Measuring capacity to deliver Public Health services at the local level: Development of a performance capacity screener for local boards of health

Tools exist to measure public health departments' capacities to provide the 10 Essential Public Health Services (EPHS). However, their length and level of detail present challenges when implemented with small and rural health departments or when integrated into other research instruments. As part of a Massachusetts Practice Based Research Network study of evidence-based public health practices, we created a screening tool to assess the extent to which local health authorities are able to provide the 10 EPHS. Based upon the standards of NACCHO's operational definition of a functional health department, our 25-item screener first assesses the presence/absence of a particular essential service element then rates the local capacity to execute that element. Items are scored on a scale of 0 to 4 and summed (100 points possible). Data obtained from 222 Massachusetts municipalities were used to assess the utility and reliability of the screener.

Respondents were primarily (86%) the Director/Health Agent. Over 90% had a population ≤ 50,000 and 42% ≤ 10,000. 44% were rural. The median municipal budget was $35,587,150. Reliability of the screener was high (Cronbach's alpha=0.88) and the summary score was normally distributed with a mean of 43.8 (SD 16.9). Capacity score was significantly and positively correlated with population size (r=.20) and municipal budget (r=0.26). Importantly, the scale demonstrated good score variability within municipalities of all sizes.

This performance capacity screener provides a practical method of assessing capacity at the local level. It represents a reliable tool with potentially wide application in the field of public health systems research.