title: Relationships among providing maternal, child, and adolescent health services; implementing various financial strategy responses; and performance of local health departments.
abstract: OBJECTIVE
  We explored the relationships between local health department (LHD) structure, capacity, and macro-context variables and performance of essential public health services (EPHS).
  
  
  METHODS
  In 2012, we assessed a stratified, random sample of 195 LHDs that provided data via an online survey regarding performance of EPHS, the services provided or contracted out, the financial strategies used in response to budgetary pressures, and the extent of collaborations. We performed weighted analyses that included analysis of variance, pairwise correlations by jurisdiction population size, and linear regressions.
  
  
  RESULTS
  On average, LHDs provided approximately 13 (36%) of 35 possible services either directly or by contract. Rather than cut services or externally consolidating, LHDs took steps to generate more revenue and maximize capacity. Higher LHD performance of EPHS was significantly associated with delivering more services, initiating more financial strategies, and engaging in collaboration, after adjusting for the effects of the Affordable Care Act and jurisdiction size.
  
  
  CONCLUSIONS
  During changing economic and health care environments, we found that strong structural capacity enhanced local health department EPHS performance for maternal, child, and adolescent health.
authors.affiliation: L. Michele Issel and Comfort Olorunsaiye are with College of Health and Human Services, University of North Carolina at Charlotte. Laura Snebold is with the National Association of County and City Health Officials, Washington, DC. Arden Handler is with School of Public Health, University of Illinois Chicago.
authors.forename: L Michele
authors.initials: LM
authors.lastname: Issel
authors.forename: Comfort
authors.initials: C
authors.lastname: Olorunsaiye
authors.forename: Laura
authors.initials: L
authors.lastname: Snebold
authors.forename: Arden
authors.initials: A
authors.lastname: Handler
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D006297:Health Services Accessibility; D006801:Humans; D009111:Local Government; D008427:Maternal Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D011635:Public Health Administration; D013597:Systems Analysis; D014481:United States