Determinants of Comprehensiveness of Essential Public Health Services Provision: A Resource Dependence Perspective

This study examines factors that are associated with the provision of essential public health services within local health departments (LHDs) using a resource dependence perspective. The study design is a cross-sectional correlational study design. The unit of analysis is the LHD. The study population includes a nationwide sample of LHDs (N = 337). Data was obtained from the National Association of County and City Health Officials' (NACCHO) 2008 National Profile of Local Health Departments. Interdependence was operationalized as partnerships with health care providers, community partnership, and academic partnerships. Munificence was operationalized as total revenue, full-time equivalents (FTEs) per capita, and population. Uncertainty was operationalized as competition (i.e., number of LHDs within state). The outcome of interest is the extent (i.e., total count) of essential services provision by the LHD. Control variables include geographic location, governance structure, and jurisdiction type. The data was analyzed using multivariate Poisson regression models. Preliminary analysis found that there was a significant positive association between LHD partnerships with health care providers (p < 0.001) as well as academic institutions (p = 0.01) and the extent of essential services provision. The study findings have important implications for improving the performance of LHDs in terms of service provision. The study findings also have implications for strategic behavior that includes creating partnerships and collaboration.