Each local public health agency has a director.[1] There is also a state regulation that addresses minimum staffing requirements for local public health agencies.[2] It provides that, in addition to meeting accreditation requirements and employing a local health director, a local agency must employ a public health nurse, an environmental health specialist, and a secretary. In general these staff members must be full-time employees, but there is an exception that allows an agency to share a health director with another agency. The accreditation rules include a provision directing an agency to employ or contract with one or more licensed physicians to serve as medical director; however, it is possible for an agency to be accredited without satisfying every provision.[3]

These minimal legal standards likely do not fully answer the practical question of how many or what types of staff members an agency needs. Instead, it is likely that staffing for local public health agencies is primarily determined by the services that local public health agencies are required to provide. There are several different sources of law that affect local services – the essential public health services law,[4] the mandated services rules,[5] and the accreditation requirements.[6] While these laws do not always address staffing needs, agency management must plan workforce development in such a way that all of the required services are available in the county. For example, one of the mandated services regulations requires that local public health agencies conduct sanitation inspections of restaurants.[7]Another law provides that the individuals who conduct these inspections be “authorized” by the state in that particular field of work.[8]Therefore, all local public health agencies must ensure that their workforce includes capacity for these types of sanitation inspections.

More information about local services is available here.

The answer varies by type of LPHA. The employees of county and district health departments are covered by the State Personnel Act (SPA).[1] Public health authorities are exempt from the State Personnel Act (SPA) and have specific statutory authority to establish salary plans for their employees.[2] Employees of consolidated human services agencies are exempt from the State Personnel Act (SPA) and are subject to county personnel ordinances and policies.[3]

Local health department employees may be removed from SPA coverage if the county commissioners establish a local personnel system that the State Personnel Commission determines is substantially equivalent to the SPA.[4]

The authority to appoint the local health director varies by type of local public health agency. For a county or district health department, the local health director is appointed by the local board of health after consultation with all applicable boards of county commissioners. Although the board must consult with the commissioners, the commissioners are not required to approve the appointment.[1] The same procedure is followed by a public health authority board when it appoints the public health authority director.[2] A consolidated human services agency director is appointed by the county manager with the advice and consent of the consolidated human services board.[3]

If the county commissioners have abolished the board of health and assumed direct control of the health department pursuant to G.S. 153A-77(a), then the commissioners have all the powers and duties of the local board of health, including the power to appoint the local health director. This is the only circumstance in which the county commissioners may directly appoint the local health director.

The answer varies by agency type. The director of a county or district health department is authorized to employ and dismiss department employees in accordance with the State Personnel Act.[1] The director of a public health authority is authorized to employ, discipline, and dismiss employees of the authority.[2] The director of a consolidated human services agency may appoint employees, but the appointments must be approved by the county manager.[3] The directors of the other types of departments are not required to obtain the county manager’s approval before appointing employees.

 

Local  Health Directors. The qualifications for a county health director, a district health director, or a public health authority director are set out in state statutes establishing minimum education and experience requirements.[1] In general, the director must have one of the following:

• A medical doctorate
• A master’s degree in public health administration plus at least one year of employment in health programs or services
• A master’s degree in another public health discipline plus at least three years of employment in health programs or health services
• A master’s degree in public administration plus at least two years of experience in health programs or health services
• A master’s degree in a field related to public health plus at least three years of experience in health programs or health services[2]
• A bachelor’s degree in public health administration or public administration plus at least three years of experience in health programs or health services

There is also a law that created a limited pilot program (one county only) to allow a person with education and experience in public health nursing to serve as a local health director, as long as the appointment is approved by the NC Secretary of Health and Human Services.[3] In fiscal year 2011-2012, Northampton County’s health director was serving pursuant to this law. 

The law creating the position of consolidated human services director does not require any specific education or experience, but North Carolina’s standards for local public health agency accreditation specify that the agency’s governing board must appoint a local health director who meets the requirements of the law that applies to county and district health directors.[4] However, the accreditation program does not require local agencies to satisfy every provision in the standards—agencies may skip a small proportion of the standards and still be accredited.[5]  Therefore, it is possible that a consolidated agency could satisfy accreditation standards without meeting the specific standard that addresses the director’s qualifications.

Other Local Health Department Employees. The minimum qualifications for other employees of county or district health departments are determined by the Office of State Personnel (OSP), as employees of those departments are subject to the State Personnel Act.[6] The OSP publishes the specific qualifications for public health department employees other than local health directors in the Local Government Desk Resource Manual.

Employees of consolidated human services agencies or public health authorities are not subject to the State Personnel Act and qualifications for positions are determined locally.