FAIRFIELD TOWNSHIP-It’s a mandatory accreditation of local health departments that is unfunded, trustees said in a letter to state Sen. Joe Schiavoni, state Rep. Tim Ginter and Heidi Fought of the Ohio Township Association.

Unfunded mandates from the state have been sore spots for city, village, township and public officials for years.

Trustee Chairman Bob Hum said it is simply that people are tired of them and those people include “taxpayers” since they are the ones who wind up forking the money over.

Trustees requested the support of “local offices and agencies as it relates to upcoming state legislation, specifically unfunded accreditation of local health departments.”

A 2013 state law requires health districts and agencies in Ohio to obtain accreditation from the Virginia-based Public Health Accreditation Board (PHAB). They have until 2018 to apply for accreditation or be accreditation recommended. The law is mandatory in 2020.

The PHAB is a non-profit company created in 2007 to serve as the national public health accrediting body and is funded jointly by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation.

The PHAB said the development of national public health accreditation has involved, and is supported by, public health leaders and practitioners from the national, tribal, state, local and territorial levels.

Wes Vins, the Columbiana County Health Commissioner, said the accreditation “is an important issue for us” but wonders about the expenses involved.

“We’re doing as much accreditation as we can … trying to spend money that is meaningful,” he said.

Vins said there is no evidence that accredited health departments are healthier and pointed out, as did the trustees, that there is an “excessive financial burden of over $175,000 that will cripple an already stressed system that delivers much-needed services to our citizens.”

The trustees were clear: “We are opposed to the state of Ohio’s mandatory accreditation of local health departments and the loss of control over health departments in Columbiana County.”

The PHAB has a five-tier fee structure based on population that it calls “moderate application fees” that support the system while drawing local health agencies into a long-term relationship.

The PHAB said “public health department accreditation is not a ‘one-time’ event; it is an ongoing quality improvement commitment.”

Vins said there is an initial accreditation fee of $21,000 based on Columbiana County’s health district population, along with an annual fee of $8,400.

Vins said Salem and East Liverpool have their own local districts and face the same mandate.

The fees to the PHAB are around $36,000, Vins said, explaining the estimated total cost will be about $175,000 “to go through the process” with his staff handling paperwork and requirements along with hiring a full-time coordinator.

Melanie Amato, a public information officer for the Ohio Department of Health, said there are 120 local health departments in the state and 12 have been accredited including the state. Vins said the mandate underpins a “culture shift” and with some quick arithmetic, using his cost as a template, 120 local health districts times $175,000 means “there is over $21 million invested in this and we don’t know if we will have better health. I’m opposed to the mandatory not the quality improvements but for us to be pushed in that direction, I think I can invest in our needs more wisely.”

Vins said the state used a grant to help defray its fees and pointed out the accreditation has an economy of scale built into it to say nothing of the “nine plans they want us to develop.”

He noted, “All these plans, it takes time and money. A lot of staff. I’m for work, but at this point it will be excessive.”

The health department’s tax base comes from inside millage that it shares with townships and villages and Vins said they want the health department putting money into keeping their communities safe.

“That’s where they want us putting our money,” he said.

And while his department may not have a choice regarding the accreditation, “if there’s a way to ease the burden” he said he would like to see it.

The PHAB website says obtaining accreditation will place the health district in a position where it will be able to be measured “against a set of nationally recognized, practice-focused and evidenced-based standards.” The health district will receive “recognition of achievement of accreditation within a specified time frame by a nationally recognized entity.”

It will also be a part of the “continual development, revision and distribution of public health standards.”

Vins said the PHAB isn’t for every health district while noting Ohio is the only state that requires the accreditation and it mandated a program that is voluntary.

The PHAB website says it is a volunteer organization and, “the goal of the voluntary national accreditation program is to improve and protect the health of the public by advancing the quality and performance of Tribal, state, local, and territorial public health departments.”

Vins said, “My question is will it make us healthier?”

And he disagreed with it being evidence-based programming.

“Accreditation is not evidence based,” he said, “until that happens I think this should be voluntary.”

Vins added, “I don’t think communities should be forced to spend this kind of money. Only the most balanced and wealthiest will be able to afford it. Poorer communities can’t afford it.” He said Ginter understands his position which is to give districts more time or money.

The trustee’s letter continued by saying that with “adequate quality assurance measure for local health departments already established by state audits, program surveys, site visits, grant reviews and routine reporting of performance standards and quality indicators that mirror costly accreditation, additional, mandated measure beyond the current oversight is ‘unnecessary.'”

It said compliance will take local staff away from “critical daily activities” to fulfill the requirements while sending local money to the Virginia-based PHAB “that could be better utilized in Ohio and Columbiana County.”

Hum said Ginter was the only response trustees received and he agreed with what they said.

shields@salemnews.net