title: State barriers to appropriating public health emergency response funds during the 2009 H1N1 response.
abstract: OBJECTIVE
  We examined state-specific administrative barriers to allocating 2009 H1N1 influenza public health emergency response (PHER) funds.
  
  
  METHODS
  We conducted a qualitative review of PHER grants management reports to identify and code barriers reported by states in allocating funds. Using linear regression, we examined the relationship between the percentage of funds allocated and each individual barrier and, separately, the cumulative effect of multiple barriers.
  
  
  RESULTS
  States reported 6 barrier types, including regulatory issues (n = 14, or 28%), contracting issues (n = 14, or 28%), purchasing issues (n = 6, or 12%), legislative issues (n = 5, or 10%), staffing issues (n = 5, or 10%), and issues transferring funds between state and local health departments (n = 4, or 8%). In multivariate models, having experienced a purchasing barrier was associated with a significant decrease in PHER allocation (B = -26.4; P = .018). Separately, the cumulative effect of having 3 barriers was associated with a decrease in PHER allocation (B = -16.0; P = .079).
  
  
  CONCLUSIONS
  Purchasing barriers were associated with delayed use of PHER funds. Moreover, the cumulative effect of any 3 barriers hampered the allocation of funds. Understanding barriers to using funds can inform future funding guidance for improved efficiency of response efforts.
authors.affiliation: Valerie A. Yeager is with the Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. David Hurst is with the Applied Science and Evaluation Branch, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA. Nir Menachemi is with the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Yeager
authors.forename: David
authors.initials: D
authors.lastname: Hurst
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
mesh_terms: D004196:Disease Outbreaks; D005376:Financial Management / Q000458:organization & administration*; D005380:Financing, Government; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000188:drug therapy* / Q000517:prevention & control*; D010561:Personnel Staffing and Scheduling; D011635:Public Health Administration / Q000191:economics*; D012111:Residence Characteristics