MCH Service Delivery Profile of LHDs: Relationship with the Performance of the Essential Public Health Services"

In the last decade, maternal and child health (MCH) programs in local health departments (LHDs) have faced a changing landscape. While MCH service delivery may have changed, the expectation to perform the Essential Public Health Services (EPHS) continues.  The Maternal, Child, and Adolescent Health (MCAH) 2012 Survey was developed by NACCHO and the UIC School of Public Health with input from CityMatCH and AMCHP and distributed to a nationally representative sample of 546 LHDs, randomly selected by NACCHO and stratified by jurisdiction size (<50,000, 50,000-499,999, 500,000+); LHDs serving large jurisdictions were oversampled. The survey included questions about LHD MCAH services and questions to measure the performance of the EPHS.  The mean number of services provided by LHDs was 13.1 or 39.4% (95% CI 36.5-42.2%) of the 35 possible services. On average, medium sized LHDs provided significantly more services (14.2) than small (12.4) or large LHDs (13.0). There was a significant positive relationship between the number of services provided and overall EPHS performance (p <.01).  In three of four service domains, those LHDS providing more than 75% of services in that domain had significantly higher mean EPHS scores. In sum, LHDs with a more robust service delivery portfolio were more likely to have higher EPHS scores. However, as these are cross-sectional data, the direction of the relationship is not clear. While prior research suggests that LHDs with more comprehensive services are more likely to perform the EPHS, the mix and match of services that maximizes EPHS performance needs to be explored.