Service Area Strategic Plan
11/23/2009   5:30 am
Department of Health (601)
Biennium: 2008-10
Service Area 1 of 1
Support for Local Management, Business, and Facilities (601 440 09)
Description

This service area provides leadership, programmatic direction, and management of human and financial resources for local health departments (LHDs). LHDs are organized into districts to achieve management efficiencies and comprise between one and ten political subdivisions. This service area includes business functions such as budgeting, accounting, and procurement and makes resource allocation decisions among political subdivisions based on need, available local matching funds, and estimates of earned revenue. Resources include local health department staff, funding, equipment, supplies, office space, buildings, and vehicles. Support encompasses ongoing assessment and evaluation to assure that services and programs of the local health department continue to match local community needs. Sound management and close oversight ensure that expenditures for essential local public health services remain as low as possible; and that programs are effective in attaining goals and comply with all applicable federal, state, and local laws, regulations, and policies.

Local health departments operate under two models. The vast majority of cities and counties contract with VDH. Three local governments (Arlington and Fairfax counties, and the City of Richmond) sought and obtained General Assembly approval to administer LHDs as a unit of local government. Richmond City has recently requested to 'reaffiliate' with VDH and efforts are underway to accomplish this. Locally administered health departments must comply with the same programmatic requirements, policies, regulations, and laws as other LHDS.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    This service area aligns with the Virginia Department of Health’s mission to promote and protect the health of Virginians by providing local leadership, business support, and overall direction for local health departments.
  • Describe the Statutory Authority of this Service
    Code of Virginia §32.1-30 requires every city and county to establish and maintain a local health department in each county and city.

    Code of Virginia §32.1-119(B) provides that persons deemed to be medically indigent shall receive the medical care services of the Department without charge.

    Code of Virginia §32.1-31 establishes operation of local health departments

    In addition to these specific citations, LHDs must comply with all federal and state human resource, procurement and general services -specific statutes and Executive Orders issued by the Governor. These are listed in detail in the agency level service area plan: Administrative and Support Services.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
City/County governments 119 119
Hotels, summer camps, campgrounds, swimming pools, migrant labor camps 6,400 6,600
Individuals Applying for food, sewage disposal or private well permits 50,000 50,500
Local health department clinic patients 148,292 7,400,000
Local health department employees 2,839 2,839
Permitted food establishments (restaurants, school cafeterias, etc.) 26,500 27,300
VDH Central Office Employees 923 923

Anticipated Changes To Agency Customer Base
The customer base of this service area reflects changes in the local population. It is affected by changes in sectors of the population such as age, immigration, emigration, and the economy. For example, during a downturn in Virginia’s economy, increased numbers of Virginians meet income requirements for certain services such as Women, Infants, and Children nutritional support or for other health care services. In times of a robust economy, these demands for service may decrease while demands for services such as health department support for the opening of new restaurants and hotels or onsite sewage disposal permits may increase.

New mandates and initiatives may affect the number of customers who are eligible for local health department services.

The customer base is changing and growing, based on projected changes in the population both from the birthrate, movement from other States, and immigration from other countries. Changes in demographics (more people who speak English as a second language, aging of the population, globalization) challenge local health departments to stay nimble, to meet changing needs and to avoiding degradation of Virginia’s health status. For example, globalization, with its increase in the frequency of travel for business and recreational purposes, has brought to Virginians the increased risk of exposure to diseases previously rarely found in the state. As a result, local health departments need to enhance disease surveillance capability.
Partners
Partner Description
[None entered]
Products and Services
  • Factors Impacting the Products and/or Services:
    Products and services are dependent on the level of available funding, legal and policy requirements affecting their use, and community conditions that affect both service demand and resource supply.
  • Anticipated Changes to the Products and/or Services
    New mandates or initiatives may require the leadership in LHDs to divert or augment current resources to respond.

    The need to plan for and respond to all types of emergencies has required LHDs to work with a broad range of local, regional, and state partners to assure appropriate actions.

    Global changes in the business world, with increasing communications and travel will continue to affect what services the local health department provides, its capacity to meet the local community’s needs, and how services are given.

    The need for interpretation and translation services to support local health department work will continue to expand in the foreseeable future.

    The use of computer and software technology will continue to increase the efficiency of business practices, bringing the local health departments increasingly in line with the private sector in such practices as the use of credit and debit cards and the provision of rapid, internet-based, customer-friendly services.

    Demographic changes in the Virginia population will increase the need for workforce development of succession planning and management.

    Senior management of the local health departments is disproportionately represented by the “baby boomers”. This will affect the demand for healthcare benefits. It also creates a need for management attention to mentoring and development of junior management staff.
  • Listing of Products and/or Services
    • Budgeting and planning for use of locally available fiscal and human resources.
    • Management of district revenue, funds, staff, supplies, procurement, equipment, facilities and properties.
    • Prioritization of the use of resources in such a manner as to enable the mandated provision of care to the indigent without charge.
    • Appropriate stewardship of funds and other resources allocated to local health departments.
    • Provision of service to customers that assures compliance with all applicable federal, state and local requirements.
    • Staff recruitment, training, and personnel management.
    • Community assessment
    • Assure there are adequate facilities to deliver services that are accessible to all Virginians.
Finance
  • Financial Overview
    Funding for local health departments is shared by the State and local governments based on an ability-to-pay measure developed by JLARC and last updated in 1988. Local government matching contributions range from a low of 18% to a maximum of 45%. The ‘cooperative health department budget’ arrangement was established by the General Assembly in 1954. Revenue earned by local health departments for patient care, permits, and issuance of death certificates also supports the operation of LHDs. Finally, this service area is responsible for managing federal grant funds that may be allocated to LHDs by statewide program offices through memoranda of understanding.
  • Financial Breakdown
    FY 2009    FY 2010
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $33,657,020 $19,306,426    $33,249,270 $19,306,426
    Change To Base $-1,121,914 $-1,722,677    $-1,732,764 $-1,740,768
               
    Service Area Total   $32,535,106  $17,583,749     $31,516,506  $17,565,658 
Human Resources
  • Human Resources Overview
    [Nothing entered]
  • Human Resource Levels
    Effective Date      
    Total Authorized Position level Ø    
    Vacant Positions Ø    
    Current Employment Level 0.0    
    Non-Classified (Filled)    
    Full-Time Classified (Filled)    breakout of Current Employment Level
    Part-Time Classified (Filled)    
    Faculty (Filled)    
    Wage    
    Contract Employees    
    Total Human Resource Level 0.0   = Current Employment Level + Wage and Contract Employees
  • Factors Impacting HR
    [Nothing entered]
  • Anticipated HR Changes
    [Nothing entered]
Service Area Objectives
 
  • Attract, recruit, develop and retain appropriate public health staff for local health department operations.
    Objective Description
    Assures adequate and appropriate staffing to perform public health functions required by the Code of Virginia or as a condition of accepting federal funding.
    Objective Strategies
    • LHD management will analyze its local recruitment and selection practices to identify ways to streamline these procedures to assure as little gap as possible when refilling existing positions or establishing new positions. Technical assistance will be provided by the Office of Human Resources as needed. LHD management will analyze their turnover to identify actions that can be taken to reduce turnover to factors that can be controlled by local management. LHD management will conduct an annual review of salaries to determine, within available resources, if internal alignment or other pay actions are needed to assure salaries are equitable and fair. LHD management will ensure that all employees who require license or certification as a condition of employment maintain current status and report any restrictions or other administrative actions to VDH management.
    Objective Measures
    • Percent of Maximum Employment Level Achieved
      Measure Class:
      Other
      Measure Type:
      Output
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      92
      Date:
      4/1/2005

      Measure Baseline Description: Percent of VDH's full time equivalent (FTE) employee positions filled

      Measure Target Value:
      97
      Date:
      6/30/2010

      Measure Target Description: Percent of VDH's full time equivalent (FTE) employee positions filled

      Data Source and Calculation: Virginia Department of Human Resource Management monthly reports on Full Time Equivalent employment levels

  • Strengthen essential public health programs through determining future needs.
    Objective Description
    Local health departments tailor their services to address the specific needs of the communities served. Ongoing assessment of community health status and characteristics promotes efficient and appropriate use of resources.
    Objective Strategies
    • Survey local health departments to determine the frequency of assessment, the data used, the individuals and organizations involved, how these findings influence programs and services, and how the results are communicated to local government, interested community partners, and VDH management. Establish a work group with representatives from local health departments and VDH statewide program areas, to review existing national assessment tools and standards and to recommend a tool to be used statewide.
    Objective Measures
    • Community needs assessment
      Measure Class:
      Other
      Measure Type:
      Output
      Measure Frequency:
      Annual
      Preferred Trend:
      Up

      Frequency Comment: Every three to five years, depending on changing local circumstances.

      Measure Baseline Value:
      10
      Date:
      6/30/2006

      Measure Baseline Description: Number of local health districts conducting a community needs assessment

      Measure Target Value:
      35
      Date:
      6/30/2010

      Measure Target Description: Number of local health districts conducting a community needs assessment at least once every three to five years

      Data Source and Calculation: Currently no standard community needs assessment.

  • Strengthen essential public health programs through monitoring and evaluating current performance.
    Objective Description
    Sound management requires taking the time to find out how actual performance measures up to planned performance. Monitoring and evaluating current performance against established goals and administrative standards promotes identification of progress and provides the opportunity to enhance performance
    Objective Strategies
    • Establish work groups with representatives from local health departments, VDH statewide central office program areas and VDH Administration to develop draft LHD performance standards, utilizing available data and national standards.
    Objective Measures
    • Performance of local health districts compared to national standards
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      10
      Date:
      6/30/2006

      Measure Baseline Description: Number of local health districts undertaking an evaluation of their performance relative to the standards.

      Measure Target Value:
      35
      Date:
      6/30/2010

      Measure Target Description: Number of local health districts undertaking an evaluation of their performance relative to the standards.

      Data Source and Calculation: Local health district and VDH Central Office statistics

  • Follow good business practices to ensure ethical stewardship of public funds.
    Objective Description
    Good business practices include adhering to all applicable State, Federal and local laws; all applicable Virginia State Government and Virginia Department of Health policies and guidelines; pertinent medical standards and adhering to ethical business practices.
    Objective Strategies
    • VDH management will share information on agency audits with local health departments. VDH Management will provide training as appropriate and maintain resource materials on the VDH website to assist local health departments to self-assess audit deficiencies, strengths and trends.
    Objective Measures
    • Compliance of Local Health Districts with Internal and External Audit requirements.
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      97
      Date:
      6/30/2005

      Measure Baseline Description: Percentage of local health districts with no material weaknesses

      Measure Target Value:
      100
      Date:
      6/30/2010

      Measure Target Description: Percentage of local health districts with no material weaknesses

      Data Source and Calculation: Office of Internal Audit, VDH Virginia Auditors of Public Accounts (APA) Special and Federal Audits (ex. WIC). Local health districts are audited on a three-year cycle by VDH Internal Auditor, one-third are audited each year.


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