What is Public Health Accreditation?

09/19/2019 By Wilson

People have expectations for their schools being accredited. Should they expect similar results from their health department? Increasingly. Health departments have begun answering positively. The main purpose of accreditation is to improve the population's health. Paving the way for accreditation will be done by both government and nongovernmental organization.


The potential role for accreditation in increasing public health infrastructure and improving health was first posted by Robert Wood Johnson Foundation. RWJF convened during a group stakeholder in 2004. The work was originally driven mostly by Robert Wood Johnson and the Centers for Disease Control (CDC), led by the development of a new accreditation agency, the Public Health Accreditation Board (PHAB).


The first couple of health entities to become accredited included the Washington and Oklahoma State departments of health as well as nine other local health departments. Due to these results, many more decide to become accredited expanding the list over time. By 2017, there was a total of 20 accredited state departments and 141 accredited local health departments. There is one centralized accredited statewide system: Florida. Meaning that the local health departments operate under the banner of the state department. With PHAB accredited health departments at so many levels approximately half of the nation's citizens are being served by an accredited health department by mid-2016.


What is Public Health Accreditation

The Public Health Accreditation Board (PHAB) is a nonprofit organization dedicated to advancing the ongoing quality improvement for tribal, state, local, and territorial public health departments. PHAB is behind the development and supervision of the Public Health Accreditation process.


PHAB’s public health department accreditation process searches for the advancement in quality and performance within public health departments. PHAB’s vision is “a high-performing governmental public health system that will make the United States a healthier nation”. PHAB’s initial accreditation assesses a health department’s capacity to carry out the ten Essential Public Health Services; manage an effective health department; and, maintain strong and effective communications with the governing entity.

State or Territorial Health Department

A state or territorial health department is described as the governmental agency with primary statutory authority to promote and defend the public health and prevent disease among citizens. This authority is described by state or territorial constitution, statutes or regulations, or established by Executive Order. State or Territorial health departments can also apply if they are a part of an umbrella organization, super public health agency or super agency that oversees public health functions as well as other government functions. Although, PHAB will review and accredit only the public health functions of the health department.


Centralized States

PHAB Accreditation described a centralized health department as a state public health organization structure that operates all or most of the local health departments. Centralized health departments have a central office that provides support, such as administrative, policy, and managerial direction. The local health departments in centralized states are organizationally part of the state health department. Employees are labeled as state employees, except for those working for the independent public health department, normally in one or more major cities or counties across the US. Where the state or territorial health department operates local or regional health departments, a single local or regional applicant or several individual applicants can decide to apply together.


Local Health Department

PHAB accreditation has defined the local health department as the governmental agency serving a jurisdiction or group of jurisdictions geographically smaller than a state and recognized as being the main statutory authority to promote and protect the public’s health and prevent disease amongst people. This authority has been labeled by the state’s constitution, statute, or regulations or established by local decree or through a formal local cooperative agreement and local aid. The organization may be a locally governed health department, a local organization of a centralized state health department, or a city, city-county, county, district, or regional health department.


Tribal Health Department

The PHAB accreditation has described Tribal health departments as a federally recognized Tribal government, Tribal organization or inter-Tribal consortium, as interpreted in the Indian Self-Determination and Education Assistance Act. Such departments have jurisdictional authority to provide public health services, as signified by constitution, resolution, law, executive order, or other legal means, intended to promote and protect the Tribe’s overall health, wellness, and safety. Federally-recognized Tribal governments will be allowed to carry out any of the public health functions in a cooperative manner through a formal agreement, partnership or collaboration.


Benefits of Accreditation

Accreditation through PHAB provides a way for health departments to assess performance improvement opportunities, improve management, develop leadership, and improve relationships with the local community. The process is one that will challenge the health department to consider the kinds of business it decide to perform and how it does that business. It will encourage and stimulate quality and performance improvement in the health department. Furthermore, it shall also stimulate greater degrees of accountability and transparency. National public health department accreditation has been created because of the desire to improve service, value, and accountability.


Any tangible benefits of working on accreditation will vary among health departments. Since accreditation is primarily about performance and quality improvement, the actual benefits to a health department all come down to assessing the needs. Accreditation provides the necessary framework for a health department to identify performance improvement opportunities, to improve business operations, develop leadership and staff, and improve relationships with the community. The process is one that will challenge the health department to consider what business it does and how it does said business.


PHAB has an ongoing commitment to documenting the effects of accreditation on the nation’s government public health departments, and by extension, the benefits to the communities they serve. PHAB’s website also showcases the early evaluation results for all of their accreditation efforts and will regularly update the result as soon as they become available.


In short, Health departments report that accreditation helps them:

●      Better identify their strengths and weaknesses

●      Document their capacity to deliver the core functions and 10 Essential Public Health Services

●      Promote transparency

●      Improve their management processes

●      Stimulate quality improvement and performance management

●      Increase their accountability to community members, stakeholders, and policymakers

●      Improve their communication with the governing entity/board of health

●      Be more competitive in funding opportunities


How to Become Accredited

The accreditation process has been structured around seven steps to accreditation. A complete detailed information about the seven steps can be found on the PHAB’s website. This toolkit was devised to provide guidance and resources to help you prepare for accreditation, and is designed around each of the seven steps outlined below:


  1. Pre-application:  Health department prepares and assesses readiness for application for accreditation, completes Online Orientation, and informs PHAB of its intent to apply.
  2. Application: Health department submits application and fee, and completes applicant training.
  3. Documentation Selection & Submission: Applicant selects documentation for each measure, uploads it to e-PHAB, and submits it to PHAB.
  4. Site Visit: Site visit of the health department is conducted by PHAB-trained site visitors and a site visit report is developed.
  5. Accreditation Decision: PHAB’s Accreditation Committee will review the site visit report and determine accreditation status of the health department.
  6. Reports: If accredited, the health department submits annual reports.
  7. Reaccreditation: As accreditation status nears expiration, the health department applies for reaccreditation.



Prior to submitting an application, any health department must submit a Statement of Intent to PHAB indicating that they are in the process of preparing to apply. Initial to submission of the SOI, the health department director and the Accreditation Coordinator must complete the PHAB Online Orientation. The SOI in on-binding remains valid for a single year and does not commit a health department to submit an application. During this pre-application period, health departments are encouraged to conduct an organizational self-assessment of their preparedness to apply and to improve the internal structure for the accreditation team.



During the year of submitting the SOI, the health departments submit a formal application and related fees to PHAB. The application process includes submission of the three PHAB prerequisites: the State Health Assessment, the State Health Improvement Plan, and the Agency Strategic Plan. The application initiates the health department accreditation process. Accreditation Coordinators will also have to attend a 2-day PHAB training, after which they can start to submit documentation of conformity with the PHAB standards and measures.


Documentation Selection and Submission

Once the PHAB has approved the application, payment of PHAB’s fees, and the completion of the Accreditation Coordinator training, health departments have up to 1 year to submit documentation to prove conformity with each of the PHAB Standards and Measures. This is one of the most time consuming and vital parts of the Accreditation process. Documentation must be submitted through the e-PHAB system, which accommodates multiple users and allows the health department to work on various parts of the submission during the meantime. The documentation submitted will be reviewed by the site visit team.


PHAB Site Visit

The PHAB site visit will serve several purposes: to verify the authenticity of documentation submitted by the health department, to seek answers to questions regarding conformity with the standards and measures, and to provide an opportunity for discussion and further explanation. The site visit will be conducted by a team consisting of 3-4 PHAB trained site visitors and will last around 2-3 days. Following the site visit, the site visit tea shall build a report describing the level of conformity demonstrated with each of the measures, any areas of excellence, and any opportunities for improvement. The health department will then have the opportunity to review the report before it’s finally submitted to the PHAB Board for the final accreditation decision.


Accreditation Decision

The PHAB Accreditation Committee will determine the accreditation status of the health department based on the site visitors report. The Committee may decide that the health department is accredited, not accredited, or is required to submit additional information. If the health department does become accredited without more work on the part of the health department, they shall have the chance to submit an action plan to PHAB. If the action plan becomes approved, implemented by the health department, and the site visitors asses the situation positively, the health department could be accredited at that time.


Reports and Sustaining Improvements

The accreditation period is five years, during which time the agency must maintain conformity with the standards and measures demonstrated during the site visit and work towards conformity of those standards found in non-conformity. All accredited health departments must submit annual reports to PHAB. Reports describe how the health department has addressed the priority areas for improvement identified by PHAB. Annual reports also indicate that the health department is still in conformity with the measures.



As the accreditation statues reach its expiration date, the health department can apply for reaccreditation. Every accredited health department is required to submit a new application in the accreditation process and will need to undergo additional training.



Any public health organization can benefit from the massive benefits of Public Health Accreditation. It ensures your organization continues to improve and strive to be the best at providing their community with the best health possible. PHAB may seem like too much, but it can help you maintain quality health care.