Are local public health agencies required to have certain numbers or categories of employees?
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.
[1]G.S. 130A-40 (county and district health departments); 130A-45.4 (public health authorities); 153A-77(e) (consolidated human services agencies).
[2]10A NCAC 46 .0301.
[3]10A NCAC 48B .0901(b)(3). The accreditation rules establish benchmarks and specify how many benchmarks must be met in each of three areas: agency core functions and essential services, facilities and administrative services, and board of health. 10A NCAC 48B .0103. The medical director provision falls under agency core functions and essential services. An agency could skip this provision and still be accredited if it met a sufficient number of the remaining provisions in that area.
Portions of the accreditation rules refer to other 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. 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).
[4]G.S. 130A-1.1.
[5]10A NCAC 46 .0201 - .0216.
[6]G.S. 130A-34.1; 10A NCAC Chapter 48.
[7]10A NCAC 46 .0213.
[8]15A NCAC 01O .0101
