title: Comparing types of local public health agencies in North Carolina.
abstract: BACKGROUND
  Some states are considering restructuring local public health agencies (LPHAs) in hopes of achieving long-term efficiencies. North Carolina's experience operating different types of LPHAs, such as county health departments, district health departments, public health authorities, and consolidated human services agencies, can provide valuable information to policy makers in other states who are examining how best to organize their local public health system.
  
  
  OBJECTIVE
  To identify stakeholders' perceptions of the benefits and challenges associated with different types of LPHAs in North Carolina and to compare LPHA types on selected financial, workforce, and service delivery measures.
  
  
  METHODS
  Focus groups and key informant interviews were conducted to identify stakeholders' perceptions of different LPHA types. To compare LPHA types on finance, workforce, and service delivery measures, descriptive statistical analyses were performed on publicly available quantitative data.
  
  
  METHODS
  North Carolina.
  
  
  METHODS
  Current and former state and local public health practitioners, county commissioners, county managers, assistant managers, state legislators, and others.
  
  
  METHODS
  In addition to identifying stakeholders' perceptions of LPHA types, proportion of total expenditures by funding source, expenditures per capita by funding source, full-time equivalents per 1000 population, and percentage of 127 tracked services offered were calculated.
  
  
  RESULTS
  Stakeholders reported benefits and challenges of all LPHA types. LPHA types differ with regard to source of funding, with county health departments and consolidated human services agencies receiving a greater percentage of their funding from county appropriations than districts and authorities, which receive a comparatively larger percentage from other revenues.
  
  
  CONCLUSIONS
  Types of LPHAs are not entirely distinct from one another, and LPHAs of the same type can vary greatly from one another. However, stakeholders noted differences between LPHA types-particularly with regard to district health departments-that were corroborated by an examination of expenditures per capita and full-time equivalents per 1000 population.
authors.affiliation: Network for Public Health Law-Southeastern Region, North Carolina Institute for Public Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. milissa@unc.edu
authors.forename: Milissa
authors.initials: M
authors.lastname: Markiewicz
authors.forename: Jill
authors.initials: J
authors.lastname: Moore
authors.forename: Johanna H
authors.initials: JH
authors.lastname: Foster
authors.forename: Maureen
authors.initials: M
authors.lastname: Berner
authors.forename: Gene
authors.initials: G
authors.lastname: Matthews
authors.forename: Aimee
authors.initials: A
authors.lastname: Wall
mesh_terms: D017144:Focus Groups; D006077:Government Agencies / Q000145:classification*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D009111:Local Government; D009657:North Carolina; D015980:Public Health Practice / Q000145:classification* / Q000191:economics*