Understanding the Resource Allocation Decisions of Public Health Officials in the U.S

Objectives: 1) Describe the nature/scope of resource allocation decisions local health officials (LHOs) confront; 2) Identify processes LHOs use when allocating resources; 3) Assess the degree of discretion reported in allocation decisions and factors influencing discretion; and, 4) Explore whether discretion affects officials' abilities to assure that public health needs are met.

Methods: We surveyed LHOs nationwide and asked: the extent to which they make certain allocation decisions; the processes used in decision-making; reported levels of discretion in allocation; and, whether community needs for certain services are met.

Findings to date: LHOs allocate personnel time to a greater extent than they shift funds among population groups or to various activities. Factors moderately/very influential in allocation decisions include effectiveness of activities (93%) and sole provider of an activity (87%). Results from decision tools, direct public input and input from county councils were moderately/very influential for <50% of respondents. Sixty-five percent of LHOs report a great deal/complete discretion in allocation decisions. LHOs who report that their communities' needs for certain services are met also report having greater discretion over allocation of funds and personnel time, than those who report that their communities needs are not met.

Conclusions/Implications: Standards for effectiveness and access are important in allocation decisions. Discretion may play an important role in LHOs' abilities to meet public health needs in their communities. LHOs' ability to apply public health funds effectively to meet community needs may be improved if funders allow greater discretion over the allocation of funds.