Are local public health agencies required to have certain numbers or categories of employees?
Each local public health agency has a director. The directors of county health departments, district health departments, and public health authorities must meet minimum education and experience requirements that are set out in state law. There is no similar education and experience requirement for the director of a consolidated human services agency. However, if the director of a consolidated agency that provides public health services does not meet those qualifications he or she must appoint a person who does.[1]
There is also a state regulation that addresses minimum staffing requirements for local public health agencies. It specifies that each agency must employ a local health director, a public health nurse, an environmental health specialist, and a secretary. These staff members must be full-time employees, but an agency may share a health director with another agency.[2]
The state’s local health department accreditation standards also address staffing directly and indirectly. One of the standards requires an agency to employ or contract with one or more licensed physicians to serve as medical director.[3] Other portions of the accreditation rules refer to additional categories of agency staff members or to particular types of expertise that the agency must possess or have access to, but they do not explicitly require the agency to have staff positions for those categories or expertise.[4]
The minimum requirements of the state regulations are a foundation but not a complete description of local public health agency staffing, which is determined primarily by the functions the departments must perform and the services they must provide.
[1] G.S. 130A-40 (county and district health departments); 130A-45.4 (public health authority); 153A-77(e) (consolidated human services agency). In general, the local health director must have education and experience in medicine, public health, or public administration related to health.
[2] 10A NCAC 46 .0301.
[3] 10A NCAC 48B .0901(b)(3). Local public health agencies do not have to satisfy 100 percent of the accreditation activities, so it is often possible for an agency to skip a particular provision and still be accredited. However, this provision is not likely to be skipped. Agencies that provide clinical services often rely on physician extenders and nurses to provide many services. These individuals must be supervised by a licensed physician who issues standing orders and oversees clinical care, which is the role of a medical director. In some agencies the local health director is a licensed physician and may serve in this role.
[4] See, e.g., 10A NCAC 41B .0203 (directing agency to assure staff have expertise in data management); 41B .0301 (requiring access to and consultation with an epidemiologist); 41B .0701 (referring to unit directors for communicable disease, nursing, and environmental health).
