Assessment of Capacity and Performance Improvement; 2001-2003

Progress of the original four partners in the New Hampshire Public Health Network has been measured by application of the Local Public Health System Performance Surveillance and Assessment Tool (20 Questions) [Word, 26 KB]. This tool is a precursor of the more extensive National Public Health Performance Standards [PDF, 592 KB]. Using the 20 Questions tool, capacity of the four original sites was assessed at baseline in April 2001 and then again in August 2003 following 2 years of funding and technical assistance for local capacity building. The 20 Questions tool was used to assess both improvements in public health infrastructure capacity and public health performance. Data are self-reported and were generated in each community through a consensus process involving multi-disciplinary, cross-sector groups ranging in size from 10 to 25 individuals.

Local Public Health Capacity Improvement

Chart 1 shows the aggregate progress toward improved local public health capacity. Capacity was measured by calculating the proportion of "Yes" responses to questions 1-19 and "No" responses to question 20 on the assessment tool. In 2001, prior to program implementation, the mean overall capability score for the four Turning Point regions (Greater Derry, Franklin area, Canaan-Enfield, Littleton area; 37 cities and towns in all) was assessed at 26%. This score is further broken down into three categories of core public health function: Assessment (questions 1-6), Policy Development (questions 7-12) and Assurance (questions 13-20). Baseline capacity was assessed to be 29% for Assessment, 29% for Policy Development and 22% for Assurance. By September 2003, significant capacity improvements were observed. The mean overall capacity score had increased to 82% and core function scores had similarly increased to 92% for Assessment, 83% for Policy Development and 75% for Assurance.

Chart 1 also shows a national benchmark reported by J. Suen, et al. Their report is based on information collected from 2,007 local public health jurisdictions responding to an assessment through the State Domestic Preparedness Equipment Program of the U.S. Department of Justice (DOJ) between July 2000 and April 2002. This assessment also incorporated the same tool applied in New Hampshire. As the chart shows, local public health entities in New Hampshire reported significantly lower capacity at baseline compared to this national benchmark. However, by September 2003, the reported capacity of these four New Hampshire public health regions exceeded the national average for local public health performance.

Local Public Health Performance Improvement

For those questions with affirmative responses, the 20 Questions Tool asks respondents to rate performance on a 5-point scale ranging from "Meets no needs" to "Meets All Needs". Performance was calculated as a percentage where the numerator is a composite score tabulated from the 20 questions responses and the denominator is the maximum possible score. Chart 2 shows the aggregate progress toward improved local public health performance.

In 2001, prior to program implementation, the mean overall performance score for the four Turning Point was assessed at 15%. For the three categories of core public health function, baseline performance was assessed to be 16% for Assessment, 17% for Policy Development and 12% for Assurance. By September 2003, significant performance improvements were also observed. The mean overall performance score had increased to 48% and core function scores had similarly increased to 56% for Assessment, 45% for Policy Development and 44% for Assurance.


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Public Health Jurisdiction Capabilities: Assessment of Core Function-Related Performance. Jane Suen, Dr.P.H., Kim Gadsden-Knowles, M.P.H. and Med Sohani, M.S., Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, Atlanta, GA  30341. APHA 130th Annual Meeting (Session 4109.0) Philadelphia, PA (11/12/02).

Downloads
Local Public Health System Performance Surveillance and Assessment Tool (20 Questions) [Word, 26 KB].

National Public Health Performance Standards [PDF, 592 KB]