In 2002, the North Carolina Division of Public Health and the North Carolina Association of Local Health Directors undertook an initiative to develop a mandatory, standards-based system for accrediting local public health departments throughout the state. Since 2002, the North Carolina Institute for Public Health (NCIPH) has provided Accreditation staff support.

North Carolina’s local health departments include rural and urban areas, large and small health departments, public health authorities, a community health alliance, and district health departments which represent multiple counties.

The focus of North Carolina’s Local Health Department Accreditation (NCLHDA) is on the capacity of the local health department to perform at a prescribed, basic level of quality the three core functions of assessment, assurance, and policy development and the ten essential services as detailed in the National Public Health Performance Standards Program. The program focuses on a set of minimal standards that must be provided to ensure the protection of the health of the public, but does not limit the services or activities an agency may provide to address specific local needs.  NCLHDA does not create a wholly new accountability system; rather it links basic standards to current state statutes and administrative code, and the many Division of Public Health and Division of Environmental Health contractual and program monitoring requirements that are already in place. 

The program comprises three functional components:

  • An agency self assessment, which includes 41 benchmarks and 148 activities
  • A three day site visit by a multidisciplinary team of peer volunteers, and
  • Determination of accreditation status by the North Carolina Local Health Department Accreditation Board.

The program process is adjudicated by an independent entity, the North Carolina Local Health Department Accreditation Board. Its members are appointed by North Carolina’s Department of Health and Human Services Secretary. The Accreditation Administrator (AA), within the North Carolina Institute for Public Health, serves by legislative mandate.

Accreditation is achieved by appropriately meeting a set of capacity-based Benchmarks as evidenced by documented completion of prescribed Activities. Benchmarks may be met by either direct provision or assurance (through contracts, memoranda of understanding, or other arrangements with community providers) of required services and activities.

While the Benchmarks being applied are similar to the NACCHO Operational Definition of a Functional Local Public Health Agency (2004) and drawn from work done in other states, the Activities are specific to practices in North Carolina local public health agencies.