysis.

Main Results:

• A positive association was found between LBOH budget authority, LHD budget-related activities, and LHD performance scores on PHAB standards.
• No significant association was observed between the type of governance structure and PHAB performance scores.
• Variations in specific LBOH roles and characteristics may explain the lack of association with governance structure.

Conclusions:

• LBOHs with budget authority play a significant role in LHD budget activities and may enhance PHAB performance scores.
• Further research is needed to explore the specific characteristics and roles of LBOHs due to existing variations.
• Understanding these nuances is essential to fully realize the benefits of expanded LBOH budgetary authority on LHD performance.