Identifying training priorities through self-assessment by Alyssa K. Landen

case site

The Structure of public health in pennsylvania

Public health infrastructure varies from state to state. Local agency responsibility can be independent or shared with the state health agency (National Association of County and City Health Officials, 2014). Health departments within a state can be centralized (state governed), decentralized (locally governed), or a mix of the two agency (National Association of County and City Health Officials, 2014). As shown in Figure 1, Pennsylvania’s structure is mixed.

(Source: National Association of County and City Health Officials, 2014)

Figure : State public health structure within the United States agency
The financing of public health and public health staff within a state also vary among states. It is estimated that from 2008-2013, local health departments in the United States lost approximately 28,000 total employees, approximately a 12% decrease in FTEs (National Association of County and City Health Officials, 2014). Although the amount of funding a state receives depends on the economic status of the state, about 50% of the funding for states come from the federal government, through grants, cooperative agreements, and contracts (Salinsky, 2010). In 2009, 76% of state health departments and 55% of local health departments reported cuts within the past 12 months (Meyer and Weiselberg, 2009). In Pennsylvania, the median annual per capita local health expenditure is less than $20 (National Association of County and City Health Officials, 2014). Such losses in funding and staff have significantly reduced the number of initiatives and programs that a community can implement, and they must find ways to insure that the programs and interventions within the state are improving the health status of the community in which they serve.

Act 315: Pennsylvania’s Local Health Administration Law

Act 315 and its amendments guide health departments within Pennsylvania. Since its establishment in 1951, provisions and amendments have been made to strengthen the act. These include (Pennsylvania Department of Health, 2013):

• 
  Steps to establish a health department in Pennsylvania
  
• 
  Act 12, which adds environmental health support
  
• 
  Provisions to chapters 13, 15, 17, and 27
  

Additionally, Act 315 provides communities with (Pennsylvania Department of Health, 2013; Local Health Administration Law):

• 
  The authority to establish local health departments to serve their residents
  
• 
  The process of how to establish a local health department
  
• 
  Financial administration guidance
  
• 
  Documentation of powers and duties of local health departments, the director, and board of health
  
• 
  Local health department jurisdiction
  
• 
  State funding to recognized health departments to deliver public health services
  

Health departments within Pennsylvania, under Act 315, are required to address administrative and supportive services, personal health services, and environmental health services (Pennsylvania Department of Health, 2013).

The allegheny county health department

The Allegheny County Health Department was founded in 1957 (Allegheny County Health Department, 2014) and today serves the over 1.2 million residents of Allegheny County Pennsylvania. A Board of Health governs the Allegheny County Health Department, its nine members receiving their appointments from the County Chief Executive and approved by the County Council (Allegheny County Health Department, 2013). During their four-year appointment, these members advise the County Health Director (and appoint one if needed) and perform the following duties (Allegheny County Health Department, 2013):

• 
  Formulate rules and regulations for the prevention of disease
  
• 
  Formulate rules and regulations for the prevention and removal of conditions which constitute a menace to health
  
• 
  Formulate rules and regulations for the promotion and preservation of the public health
  

The Allegheny County Health Department is one of only 6 county and 4 municipal health departments in Pennsylvania (Pennsylvania Department of Health, 2013). The mission of the Allegheny County Health Department is “to protect, promote, and preserve the health and well-being of all Allegheny County residents, particularly the most vulnerable” (Allegheny County Health Department, 2014). The workforce of the health department strives to fulfill the mission of the health department through programs and interventions aimed at improving health and well-being.
The health department employs 349 individuals, not including contractors (as of September 30, 2014). Demographics of health department employees are not available because the health department is an equal opportunity employer. Based on a self-assessment, it is possible to determine the number of years individuals working at the health department have been in their current role (Figure 2 and Table 1) and distinguish which programs individuals work in (Figure 3 and Table 2). Appendix A provides a current organizational structure of the Allegheny County Health Department.
Figure : Allegheny County Health Department percent of employees by years in current position

Table : Allegheny County Health Department number of employees by years in current position

Allegheny County Health Department Number of Employees By Years In Current Position	Response Count	Percent (%)
Less than 1 year	49	14.8
1-5 years	76	22.9
5-10 years	70	21.1
10-15 years	34	10.2
15-20 years	24	7.2
Over 20 years	79	23.8

Figure : Allegheny County Health Department percent of employees by program

Table : Allegheny County Health Department number of employees by program

Allegheny County Health Department Number of Employees By Program	Response Count	Percent (%)
Administration	30	9.0
Air Quality	46	13.9
Chronic Disease and Injury Prevention	2	0.6
Dental	5	1.5
Directors Office/Leadership Team	3	0.90
Epidemiology and Biostatistics	8	2.4
Food Safety	24	7.2
Housing and Community Environment	26	7.8
Infectious Diseases/STD	41	12.3
Legal	3	0.9
MIS	2	0.6
Maternal Child Health	31	9.3
Other	10	3.0
Preparedness	3	0.9
Public Drinking Water/Waste Management	33	9.9
Public Health Laboratory	14	4.2
Public Information, Health Information and Publications	4	1.2
WIC	47	14.2

It is important to note that most of the individuals working in the health department work in regulatory roles and very few provide administrative support.
To better prepare employees to achieve the ten essential services of public health, the health department currently offers a limited set of trainings to employees. These trainings include:

• 
  Required Preparedness Trainings
  
  • 
    Incident Command System 100 and 700
    
  • 
    Points-of-Dispensing
    
  • 
    American Heart Association CPR
    
  • 
    American Heart Association First Aid
    
  • 
    Hazmat Awareness (environmental health staff only)
    
• 
  Non-Required Preparedness Trainings
  
  • 
    Personal Preparedness
    
  • 
    Swift Water Awareness
    
  • 
    Incident Command System 300/400 (for certain staff only)
    
• 
  Health Department Wide Trainings
  
  • 
    HIPAA
    
  • 
    New Staff Orientation
    
  • 
    Public Health 101
    

Additional trainings are needed to improve the competencies and capabilities of the workforce at the Allegheny County Health Department.