Public Health Accreditation Board

Frequently Asked Questions

PHAB: Organization and History

1. What is PHAB?

The Public Health Accreditation Board (PHAB) is the accrediting body for national public health accreditation. The non-profit organization was created to promote and manage the national accreditation program. PHAB convenes public health leaders and practitioners from around the country to develop national standards and processes, tests them in the field, assesses their strengths and areas for improvement and revises them as necessary.

2. What is PHAB’s mission?

PHAB is dedicated to promoting and protecting the health of the public by advancing the quality and performance of all public health departments in the U.S. PHAB works in pursuit of creating a high-performing public health system that will make us the healthiest nation.

3. How and why was PHAB created?

PHAB was incorporated in 2007, after public health leaders explored the feasibility of a national accreditation program. The field saw the need for, and value of, public health accreditation, and advocated for the implementation of a national voluntary program. PHAB was developed in accordance with the recommendations generated by the Exploring Accreditation Steering Committee (read the Committee’s Final Report). The Steering Committee was comprised primarily of state and local public health officials, including boards of health, and their work was informed by existing state-based accreditation programs and accreditation experts from other fields.

4. How is PHAB funded?

The Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation are funders, and partners, of PHAB. The goal is for the accreditation program to be self-sustaining with reasonable revenues from the application fees and if necessary be supplemented by additional support.

5. Who are PHAB’s partners?

The development of the national voluntary public health accreditation program has involved, and is supported by, public health leaders and practitioners from the national, state and local levels. PHAB is also supported by a number of leading national public health organizations such as the American Public Health Association (APHA), Association of State and Territorial Health Officials (ASTHO), Centers for Disease Control and Prevention (CDC), National Association of County and City Health Officials (NACCHO), National Association of Local Boards of Health (NALBOH), National Indian Health Board (NIHB), National Network of Public Health Institutes (NNPHI), Public Health Foundation (PHF) and Robert Wood Johnson Foundation (RWJF).
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National Accreditation Program

About the Program

1. What is the purpose of the national accreditation program?

The goal of the national public health accreditation program is to improve and protect the health of the public by advancing the quality and performance of all health departments in the country – state, local, territorial and tribal. Accreditation will drive public health departments to continuously improve the quality of the services they deliver to the community.

2. Why now?

Public health departments play a critical, but often unrecognized role in promoting and preserving the health of people in communities across the country. Despite the important role health departments play in our communities, there has not been a national system for ensuring their accountability and quality – until now. Other community services and organizations have seen the value of accreditation, such as schools, daycare centers, police departments and hospitals. Now, there is an opportunity for public health departments to measure their performance, get recognition for their accomplishments and demonstrate accountability within their communities. Also, as the public health field faces increasing challenges from epidemics and disaster preparedness, it is more important than ever that systems are in place to ensure their effectiveness and quality of services.

3. What is the timeline?

In September 2009, PHAB launched a national beta test in which thirty state, local and tribal health departments will complete the full accreditation process and provide feedback on the programs and the standards. The beta test will run through the end of 2010. As the beta test and program development progress, public health departments across the country will be preparing for national accreditation. After the accreditation program is adjusted based on input from the beta test, the national public health accreditation program will launch in 2011. By 2015, PHAB aims to have 60 percent of the U.S. population served by an accredited public health department.

4. Who is eligible to apply for national accreditation?

The governmental entity that has the primary statutory or legal responsibility for public health in a state, territory, tribe or at the local level is eligible for accreditation. This includes state health departments, territorial health departments, local (city and county) health departments and tribal health departments. Eligibility is intended to be very flexible and inclusive, accommodating the many different configurations of governmental public health at all levels, including both centralized and decentralized state health departments, health departments that are part of a larger governmental agency, health departments that do not have environmental health responsibility, regional and district health departments and local health departments that share resources in order to fulfill particular functions More eligibility information is available here.

5. What is the difference between public health accreditation and public health credentialing?

Both credentialing and accreditation efforts are active in the public health community right now. Accreditation is a voluntary program that measures the degree to which state, local, tribal and territorial public health departments meet nationally recognized standards and measures. Credentialing is a process that measures the knowledge and skills of individuals with graduate level degrees in public health.

The National Board of Public Health Examiners (NBPHE) was established in September 2005 as an independent organization and administers a voluntary certification exam for students and graduates of approved public health schools and programs. Visit the National Board of Public Health Examiners Web site for more information on credentialing.

6. Will there be certain staff credentials (for example, training, certifications, licenses, etc.) that will be required for a health department to have in order to receive accreditation status?

The standards, as they are currently drafted, do not require specific credentials or licenses to achieve PHAB accreditation. The health department however, will need to demonstrate that it has the capacity to meet the standards and provide the public health services.

7. How will regional arrangements be handled? Will there be multi-jurisdictional applications?

Details of the application process are under development, however, regional or cooperative arrangements will be eligible to apply. Eligible applicants are described in more detail here.

8. How can state, local and tribal public health officials get involved in developing the program?

Public health officials and governing bodies are involved in a number of ways, including serving on PHAB’s Board of Directors, Committees and Workgroups. Additionally, public health officials can provide helpful and ongoing feedback to PHAB throughout the beta test process by reviewing documents and submitting comments and recommendations.

9. When will national accreditation start for health departments?

Program development is currently underway at PHAB, with an expected launch of the national program in 2011. PHAB’s Committees and Workgroups developed the standards and measures, the procedures to assess health departments and a research and evaluation plan. The standards, measures and processes were formally adopted for the national beta test and will be revisited following the completion of the beta test. You can read more about the standards, measures and processes here.

10. How long will a health department be accredited for?

A five-year accreditation cycle has been adopted by the PHAB Board.
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The Standards

1. Who developed the accreditation standards, measures and processes?

PHAB’s Board of Directors and the PHAB Standards Development Workgroup, along with significant feedback from public health leaders and practitioners, developed the standards, measures and processes that were formally adopted by PHAB’s Board in August 2009. PHAB held a public vetting process on the draft standards which resulted in a tremendous amount of feedback from the public health field. PHAB received 4,000 individual comments, online surveys and group feedback forms. The Standards Development Workgroup reviewed all public comments thoroughly and is grateful for the invaluable feedback provided by all who participated in the public vetting process. The standards and measures, along with guidance for documentation, will be available for use during the beta test process and can be downloaded here.

2. There are many standards already in use in state and local health departments. What is the relationship between the various sets of standards in the field and the new accreditation standards?

The PHAB standards and measures were developed with consideration of 1) NACCHO's Operational Definition of a Functional Local Health Department, 2) the instruments of the National Public Health Performance Standards Program, 3) existing standards and measures from state-based accreditation and related programs, and 4) ASTHO’s report on services offered by states. The Standards Development Workgroup reviewed numerous standards and measures and selected what they felt were the best of the best. More information on the principles guiding standards development can be found here.

3. How will the measures be applied to health departments that are being reviewed for accreditation? Will there be equal weighting for all measures? Will health departments need to meet all of the measures in all of the domains?

The application of the measures and how they might be weighted will be tested during the beta test. The beta test will look at various scales, scoring and weighting schemes. Health departments will not have to meet 100 percent of the measures. They will however, be expected to meet minimum thresholds that will be established at the domain level.
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Benefits of Accreditation

1. What are the benefits of accreditation?

Several states have accreditation programs for local health departments, and PHAB continues to learn from their experiences. The following benefits have been realized by accredited local health departments, and PHAB surmises that states receiving accreditation status also stand to enjoy these benefits:

  • The accreditation assessment process provides valuable, measurable feedback to health departments on their strengths and areas for improvement.
  • Engaging in the accreditation process provides an opportunity for health departments to learn quality and performance improvement techniques that are applicable to multiple programs.
  • Gaining accreditation status has resulted in increased credibility among elected officials, governing bodies and the public.
  • The recognition of excellence brought on by meeting accreditation standards has positively impacted staff morale and enhanced the visibility of the health departments.
  • Accreditation is a means of demonstrating accountability to elected officials and the community as a whole.

2. Is there a connection between accreditation and improved public health outcomes?

The ultimate goal of an accreditation program is to improve the public’s health through improved quality and performance of public health departments. To date, however, there is little research supporting the outcomes correlated with public health interventions. Whether improved health outcomes are realized through implementation of quality improvement processes is a primary research question, and one that PHAB’s Research & Evaluation Committee will pursue as the accreditation program is developed and implemented.
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Preparation and Costs

1. How can I prepare for accreditation?

Public health departments can start preparing for accreditation now, before the launch of the national program in 2011. We encourage you to:

  • Review your agency’s practices against the standards and measures.
  • Engage in quality improvement efforts by learning, educating your colleagues, and building internal capacity for ongoing quality improvement.
  • Develop and/or improve your department’s community health assessment, community health improvement plan, and strategic plan.
  • Review accreditation materials and share your feedback with us. Your input will be collected and considered in revisions to the program.
  • Start working on three specific documents that will help to prepare your agency for accreditation. The following will be required for health departments to complete for the national accreditation process, so it’s not too early to start on them now:
  • A community health assessment, in which a health department assesses the health needs in the community, the health status of the community and plans its services through the second document.
  • A community health improvement plan, which maps out exactly what a health department is going to do as it works with partners to improve the health status of its jurisdiction.
  • A strategic plan for the health department, which indicates a health department’s service priorities and how it plans to accomplish its strategic goals.

ASTHO plans to release a toolkit designed to help state health departments prepare for accreditation. The toolkit will provide a framework for assessing readiness for accreditation, identify opportunities and strategies for performance improvement, provide information and resources designed to assist health departments prepare for applications for accreditation, and suggest ways to continue performance improvement in between accreditation cycles.

NACCHO offers tools and resources for local health departments interested in accreditation preparation and quality improvement. A good starting point is to determine the degree to which your local health department is meeting the Operational Definition standards and metrics. NACCHO offers an agency self-assessment tool for the Operational Definition metrics to score the health departments capacity in meeting each indicator. NACCHO also provides information on strategies for smaller local health departments (such as joint applications and regionalization).

NALBOH recognizes that governing bodies, boards of health and public health governmental entities are becoming more interested and engaged in quality improvement activities, and are eager to play a significant role in the accreditation process. Currently, NALBOH is supporting several quality improvement activities.

2. How much does accreditation cost?

PHAB has convened a Fees and Incentives Workgroup to determine application fees, with an underlying principle of developing a fee structure that does not present financial barriers to health departments wishing to participate in the accreditation process. A number of recommendations regarding the costs of accreditation were generated by the Exploring Accreditation Steering Committee and will inform PHAB’s deliberations.

3. How much does it cost to prepare for accreditation?

These costs have not yet been quantified. Health departments participating in the beta test will document the resources required to undertake the process, which will inform the national accreditation program. Additionally, many local health departments (LHDs) accredited by state-based programs attest that the cost of preparing is worth it. LHDs have received funding based on accreditation status, have noted areas where cost efficiencies can be gained based on self-assessment results or site visit reports, and noted many other benefits that justify the cost.

4. What are the incentives to participate?

The Exploring Accreditation Project Steering Committee determined that all incentives should be uniformly positive, supporting public health departments in seeking accreditation and achieving high standards. PHAB will devote significant attention to securing specific, tangible incentives and benefits for those who participate. A workgroup will address the need for robust incentives for participation. Further, research on incentives conducted at the University of North Carolina is guiding PHAB’s work, including a survey of potential applicants on categories of incentives including:

  • Financial incentives (for accredited agencies and for agencies applying for accreditation)
  • Grants administration
  • Grants application
  • Infrastructure and quality improvement
  • Technical assistance and training

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Beta Test

For questions about the beta test, please visit the beta test FAQs.