RESUMO
CONTEXT: Some states are considering restructuring local public health agencies (LPHAs) in hopes of achieving long-term efficiencies. North Carolina's experience operating different types of LPHAs, such as county health departments, district health departments, public health authorities, and consolidated human services agencies, can provide valuable information to policy makers in other states who are examining how best to organize their local public health system. OBJECTIVE: To identify stakeholders' perceptions of the benefits and challenges associated with different types of LPHAs in North Carolina and to compare LPHA types on selected financial, workforce, and service delivery measures. DESIGN: Focus groups and key informant interviews were conducted to identify stakeholders' perceptions of different LPHA types. To compare LPHA types on finance, workforce, and service delivery measures, descriptive statistical analyses were performed on publicly available quantitative data. SETTING: North Carolina. PARTICIPANTS: Current and former state and local public health practitioners, county commissioners, county managers, assistant managers, state legislators, and others. MAIN OUTCOME MEASURE: In addition to identifying stakeholders' perceptions of LPHA types, proportion of total expenditures by funding source, expenditures per capita by funding source, full-time equivalents per 1000 population, and percentage of 127 tracked services offered were calculated. RESULTS: Stakeholders reported benefits and challenges of all LPHA types. LPHA types differ with regard to source of funding, with county health departments and consolidated human services agencies receiving a greater percentage of their funding from county appropriations than districts and authorities, which receive a comparatively larger percentage from other revenues. CONCLUSION: Types of LPHAs are not entirely distinct from one another, and LPHAs of the same type can vary greatly from one another. However, stakeholders noted differences between LPHA types-particularly with regard to district health departments-that were corroborated by an examination of expenditures per capita and full-time equivalents per 1000 population.