HD59 - Review of the Performance and Management of the Virginia Department of Health


Executive Summary:
In 1998, the General Assembly passed House Joint Resolution 137 directing JLARC to study the functional area of Health and Human Resources, including the Virginia Department of Health (VDH). One year later, through the 1999 Appropriations Act, the General Assembly specified that JLARC should focus its review of VDH on the "organization, management, and performance" of VDH. The General Assembly also required that JLARC's review include VDH's newly developing role in regulation and providing oversight of managed care organizations.

VDH is a large State agency that is statutorily required to administer a comprehensive program of public health services. Through Section 32.1-2 of the Code of Virginia, the General Assembly outlined the purpose and priorities for public health with the following language:

The General Assembly finds that the protection, improvement, and preservation of public health and of the environment are essential to the general welfare of the citizens of the Commonwealth. For this reason, the State Board of Health and the State Health commissioner, assisted by the State Department of Health, shall administer and provide a comprehensive program of preventative, curative, restorative, and environmental health services, educate the citizenry in public health and environmental health matters...collect and preserve vital records and health statistics...and abate hazards nuisances to the environment, thereby improving the quality of life in the commonwealth.

Currently, most of the public health programs are delivered through 119 local health departments under the general auspices of 35 health districts. These programs include State-mandated services for the control of communicable and sexually transmitted diseases, and the regulation of food service establishments and onsite sewage systems. Additionally, most of the local health departments across the State provide a variety of non-mandated indigent health care services for persons who are uninsured.

Two factors raised concerns about the operation of VDH and prompted the legislative action that led to this review. First, in the past seven years there has been a considerable lack of continuity in the leadership of VDH and among senior management staff. This has prompted questions about the general management and direction of the State's public health system. Second, there have been numerous citizen complaints concerning the local delivery of some public heath services especially in the are of environmental Health.

In terms of local service delivery, the findings for this review indicate that despite problems with staffing, local health departments have generally done a good job in organizing and delivering services in the core programs of public health. Services for each of the major communicable disease programs have been properly organized and delivered in order to combat the high morbidity rates for certain diseases. In the area of environmental health, local health departments appear to have programs in place which ensure that legislative intent is met regarding the inspection of restaurants and the construction of onsite sewage systems.

Nonetheless, there are problems with some of the State's public health programs that must be addressed to ensure the long-term effectiveness of these programs. Long-standing funding shortages have hampered the ability of district directors to achieve equitable staff allocations in the local health departments. This has mitigated local efforts to treat persons who have the tuberculosis infection and slowed the use of outreach and client-tracking strategies that are needed to increase immunizations for children, especially in the State's major urban areas. Also, significant legislative changes are needed to improve the State's outdated restaurant inspection program.

If these problems are to be effectively addressed, VDH will need more consistent leadership in the commissioner's office. Over the last eight years, constant turnover in this position and among key senior management positions has hindered the management and operation of VDH in a number of ways. Most notably, the agency's internal planning process has been weakened and its efforts to update its computer system have been undermined. Key policy questions regarding the role of local health departments in the delivery of non-mandated primary healthcare services remain unresolved. Furthermore, the funding problems experienced by the local health departments and some of the central office divisions responsible for various regulatory functions in the agency have been largely unaddressed.

The remainder of the report summary discusses six areas, which should be focal points for needed improvements at VDH. These areas include: (1) the communicable disease program, (2) the restaurant inspection program, (3) the on-site sewage system and permitting process, (4) the funding of community health, (5) the performance of central office regulatory functions, and (6) the continuity of leadership.