County health departments

Special Examination Report No. 14-13

December 2014

Georgia Department of Audits and Accounts
Performance Audit Division
Greg S. Griffin, State Auditor Leslie McGuire, Director

Why we did this review
This review of the county health departments was conducted at the request of the Senate Appropriations Committee. The committee asked us to:
(1) identify the current scope of county health departments, with attention to costs to operate, current services, and number and type of employees; and
(2) discuss the ability of county health departments to identify and tailor services to address the needs of their local area through basic health services.
About DPH and County Health Departments
Georgia's public health administration system is a "hybrid" one, where the Department of Public Health (DPH) and local county boards of health establish systems to assure the public's health. The state is divided into 18 public health districts, each led by a district health director (a licensed physician) who serves as the management liaison between the state and the local government.
County health departments deliver population-based and direct health care programs and services designed to protect the population from the spread of disease, environmental hazards, and injuries; to promote healthy behaviors; to respond to public health emergencies; and to assure the quality and accessibility of health care services.

County Health Departments
Requested information on cost, staffing, and services
What we found County health departments expended an estimated $408.6 million in federal, state, local, and earned funds in fiscal year 2014. Federal and state funds accounted for $141.5 million (35%) and $130.9 million (32%), respectively. Fees, insurance payments, and local funds comprise most of the remaining spending (33%). The majority of federal funding is delivered in the form of programmatic grant-in-aid, and the majority of state funding is delivered in the form of general grant-in-aid. Approximately 65% of expenditures were for personal services.
As of June 30, 2014, county health departments employed 5,299 personnel, 4,416 full-time and 883 part-time. We estimate the number of full-time equivalent positions to be 4,984. Non-clinical staff account for approximately 60% of personnel, and clinical staff account for approximately 40%. The largest clinical category is public health nurse with 1,272 employees, 1,096 full-time and 176 part-time. The majority of the public health nurses are registered nurses, with 815 full-time and 104 part-time employees.
County health departments deliver a set of core population-based and direct health care services. Population-based program areas include emergency preparedness, environmental health, and epidemiology. Direct health care program areas include maternal and child health, infectious disease control, and health promotion and disease prevention. In fiscal year 2014, approximately 80% of direct health care hours were used to support three services within the programs above: women, infants, and children (WIC) clinical services (34.0%), immunizations (29.6%), and family planning (15.5%).
Some of the current programs and services delivered by county health departments do satisfy a portion of the basic health service

270 Washington Street, SW, Suite 1-156

Atlanta, Georgia 30334

Phone: (404)656-2180

www.audits.ga.gov

needs of eligible client populations. However, county health departments are not designed to serve as a patient's "medical home" where the full range of primary care services for individuals are delivered and managed. While district health directors and local managers are aware of basic health needs in their communities, their ability to modify the programs and services in order to satisfy the basic health needs of the local area is constrained by four factors:
1. A reliance on expanded-role public health nurses who have limited authority to independently assess and treat illnesses and injuries
2. A funding model that restricts most expenditures to grant-funded programs and objectives
3. A limited ability to collect fees for clinical services, due to inability of patients to pay and a limited ability to bill private insurers
4. A primary mission to deliver public health not individual health services
Despite these constraints, some current programmatic funding is used to deliver primary health care and case management to certain eligible populations (most frequently children or HIV/AIDS patients). And in a limited number of county health departments, management has expanded services to meet more advanced clinical needs, such as dentistry. Some county health departments have established referral partnerships with community health centers that work in medically underserved areas to assure the basic health service needs of the local area are met.
What we recommend This report is intended to provide answers to questions posed by the Senate Appropriations Committee. We hope that this report provides pertinent information to help inform policy decisions.

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Table of Contents

Purpose of the Special Examination

1

Background

1

What is Public Health?

1

Georgia's Public Health System

1

Categories of Services Provided by County Health Departments

5

Requested Information

6

What is the cost to operate county health departments?

6

What are the current services provided by county health departments?

11

What are the number and type of employees in county health departments?

18

What is the ability of county health departments to identify the basic health

service needs of their local area?

24

What limits the ability of county health departments to address the basic

health service needs of their local area?

25

How have some county health departments expanded services to address the

basic health service needs of their local area?

29

Appendices

32

Appendix A: Objectives, Scope, and Methodology

32

Appendix B: District Expenditures and Staff

34

Appendix C: Programmatic Grant-In-Aid Expenditures

49

Appendix D: Expenditures by Health Districts

50

Appendix E: Location and Purpose of Programmatic Grant-in-Aid

51

Appendix F: Basic Health Services Provided by County Health Departments

59

Appendix G: Primary Care Service Case Studies

60

Appendix H: Dental Services

61

Appendix I: Telemedicine Case Studies

62

Appendix J: Federally Qualified Health Centers

63

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Purpose of the Special Examination
This review of county public health departments was conducted at the request of the Senate Appropriations Committee. The committee asked us to
1. identify the current scope of public health departments, with attention to costs to operate, current services, and number and type of employees; and
2. discuss the ability of public health departments to identify and tailor services to address the needs of their local area through basic health services.
A description of the objectives, scope, and methodology for this review is included in Appendix A. A draft report was provided to the Department of Public Health (DPH) for review, and technical changes were made as a result of DPH's review.
Background
What is Public Health? Public health focuses on health threats to the public as a whole, instead of the wider range of health care needs that can be present for any individual. The Centers for Disease Control and Prevention states that the purpose of public health is to protect the population from the spread of disease, environmental hazards, and injuries; promote healthy behaviors; respond to the public health needs arising from natural disasters; and assure the quality and accessibility of services.
Public health professionals do provide some clinical services to individual patients. Those services are frequently associated with communicable diseases (e.g., influenza and STDs), maternal and child health, or chronic diseases. In some locations, public health officials take on a broader role, delivering a wider range of clinical services to those without access to other providers.
Georgia's Public Health System State and local governments share administrative authority within Georgia's public health system. Services to the public are delivered by county health departments, but county boards of health, district health directors, and the Department of Public Health all play roles in system governance. Various federal agencies provide significant funding, and, in doing so, influence the type of services delivered. State, local, and federal governments provide approximately 80% of county health department funding. The entities' roles are described below, and their role in funding is shown in Exhibit 1.

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Exhibit 1 Funding and Organization of County Health Departments

Source: Department of Public Health, A Guide to Serving on the County Board of Health (2013)

DPH enters into an annual master
agreement with counties to
establish funding and services.

Georgia Department of Public Health
The Georgia Department of Public Health (DPH) is the state's lead agency for promoting and establishing public health. DPH has a mission "to prevent disease, injury, and disability; promote and well-being; and prepare for and respond to disasters." To accomplish its mission, DPH has three basic functions:
1. Assess the health of the community by (a) monitoring the health status and needs of individuals and the community and (b) diagnosing and investigating diseases, injuries, and health conditions
2. Ensure the health of individuals and the safety of the community through the provision of health services
3. Establish and implement sound public health policy
Much of DPH's interaction with county health departments comes through the provision of funding and the employment of district personnel. DPH receives and distributes state and federal funds to public health districts and county health departments. DPH contracts with each county board of health through an annual master agreement that contains a list of services to be provided and funding amounts. DPH also employs district health directors and provides funds for a limited number of personnel in each district.

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Georgia is divided into 18 public health districts, which are each led by a district health
director.

Public Health Districts and County Health Departments
The state is divided into 18 public health districts (Exhibit 2). Each public health district is comprised of one or more (up to 16) of the state's 159 counties and is led by a district health director (director) who serves as the chief executive officer for each county health department within the district. The director has authority over the day-to-day administration of health departments, including personnel, as well as the right of approval over the scope of services and operating details of the departments. Directors are Georgia-licensed physicians who are appointed by the DPH commissioner and approved by the county boards of health within the district.

Exhibit 2 County Health Departments are Organized into 18 Health Districts

Dade

Catoosa

Walker

Whitfield

Murray
1-2

Fannin Gilmer

Union

Chattooga

Gordon

Pickens

Dawson Lumpkin

Towns

Rabun

White Habersham

2-0

Stephens

1-1
Floyd

Bartow

Hall

Cherokee

Forsyth

Banks Franklin

Hart

1-1 Northwest 1-2 North Georgia 2-0 North 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton 3-4 East Metro 3-5 DeKalb 4-0 Four 5-1 South Central 5-2 North Central 6-0 East Central 7-0 West Central 8-1 South 8-2 Southwest 9-1 Coastal 9-2 Southeast 10-0 Northeast

Jackson

Madison

Elbert

Polk

Cobb

Gwinnett

Barrow

Clarke

Oglethorpe

3-1 Paulding

3-4

Haralson

3-5

Walton

10-0 Oconee

Wilkes

Carroll

3-2 Douglas
3-3 Fulton

Dekalb Clayton

RockdaleNewton

Morgan

Greene Taliaferro

Lincoln Columbia

Heard

Coweta

Fayette

Henry

Spalding

Butts

Jasper

Putnam

Warren

Hancock

Glascock

Richmond

Chattahoochee McDuffie

Troup

4-0
Meriwether

Pike

Lamar Monroe

Upson

Harris

Talbot

Crawford

Jones
5-2
Bibb

Baldwin Wilkinson

Jefferson Washington
Johnson

6-0 Burke

Jenkins

Burke Screven

Muscogee

Taylor

Peach

Twiggs

Laurens

Emanuel

Marion Schley

Macon

7-0
Stewart Webster

Sumter

Quitman

Clay

Randolph

Terrell Lee

Houston Bleckley

5-1 Treutlen

Montgomery

Dooly

Pulaski

Dodge

Wheeler

Crisp

Wilcox

Telfair

Turner

Ben Hill

Jeff Davis

Candler

Bulloch

Effingham

Toombs

Evans

Tattnall

Appling

Bryan

Chatham

Liberty
9-1
Long

Calhoun

Dougherty

Worth

Irwin Tift

Coffee

Bacon

Wayne

Early
Miller Seminole

Baker Decatur

Mitchell

Berrien

Atkinson

Ware

8-2
Grady

Colquitt

Cook

Thomas

Brooks

Lanier
8-1

Lowndes

Echols

9-2
Clinch

Pierce Brantley
Charlton

McIntosh Glynn Camden

Source: Georgia Department of Public Health

Each public health district has a district office where personnel administer programs and coordinate services delivered within county health departments. District staff report to the district health director or another manager at the district, but they also receive guidance and advice from state administrators at DPH. The director serves as

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Day-to-day administrative
and clinical operations in county health departments are overseen by a nurse manager.

the liaison between the state and counties to pursue federal, state, and local public health goals.
For districts with more than one county, a lead county is designated to facilitate and administer district-wide or multi-county programs. The lead county is usually a larger county with more financial resources than others in the district. The district office is usually located in the lead county. District personnel are employees of either the state or a county board of health. These personnel provide administrative support to county health departments and provide health services that may be provided more economically at the district level (e.g., public awareness campaigns and services with low demand within a single county).
Each county has at least one county health department facility, though some departments operate multiple sites. O.C.G.A. 31-3-9 requires that county governments provide facilities and equipment to the county board of health, though DPH officials noted that operating costs (e.g., electricity) are not required.
On-site administration and clinical service oversight is delegated to a nurse manager at the facility, who reports to the district health director. A majority of clinical personnel that deliver direct health care are expanded-role public health registered nurses (see description on page 20). Most health departments do not employ physicians, though some may contract with physicians for the delivery of specific services. Health department personnel are usually county employees.
County Boards of Health County health departments work under the auspices of county boards of health that were established by legislation enacted in 1914. Though DPH maintains some oversight over the county boards of health, they are separate legal entities.1 Boards are responsible for assessing local health needs, advocating for public health programs, and approving and presenting the county health department budget to the county commission.
Boards are comprised of seven members, including one physician, one advocate for needy and elderly consumers, two advocates for all consumers of health care, and one representative from each of the following governmental units: the county governing authority, the county school system, and the largest municipality in the county.
Federal Health Agencies/Programs DPH applies for and receives federal government grants, which are used to establish programs and services delivered through county health departments. In addition, local health departments may solicit the federal government for grant funding directly.
The two largest federal grantors to DPH are agencies and bureaus within the U.S. Department of Health and Human Services and the U.S. Department of Agriculture. Examples of county health department activities funded by the federal government include vaccinations for children, Ryan White HIV/AIDS program, and WIC nutritional services.

1 For example, boards cannot create rules and regulations that conflict with DPH rules and regulations, and persons affected by a board order or action in proceedings may appeal to DPH.

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Categories of Services Provided by County Health Departments
County health departments provide both population-based and direct health services. Some of these services are mandated by state law or required by the master agreement between DPH and each board of health.

In most locations, county health
departments provide only a limited set of
direct health services, such as immunizations, health screenings, and communicable disease treatment.

Population-Based Services These are services intended to protect the general public, as opposed to an individual patient. Population-based services often do not involve a one-on-one relationship between medical personnel and a patient, and in many cases, they are performed by nonmedical personnel in the health department or by personnel in the district office or central office. Examples of population-based services include inspecting restaurants, identifying and controlling diseases, preparing for emergencies, and promoting healthy behaviors.
Direct Health Care Services These are services such as diagnosis, monitoring, and treatment delivered by health care professionals in a oneon-one setting. Direct health care services within health departments often target high-risk individuals (such as those with communicable diseases), women, and children.

It should be emphasized that while health departments provide direct care services, most do not offer all of the services of a primary health care provider. As discussed later in this report, while some services typically considered primary health care are offered by county health departments (e.g., immunizations), many other primary care services are generally not available (e.g., diagnosis of acute illnesses or injury).

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Requested Information

What is the cost to operate county health departments?

County health departments expended an estimated $408.6 million in federal, state, local, and earned funds in fiscal year 2014. Federal and state funds accounted for $141.5 million (35%) and $130.9 million (32%), respectively, while fees and insurance payments and local funds comprised much of the remaining spending. Approximately 65% of expenditures were personnel-related. In addition to the $408.6 million expended, health departments utilized additional resources in the form of vaccines, family planning pharmaceuticals, and nutritional program food vouchers.

County health departments
spent approximately $408.6 million in fiscal year
2014.

No source accurately identifies the operating costs of each of the 159 county health departments, because lead counties' expenditures include those for services distributed throughout all counties in the district. This results in county expenditures that appear higher or lower than the true cost of delivering services to the county's residents. However, DPH's uniform accounting system (UAS) and our survey of districts allowed us to determine the expenditures for each of the 18 districts, which are presented in Appendix B and Appendix D. We found that district expenditures ranged from $10.8 million to $36.7 million, with per capita expenditures ranging from $25 to more than $70 (state average of $41).

Expenditures by Fund Source
County health departments rely on multiple sources to fund their programs. As shown in Exhibit 3, the largest sources of funds are the federal and state governments. Federal agencies provide significant programmatic grant-in-aid (PGIA), while the state provides a large amount of funds through general grant-inaid (GGIA). In addition, county health departments use local contributions, money generated from fees and insurance payments, and other grants. Expenditures from each fund source are discussed in more detail below.

Exhibit 3 County Health Departments Spent $408.6 Million in Fiscal Year 2014

Fund Source Federal
Programmatic Grant-Aid Other Federal Grants State Programmatic Grant-Aid General Grant-in-Aid Other State Fund Types Fees and Insurance Local Other Total 1 Does not sum to total due to rounding. Source: UAS and DOAA survey

Expenditure % $141,549,730 35%
$ 111,742,881 $ 29,806,849
$130,916,204 32% $ 22,954,066 $ 84,554,333 $ 23,407,805
$74,330,067 18% $52,951,192 13%
$8,838,874 2% $408,586,0661

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What is Grant-in-Aid?
County health departments expended more than $219 million grant-in-aid (GIA) funds during fiscal year 2014. GIA consists of state and federal funds originally provided to the Department of Public Health, which allocates the funds to county boards of health and districts. GIA comes in two forms: general and programmatic.
General Grant-in-Aid: $84.6 million. GGIA funds are state funds that are intended to support the county's public health infrastructure. While the funds are not tied to specific programs, they must be spent in compliance with the master agreement between DPH and the county board of health. The agreement requires that a county's public health services include family planning, environmental health, epidemiology, health promotion and disease prevention, infectious disease control, and emergency preparedness. GGIA funds are allocated to counties through a formula, last updated in 2011, that considers a county's population share (40%), poverty share (40%), and poverty rate (20%).
Programmatic Grant-in-Aid: $134.7 million. PGIA funds are directed for the provision of specific program services, such as STD surveillance or hearing tests for newborns. Approximately 83% of PGIA originated from a federal agency. Various federal agencies provide grants to DPH to target specific public health areas (e.g., emergency preparedness, HIV treatment). DPH uses annexes to distribute the PGIA to districts and counties. More information on the purpose and fund source of PGIA is available in Appendix C and Appendix E.

Federal: County health departments expended $141.5 million in federal funds, accounting for 35% of expenditures. Federal funding is allocated to counties mainly through PGIA. Finally, counties may also independently apply for and receive federal grants, without the funds passing through DPH.
State: County health departments expended $130.9 million (32%) in state funds. These state funds were allocated by DPH as GGIA ($84.6 million), PGIA ($23.2 million), and other forms of state funding ($23.4 million).
Fees and Insurance: County health departments expended $74.3 million (18%) in funds generated through fees and payments from private and public insurance providers. County health departments charge user fees for services such as septic tank inspections, family planning services, and immunizations. In most cases, fees generated by grant-funded programs must be used to supplement the budget for that particular program.
Local: County health departments expended $53.0 million (13%) in funds contributed by local governments. While some municipalities contribute, all Georgia counties are required to contribute to their local county health department. According to DPH officials, the minimum level of contribution has not changed in over 40 years; however, many counties allocate more funding than the minimum requirement. As discussed on page 9, the amount and proportion of expenditures that are locally funded varies by district.
Other: County health departments expended $8.8 million (2%) in funds from other sources. This fund type includes donations, contracts, and grants from private organizations, such as the Blue Cross Blue Shield of Georgia Foundation and the United Way.
Additional Resources County health departments also utilized resources during fiscal year 2014 that are not included in the expenditure amounts above. County health departments do not receive funding for these programs, but instead receive other items of value for distribution to clients. These federal resources include:

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Women, Infants, and Children (WIC) Food Cost: $141 million. This funding covers the cost of food purchased with WIC food vouchers. As part of the WIC program, participants receive vouchers/checks to purchase certain types of food from approved vendors.
Immunization Program: $18.6 million. The CDC purchases vaccines at a discount and distributes them to grantees, including DPH. This allows county health departments and other healthcare providers registered with DPH to provide all recommended vaccines at no cost. The total allocation to Georgia is valued at $120.3 million; however, DPH estimates the value of vaccines used by county health departments to be $18.6 million.
Family Planning Pharmaceuticals: $3.1 million. Participants in the family planning program may require pharmaceuticals and contraceptive options. County health departments can purchase pharmaceuticals through the federal Health Resources and Services Administration Office of Pharmacy Affairs 340B Program. This program allows county health departments to take advantage of group purchasing and access to lower-cost drugs.
Expenditures by Type
As shown in Exhibit 4, 65% ($267.5 million) of county health department expenditures are for personal services, including salaries, FICA, and retirement.2 The remaining 35% ($141.1 million) includes a number of smaller categories, including indirect costs ($18.6 million), supplies and materials ($13.5 million), and pharmaceuticals ($10.4 million). Numerous smaller categories total $47.6 million, and another $9.9 million is unclassified. These unclassified expenditures, which were reported by districts via a DOAA survey, are from grants secured independently by the counties. For that reason, the health departments are not required to report detailed expenditure information to DPH.
Exhibit 4 Personal Services Account for Majority of Expenditures

Other 35%

Personal Services
65%

Source: UAS data and DOAA survey
Expenditures by District District expenditures depend on multiple factors, including the amount of funds provided by the state, federal, and local governments, as well as the amount collected
2 Figure does not include personal service costs associated with district health directors or other state employees in the districts.

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for services in fees and insurance. As shown in Exhibit 5, district health care expenditures ranged from a high of $36.7 million in District 3-2 Fulton to a low of $10.8 million in District 3-3 Clayton. A table showing the total district expenditures by fund source is available in Appendix D.

State and federal funds comprised approximately 60% to 85% of expenditures for most districts, with the exceptions of districts 3-2 Fulton and 2-0 North. District 3-2 Fulton expended a significant amount of local funds, while District 2-0 North had a combination of higher than average expenditures of local funds and fees/insurance.

Local funding varied significantly among the districts. District 3-2 Fulton expended $15.2 million in local funds, representing 42% of the district's expenditures. In contrast, District 5-1 South Central expended approximately $330,000 in local funds, or 3% of the district's total expenditures.

Exhibit 5 District Expenditures Ranged from $10 Million to More Than $35 Million in Fiscal Year 2014

$40,000,000

Federal

State

Fees and Insurance

Local

Other

$35,000,000

$30,000,000 $25,000,000

$20,000,000 $15,000,000 $10,000,000

$5,000,000 $-

Fulton Coastal DeKalb East Metro Southeast Southwest LaGrange Cobb-Douglas Northwest
North North Central
Northeast East Central West Central North Georgia South Central South Central
Clayton

3-2 9-1 3-5 3-4 9-2 8-2 4-0 3-1 1-1 2-0 5-2 10-0 6-0 7-0 1-2 8-1 5-1 3-3
Source: UAS data and DOAA survey
Exhibit 6 shows that the per capita expenditures varied significantly across districts. The statewide per capita expenditure was $41, and all districts ranged between $26 and $73 dollars per resident. District 9-2 Southeast spent the highest amount per resident at $73 per resident. District 3-4 East Metro spent the lowest amount at $26 per resident. Three districts exceeded $60 per resident and two of those were above $70. It should be noted that this is not a measure of the cost of delivering an individual service. The number of clinical services delivered does not necessarily vary to the same degree as the population (i.e., districts with different populations may deliver the same number of services).
Varying per capita spending levels are due to funding not being tied solely to the population size. While 40% of general grant-in-aid is based on a county's share of

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the state population, the remaining portion is attributed to measures of poverty.3 In addition, various types of programmatic grant-in-aid are tied to a public health need, not the number of residents. Finally, local governments do not contribute funding to county boards of health based solely on the number of residents.
The size of a district's population greatly affects the per capita expenditure. Regardless of the size of the total budgets, districts with lower populations generally spent more per capita. For example, District 5-1 South Central expended the second highest amount per resident. However, this district has the lowest population in the state. As shown in Exhibit 6, higher population areas in north Georgia tended to have lower per capita expenditures than less populated southern Georgia.
Exhibit 6 Per Capita Expenditures Vary Significantly Across Districts

$71 and above per district resident
$61 - $70

2 Districts 1 District

$51 - $60

2 Districts

$41 - $50

6 Districts

$31 - $40
$30 and below per district resident

4 Districts 3 Districts

Dade

Catoosa

Walker

Whitfield

Murray
1-2

Fannin Gilmer

Union

Chattooga

Gordon

Pickens

Dawson Lumpkin

Towns

Rabun

White Habersham

2-0

Stephens

1-1
Floyd

Bartow

Hall

Cherokee

Forsyth

Banks Franklin

Hart

Jackson

Madison

Elbert

Polk Haralson

Cobb

Gwinnett

3-1 Paulding

3-4

Douglas

3-2

3-5
Dekalb

Barrow Walton

Clarke Oglethorpe
10-0 Oconee

Wilkes

Lincoln

Rockdale

Carroll

Fulton Clayton
3-3

Newton

Morgan

Greene Taliaferro

Columbia

McDuffie

Heard

Coweta

Fayette

Henry

Spalding

Butts

Jasper

Putnam

Warren

Hancock

Glascock

Richmond

Troup

4-0
Meriwether

Pike Lamar Upson

Monroe

Jones
5-2

Bibb

Harris

Talbot

Crawford

Baldwin Wilkinson

Jefferson Washington
Johnson

6-0 Burke Jenkins

Screven

Muscogee

Taylor

Peach

Twiggs

Laurens

Emanuel

Chattahoochee

Marion Schley

Macon

7-0
Stewart Webster

Sumter

Quitman

Clay

Randolph

Terrell Lee

Houston Bleckley

5-1 Treutlen

Montgomery

Dooly

Pulaski

Dodge

Wheeler

Crisp

Wilcox

Telfair

Turner

Ben Hill

Jeff Davis

Candler

Bulloch

Effingham

Toombs

Evans

Tattnall

Appling

Bryan

Chatham

Liberty
9-1
Long

Calhoun

Dougherty

Worth

Irwin Tift

Coffee

Bacon

Wayne

McIntosh

Early
Miller Seminole

Baker Decatur

Mitchell

Berrien

Atkinson

Ware

8-2
Grady

Colquitt

Cook

Thomas

Brooks

Lanier
8-1

Lowndes

Echols

9-2
Clinch

Pierce Brantley
Charlton

Glynn Camden

Source: UAS data and US Census Bureau data

3 The 2011 formula is not used to distribute all general grant-in-aid funds. Counties set to lose funds as a result of the new formula were held harmless in 2011 through 2014.

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What are the current services provided by county health departments?
County health departments offer a common set of direct care and population-based programs and services across the state. In addition, districts and counties may offer additional, unique services due to targeted programmatic grant-in-aid, local funds, or other resources.
The direct care services offered by most county health departments meet only a portion of an individual's basic health care needs. These county health departments do not offer the range of services found with a primary care provider. In addition, many services are restricted to patients that meet program eligibility requirements.
It should be noted that DPH does not currently maintain a list of services offered by each county health department. This is partly attributed to counties' ability to independently apply for federal and private funds, as well as the local boards' autonomy in funding local programs. We compiled the list of common programs and services by reviewing the agreements between DPH, county boards of health, and districts; DPH's accounting system for health departments; and a DPH clinical cost study. We then asked DPH and district personnel to confirm the service listing.
Direct Care Programs and Services Available in all Counties Direct care programs and services are generally delivered by health professionals in a one-on-one setting. Within county health departments, these services often target high-risk individuals (e.g., those with communicable diseases), women, and children.
County health departments provide a common set of direct care programs and services within three DPH program areas (Exhibit 7). A description of the program areas and the services available in all districts and health departments is below.

Exhibit 7 Common Direct Care Program Areas

Program Areas Maternal and Child Health
Health Promotion and Disease Prevention Infectious Disease Control Source: DPH documents

Examples of Common Services
- Family planning - Nutrition services for women, infants, and children - Healthcare for children with special needs - Pregnancy testing
- Oral health education - Breast and cervical cancer screening
- Immunizations - HIV/AIDS services - Detection and treatment of tuberculosis - STD treatment

Maternal and Child Health County health departments offer programs and services to address certain health care needs of pregnant women, mothers, and children.
o Children's Health A wide range of services and programs are available to children who meet eligibility criteria related to family income and/or the presence of special health needs. Public health nurses can make clinical assessments and treat conditions such as conjunctivitis, diaper rash, ear

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Loss of Federal Funds for Family Planning
In July 2014 the U.S. Department of Health and Human Services awarded a $7.8 million family planning grant (Title X) to Family Health Centers of Georgia, a federally qualified health center, which will use sub-recipients to provide services around the state. According to DPH officials, DPH had received the grant since 1965 and distributed the funds to county health departments.
DPH officials do not know the extent of the new provider's network. Partly for this reason, DPH officials have decided that county health departments will continue to offer family planning services. DPH has restructured its family planning program and implemented a sliding fee scale based on income. Services will continue to be available in all 159 counties.

infections, ringworm, head lice, common colds, fever, and whooping cough. All counties also provide hearing screening and diagnostic testing referral for all newborns.
Multiple programs specifically target children with special needs by screening and linking them to needed services. The county health departments have programs to screen, coordinate care, and refer children to public health and other services (e.g., physical therapy, speechlanguage therapy). They may also provide care coordination and other health services, even those provided by other entities, to children through age 21. The services may include paying for services such as medication, physical exams, and hospitalization.
o Family Planning All counties provide a range of reproductive services to women of childbearing age and their partners. Services include pregnancy tests, health screening, birth control counseling, and contraceptive implants. Federal Title X funds were not provided to DPH in fiscal year 2015, but DPH officials intend to continue providing family planning services with state funds and funds generated by sliding scale fees (see box above).
o Prenatal/Perinatal Care All counties provide Presumptive Eligibility Medicaid determinations so that pregnant women may receive offered services.
o Women, Infants, and Children (WIC) WIC provides nutrition services to women, infants, and children in eligible families. Participants may receive a nutrition assessment, nutrition education, breastfeeding support, referrals to health or social service providers, and vouchers for healthy food.

Health Promotion and Disease Prevention County health departments implement evidence-based strategies that address disease prevention, health promotion, early detection, and screening.
o Cancer Screening All county health departments provide breast and cervical cancer screening for women who meet income, insurance, and age criteria.
o Oral Health This program is designed to provide children, pregnant women, and some adults access to oral health preventive treatment services and oral health literacy education. Services that are available in all counties include screenings by nurses or dental hygienists.

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Infectious Disease Control County health departments provide services intended to prevent, diagnose, and treat a variety of infectious diseases.
o HIV/AIDS County health departments provide case management and education services for persons with HIV or AIDS. They either have physicians who provide primary care services or they coordinate care delivery by outside physicians. Public health nurses can provide limited clinical services, such as monitoring the health of those taking prescribed medications and dispensing medications to address designated health conditions that may arise.
o Immunization Several programs work to reduce the incidence of vaccinepreventable diseases through education, training, and vaccination. Immunizations are available for clients of all ages.
o Sexually Transmitted Diseases County health departments provide diagnosis and treatment, education, and counseling for STDs. These services are available for men and women.
o Tuberculosis County health departments can conduct tests to determine exposure to tuberculosis. They can also diagnose and treat individuals with tuberculosis, as well as conduct contact investigations to identify those in need of preventive treatment.
While county health departments offer a range of services, a significant majority of the clinical time was spent in only three areas. As shown in Exhibit 8, data from DPH's recent clinical cost study4 shows that nearly 80% of clinical time in fiscal year 2014 was spent in WIC clinical (34.0%), immunizations (29.6%), and family planning (15.5%).
Exhibit 8 Nearly 80% of Clinical Time in Fiscal Year 2014 Spent in Three Programs

100%

Clinical Resources

Cumulative Percentage

90%

80%

70%

60%

50%

40%

34.0%

30%

20%

29.6%

15.5%

21%

10%

0% WIC (Clinical Only)

Immunizations

Family Planning

Other

1Programs are measured by the level of clinical resources (time) consumed in order to offer the service. 2Other combines 18 programs. Source: DPH Clinical Cost Study, 2014

4 The DPH Clinical Cost Study tracked clinical staff contacts in a number of programs. The study assigned a relative value unit (RVU) to each service that could be provided by a health department. Services that required more clinical resources (e.g., time or complex decision making) to perform had a higher RVU than those requiring less time.

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County Health Departments' Provision of Basic Health Services
While county health departments generally do not provide the full range of health care services offered by primary care providers, the health departments' direct care services inevitably provide patients with a portion of their basic health care needs. Basic health needs most frequently met by county health departments are in the areas of preventive services and treatment for infectious diseases, but those services are limited to patients who meet eligibility requirements. Other basic health needs are generally not met by county health departments.
Below is a list of basic health care needs as defined in the U.S. Public Health Service Act and an overview of how they are addressed in county health departments. We determined the prevalence of these types of health services through interviews of DPH and district officials, reviews of DPH documents, and a survey of health district personnel (see Appendix F for additional results on the survey).
Physician or mid-level practitioner services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology County health departments generally do not hire physicians and mid-level practitioners. When physicians are working in health departments (employed or contract), they are most frequently providing services to those with HIV/AIDS (as part of the Ryan White program) or to children. Advanced practice registered nurses (APRNs) most frequently conduct family planning services or provide services to those with HIV/AIDS.
Diagnostic lab and radiologic services A majority of county health departments offer chest x-rays for tuberculosis patients, but none offer general x-ray services for injuries such as bone fractures. Whether conducted on-site or off-site, all county health departments offer lab testing for pregnancy and STDs. A majority (72%) offer lab testing to test the function of major organs such as liver, thyroid, and kidney.
Preventive health services
o Prenatal/perinatal All counties provide Presumptive Eligibility Medicaid determinations for pregnant women so that they can receive offered services. A majority of county health departments provide case management services to assist Medicaid-eligible pregnant women in gaining access to needed services, and some counties provide prenatal services directly to patients.
o Cancer screening All county health departments offer breast and cervical cancer screening, while some offer screening for other types of cancer such as colon (36%), testicular (28%), and skin (28%). These services do not positively affirm cancer, but would serve as impetus for referral to a specialist.
o Immunizations All county health departments offer child and some adult vaccinations, as well as those for seasonal flu.
o Well-child Although all county health departments provide child vaccinations, which are part of well-child visits, not all provide a complete physical examination.
o Lead, communicable diseases, and cholesterol screenings All county health departments provide screenings for various communicable diseases, including STDs. Screenings for chronic conditions such as diabetes and high blood pressure are performed by 26% of counties.
o Pediatric eye, ear, dental screenings All county health departments offer eye, ear, and dental screening for children.
o Family planning All county health departments provide family planning services, including education and contraceptives.
o Preventive dental All county health departments provide education and promotion of healthy behaviors, including programs in some schools. Approximately 40% of counties provide cleaning and sealant services to children, with fewer departments providing adult services.
Emergency medical County health departments are not intended to serve as emergency medical providers; however, nurses are capable of providing limited emergency medical services for conditions such as allergic reactions (e.g., anaphylaxis), shock, or bleeding. Personnel coordinate patient transfer with the local emergency medical system after initial care.
Appropriate pharmaceutical services All county health departments have registered nurses who have statutory authority to order and dispense pharmaceuticals, such as contraceptives, vaccines, and antibiotics for certain conditions. This is done in accordance with a nurse protocol agreement signed by a physician and a drug dispensing procedure. A few counties provide a wider range of medications for HIV/AIDs patients.

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A small number of county health
departments offer expanded clinical
services, often dental services or
comprehensive care for HIV patients.

Direct Care Programs and Services Available in Some Counties
Some county health departments may provide direct care programs and services that are not available in others. Several county health departments offer dental services, and a smaller number offer primary care services delivered by physicians. In addition, DPH works with district health directors and staff to marginally expand programs and services via additional PGIA to districts or county health departments.
As stated previously, no complete list of programs and services in each county health department exists. While we were able to identify programs and services offered statewide, we were not confident that an accurate inventory of all programs and services in each county could be created.5 We identified selected basic health services provided in each county, as well as some counties that provided comprehensive dental or primary care services. We also provide examples of programs and services funded through PGIA provided to selected counties or districts.
Primary Care Few county health departments provide the range of clinical services offered by primary care physicians.. In most instances in which officials reported that county health departments delivered expanded clinical services for patients, the services were limited to the treatment of sexually transmitted infections and pediatric care. Appendix G presents a map with a sample of case studies we identified.
Dental Services A significant percentage of county health departments provide expanded clinical services for dental care, especially pediatric dental care. Approximately one-third of county health departments report offering preventive and diagnostic dental care such as cleaning (39%) and sealants (37%). However, fewer county health departments offer more intensive clinical care such as fillings (26%), oral surgery (4%), and dentures (2%). Appendix H presents a map of the dental services offered by county.
Other PGIA Services Some PGIA is not distributed to all county health departments but instead to a subset of districts or counties. Programs intended to reduce the likelihood of stroke and heart attacks, to prevent sexual violence, and expanded services to reduce pregnancy are examples offered in multiple districts. Examples of more targeted programs include increasing male participation in family planning in one county, providing treatment and management of heritable disorders in a few cities, providing tuberculosis nurses in two counties, and providing education, leadership opportunities, and clinical reproductive health services in a single county.
Appendix F also notes basic health services offered in only some counties. These include screenings for colon, testicular, and skin cancer, the diagnosis and treatment of acute and chronic conditions, certain types of lab tests, and chest x-rays.

5 For example, many programs are funded at the district level and available services vary from one county to the next, and other programs are provided with local or outside funds not reported to the state.

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Population-Based Program Areas
Population-based programs are intended to protect the population as a whole and do not involve a one-to-one setting with a patient (i.e., non-clinical setting). We found that county health departments provide a common set of population-based programs and services within three DPH program areas (Exhibit 9). A description of the program areas and the services common to all districts is included below.

Exhibit 9 Common Population-Based Program Areas

Program Areas Emergency Preparedness
Environmental Health Epidemiology Source: DPH documents

Examples of Common Services
- Create plans to address public health needs resulting from natural disaster
- Inspect restaurants - Inspect and approve septic systems
- Track and report certain communicable diseases - Provide infection control guidance and training

Emergency preparedness, environmental health, and epidemiology are populationbased program areas established in the master agreement between DPH and the county boards of health. These population-based program activities and services occur in all counties, though they may be provided by district or lead county personnel.

Emergency Preparedness County health departments plan responses to natural disasters, man-made accidents, disease epidemic or pandemics, and acts of terrorism. Plans and training exercises involve coordinating with other local, state, and federal agencies. County health departments also conduct mass vaccination operations and community education campaigns, and they may be asked to coordinate or assist with quarantine/surveillance of persons infected with infectious diseases (e.g., Ebola virus).

Environmental Health County health departments provide surveillance, education, and enforcement of environmental regulations. Environmental health staff enforce standards set by the DPH for food services, tourist accommodations, on-site sewage disposal, swimming pools, and tattoo parlors/body crafting.

Epidemiology Each district is funded to staff a full-time epidemiologist and is charged with monitoring, investigating, researching, and analyzing diseases and adverse conditions. District officials work with health care providers to detect and control more than 50 reportable diseases, such as tuberculosis, rabies, HIV, and hepatitis B and C.

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Programs and Services Mandated by State Law

Many sections of state law address both population-based and direct care programs and services typically provided by county health departments. DPH does not maintain a list of mandated direct care and population-based programs and services. However, we obtained a similar list from district officials from District 3-1 Cobb-Douglas. The district determined that 20 of its 29 programs were mandated by state law. Some statutes appear to allow public health officials to provide services to protect the public, but do not appear to require a particular program or service.

It is worth noting that non-mandated programs and services may also have value and public health importance. Georgia law provides discretion to DPH, county boards of health, and district health directors so public health experts can address threats as they arise whether statewide or local. We found that some programs identified as non-mandated are available statewide (e.g., Breast and Cervical Cancer Prevention, Children 1st, Babies Can't Wait).

Direct Care Programs

Mandated Program and O.C.G.A.

Non-Mandated

Chronic Disease Prevention 31-2-2(7) & 31-12A-1(13)
Universal Newborn Hearing and Screening1 31-1-3(2); 31-1-3(b); 31-14-7
Children's Medical Services1 31-2-1(2); 31-2-1(7); 31-2-2(1); 31-2-2(2); 31-2-2(4)

Adolescent Health and Youth Development Injury Prevention/SafeKids
Children 1st 1

WIC 31-2-2(1); 31-2-2(4)

Early Intervention/Babies Can't Wait1

Immunizations 31-2-1(4); 31-2-2(3); 31-2-2(4)
Child Health Not primary care physicians or well-child visits 31-1-23(a)(1); 31-2-1(7); 31-2-2(1); 31-2-2(2); 31-2-2(4)

Perinatal Case Management
Child Health Primary care physicians; well-child visits

Family Planning 31-2-1(12); 31-2-2(4); 31-9A(1); 49-7-3; 49-7-4; 49-7-5; 49-7-6

School Health

Sexually Transmitted Infections 31-2-1(4); 31-2-2(4); 31-17-3; 31-12-2; 31-22-7; 31-41-11
Oral Health Not full dentistry services 31-2-1(8); 31-2-2(4); 31-2-2(7)

Breast and Cervical Cancer Prevention
Dental

HIV Testing 31-2-1(4); 31-2-2(3); 31-2-2(4); 31-17A-2; 15-11-66.1(b); 24-9-47; 24-9-40.1; 31-12-2; 31-22-7; 31- HIV Treatment 41-11

Tuberculosis 31-2-1(4); 31-2-2(3); 31-2-2(4); 31-14-2,3; 31-14-10; 31-12-2; 31-22-7; 31-41-11

International Travel Health

Population-Based Programs

Mandated Program and O.C.G.A.

Non-Mandated

Epidemiology 31-2-1(1); 31-2-1(4); 31-2-1(11); 31-2-2(4); 31-2-3; 31-19-1

None

Food Service 31-2-1(11); 31-2-2(4); 26-2-371; 31-2-372-411
Public Swimming Pools 31-2-1(11); 31-2-2(4); 31-12-11; 31-45-4; 31-45-8; 31-45-11

Onsite Sewage Management Systems 31-2-1(3); 31-2-2(4); 31-2-1(11); 31-3-2.1(c); 31-3-5(b-d); 31-3-11(b); 31-27-3
Tourist Accommodations 31-2-1(11); 31-2-2(4); 31-28-2; 31-28-5

Trailer Parks 31-2-1(11); 31-2-2(4)
Body Art 31-2-1(11); 31-2-2(4); 31-40-2

Nuisance Complaints 31-2-1(11); 31-2-2(4); 31-5-9; 31-5-10; 31-5-21; 31-19-1; 31-19-5; 31-19-7; 31-18-75(a); 125-2-3.04; 31-9-7; 4-8-22(c); 4-8-22; 31-9-7

Emergency Preparedness and Response 31-2-1(1); 31-2-1(91); 31-2-2(4); 31-35-11; 31-35-11(e)

1 Associated services are listed under Child Health category on pages 11-12

Source: District 3-1 Cobb-Douglas

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What are the number and type of employees in county health departments?

As of June 30, 2014, county health departments employed 5,299 employees, of which 4,416 were full-time.6 We estimated the number of full-time equivalents to be 4,984. More than 1,200 of the employees are nurses, with the vast majority of those being registered nurses (RNs).

There are 5,299 personnel working for county health departments, 4,416 full-time and 883
part-time.

To determine the number of employees, we surveyed human resources personnel in the districts. Our analysis includes employees working in individual county health departments, as well as those assigned to the district office. District employees may be employees of the state or the district's lead county. They support the county health departments, but they may also travel to the counties and provide direct services to residents.

Public health does not focus solely on the delivery of clinical services and that is reflected in the staffing distribution. As shown in Exhibit 10, we categorized 40% of positions as clinical and 60% as non-clinical. A description of the positions included in the two categories is included below, and Appendix B shows the number and type of staff by district and county.

Exhibit 10 Clinical Staff Accounted for 40% of the June 2014 Workforce

Non-Clinical 60%

Clinical 40%

Source: DOAA survey
Clinical Staff As of June 30, 2014, county health departments employed an estimated full time equivalent (FTE) of 1,993 clinical staff (1,669 full-time and 488 part-time). Exhibit 11 shows the number of full-time and part-time clinical staff by job category, as well as the estimated FTE. A discussion of the major staff categories and job duties is provided below.

6 Employee figures include state- and county-employed staff working in district offices.

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Exhibit 11 Registered Nurses are the Largest Category of Clinical Staff

Clinical Staff Nursing Staff1
Registered Nurse Licensed Practical Nurse Advanced Practice Registered Nurse Allied Health Professional Nutritionist Physician2 Dentist Physician Assistant Dental Hygienist Pharmacist Clinical Staff Total

Full-Time
1,096 815 192 89 212 278 28 15 20 16 5
1,669

Part-Time
176 104
24 48 175 44 48 23
0 6 16 488

FTE
1,207 881 206 120 333 308 61 29 20 20 15
1,993

% of FTE
61% 44% 10%
6% 17% 15%
3% 1% 1% 1% 0.8% 100%

1 Nurse managers are included in all three nurse types. For example, a district may require a program director to be a nurse and that nurse may not be providing clinical services to clients. 2 Physician total includes 16 full-time district health directors. Directors work as the head of the district office and the CEO of every county board of health. While they do not primarily work in a clinic, physicians are required to be board certified.
Source: DOAA survey

Public Health Nurses Public health nurses are the primary personnel to deliver direct health care services in Georgia's county health departments, and they make up the largest category of clinical staff (61% of clinical FTE). In total, there are 1,272 public health nurses: 1,096 full-time and 176 parttime.
There are three types of public health nurses: advanced practice registered nurses (APRN), registered nurses (RN), and licensed practical nurses (LPN). Each has a different set of qualifications. These distinctions determine the type of clinical services that nurses can deliver. APRNs and RNs may serve as expanded-role public health nurses (see box on following page).
o Advanced Practice Registered Nurses There are 120 FTE APRNs. They are the highest level of certified nurse staff in county health departments and work under protocols that are broader than those for an RN. For example, APRNs are permitted to insert or implant contraceptive devices. Many public health APRNs provide services in family planning or Ryan White HIV/AIDS clinics and do not provide the range of services delivered in an urgent care clinic.
o Registered Nurses There are 881 FTE RNs, and they account for 44% of clinical staff. Public health RNs practice under expanded nurse protocols, which allow them to conduct medical acts typically not performed by RNs in private practice. However, RNs cannot perform advanced services executable by APRNs.

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What are Expanded-Role Public Health Nurses?
County health departments rely on expanded-role nurses to perform many of the clinical services offered. Expanded-role nurses are RNs or APRNs who undergo additional training, typically lasting 12-18 months. Once a nurse meets all the additional requirements they are authorized to practice under nurse protocol (O.C.G.A. 43-3423).
Under delegation of a physician, expanded-role nurses may perform medical acts that are typically not performed by RNs in private practice. For example, an expanded-role nurse may perform full physical examinations and administer drugs.
According to DPH, the number of public health RNs has dropped from nearly 1,800 in 1990 to just over 1,000 in 2013. (Our survey found 815 full-time and 104 part-time in June 2014.)

o Licensed Practical Nurses There are 206 FTE LPNs, accounting for 10% of the clinical staff. LPNs can execute a limited number of services, including immunizations, lab testing, and sample collections with general supervision. They do not meet the qualifications to provide the services included in the public health nurse protocol.

Allied Health Professionals There are 333 FTE allied health professionals, accounting for 17% of clinical staff. Allied health professionals include technicians, assistants, therapists, and technologists. Those employed in county health departments include speech language pathologists, occupational therapists, and medical technologists.
Nutritionists There are 308 FTE nutritionists, accounting for 15% of clinical staff. Nutritionists counsel clients on nutritional principles, assess nutritional needs, and develop dietary plans. They work with individuals and the community to promote accurate nutrition information.
Physicians There are 61 FTE physicians, accounting for 3% of clinical staff. Physicians are qualified to provide clinical services (e.g., examine patients, diagnose conditions, and provide treatment) and direct clinical operations. There are 28 full-time and 48 part-time physicians. Excluding district health directors, there are 12 full-time physicians. However, they are not distributed throughout the state, working mainly in Districts 3-2 Fulton, 3-5 DeKalb, and 9-1 Coastal. They generally treat HIV patients and children.
Physician Assistants There are 20 FTE PAs and all are full-time. PAs provide direct patient services under the direction of a supervising physician. Like physicians, they are not evenly distributed throughout the state, with 50% employed by District 3-2 Fulton.
Dentists There are 29 FTE dentists, with 15 full-time. Dentists provide services such as extractions and oral surgery. Dentists are not employed throughout the state. Four districts do not employ any dentists, and four districts account for over 60% of all dentists.
Dental Hygienists There are 20 FTE dental hygienists. Dental hygienists provide oral health care under the direction of a dentist and may provide dental screenings. Hygienists are not distributed evenly among districts.

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Program managers
and administrative /clerical staff
account for 52% of nonclinical staff.

Four districts do not employ any hygienists, while 60% work in five districts.

Pharmacists There are 15 FTE pharmacists, though only five are full-time. Pharmacists may prepare and dispense drugs and vaccines. In addition they order medical supplies and manage pharmaceutical inventory. Pharmacists are not distributed evenly throughout the state; 10 of 18 districts employ a pharmacist. The variation is due to lack of funding, local availability, and volume of medications. Funding from tuberculosis and HIV programs is able to cover the cost of a few pharmacists around the state.

Non-Clinical Staff
As of June 30, 2014, county health departments employed the full-time equivalent of 2,991 non-clinical staff (2,746 full-time and 395 part-time). Exhibit 12 shows the number of full-time and part-time staff by category, as well as the estimated FTE. A discussion of the major staff categories and job duties is provided below.

Exhibit 12 Majority of Non-Clinical Staff are Program Managers/Admin Personnel

Non-Clinical Staff Program Managers & Admin Staff Environmental Health Staff Accounting/IT/Billing/HR Staff Social Workers/Case Manager Other Communicable Disease/STD Specialist Emergency Preparedness Staff Public Health Educator Epidemiologist
Total 1 Does not sum to total due to rounding. Source: DOAA survey

Full-Time 1,456 430 338 146 115 101 79 56 25 2,746

Part-Time 203 36 41 26 66 4 4 14 1 395

FTE 1,581
453 363 162 157 103
82 66 26 2,9911

% of FTE 53% 15% 12%
5% 5% 3% 3% 2% 1% 100%

Program Managers/Administrative Staff There are 1,581 FTE program managers and administrative support staff, accounting for 53% of nonclinical staff. Program managers and administrative staff perform a wide range of duties in county health departments. They implement and administer programs, conduct clerical assignments, and may augment the services of clinical staff. Support staff can assist clinical staff by performing patient intake, running the front desk, and determining a patient's program eligibility.

Environmental Health Staff There are 453 FTE environmental health staff, and they account for 15% of non-clinical staff. Environmental health staff evaluate programs and facilities (e.g., restaurants, tourist accommodations, septic systems) for compliance with environmental laws, rules, and regulations.

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Accounting/IT/Billing/HR Staff There are 363 FTE staff in accounting, IT, billing and HR positions, and they account for 12% of non-clinical staff.
Social Workers and Case Managers There are 162 FTE social workers and case managers, and they account for 5% of non-clinical staff. Social workers and case managers connect patients to programs and perform assessments and counseling. They frequently work with HIV patients, elderly patients, and children.
Communicable Disease and STD Specialists There are 103 FTE communicable disease and STD specialists, accounting for 3% of non-clinical staff. These specialists identify networks of individuals who need testing and treatment for communicable diseases such as STD, HIV, or tuberculosis.
Emergency Preparedness Staff There are 82 FTE emergency preparedness staff, and they account for 3% of non-clinical staff. They work with other community entities to prepare emergency action plans.
Other There are 157 staff considered "other," and they account for 5% of non-clinical staff. This category include interpreters, public information officers, vital records staff, purchasing staff, community liaison, cancer registry specialist, and grant specialists. It also includes any housekeeping and maintenance staff.
Public Health Educators There are 66 FTE designated as public health educators, accounting for 2% of the non-clinical workforce. Educators promote and improve community health by assisting individuals and communities to adopt healthy behaviors.
Epidemiologists There are 26 FTE epidemiologists, accounting for 1% of the non-clinical workforce. An epidemiologist studies the control of communicable and/or chronic diseases through data analysis and investigations. They monitor the public's health, and they develop policies and procedures for new and existing disease control programs.
Staff by District The ratio of FTE staff in health districts to the general population varies significantly throughout the state. The statewide ratio of health district staff to the general population is 1:2005. The ratio ranged between 1:1,115 in District 8-1 South and 1:3,517 in District 3-2 Fulton. The ratio of health district staff to general population is presented in Exhibit 13.
Clinical to Population The state-wide average of FTE clinical staff to the general population is 1:5,164 with a high of 1:9,882 (District 3-2 Fulton) and a low of 1:2,528 (District 7-0 West Central).
Non-Clinical to Population The state-wide average of FTE non-clinical staff to the general population is 1:3,266, with a high of 1:5,460 (District 3-2 Fulton) and a low of 1:1,794 (District 5-1 South Central)

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Exhibit 13 All Districts Have a Majority Non-Clinical Staff and Staff Ratio Varies Across State

450

400

350

300 2,500
250 2,000
200
1,500 150

100

50

0

Source: DOAA survey

Clincal FTE

Non-Clincal FTE

Number of FTEs
8-1 South 5-1 South Central 8-2 Southwest 9-2 Southeast 7-0 West Central 1-2 North Georgia 3-5 DeKalb 9-1 Coastal 6-0 East Central 5-2 North Central 3-3 Clayton 10-0 Northeast 1-1 Northwest
2-0 North 4-0 LaGrange 3-1 Cobb-Douglas 3-4 East Metro 3-2 Fulton
1 FTE to District Population

1 FTE to Total Population

4,000

3,500

3,000

1,000

500

-

23

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What is the ability of county health departments to identify the basic health service needs of their local area?

County health department personnel appear to be aware of the unmet basic health needs of their communities, though not all have conducted formal community health assessments (CHAs). One health director indicated that formally documenting the needs may not result in significant changes to operations due to limited resources and a limited ability to modify services.

CHAs are a standard method for identifying the health care needs of a community. They are reports or analyses that use demographic and health care data to help decision makers draw conclusions about the health risks and health care needs of the local community and the presence (or lack) of health care providers to deliver those services. County health departments may conduct CHAs or may participate in one conducted by another party, such as a local hospital. The National Association of County and City Health Officials (NACCHO) recognizes CHAs as a critical component in an effective public health system.

A majority of the 18 health districts
conduct either formal or informal community health assessments to identify the major health risks and needs of citizens.

A majority of health districts (13 of 18) report that either a formal or informal CHA is conducted as part of normal business procedure for their area. (An informal CHA may include limited data analysis and identification of other health resources, without publication of a report.) Districts that report conducting or participating in CHAs stated that they occur every one to five years. Eight of 18 districts reported that they have attained or are currently in pursuit of voluntary accreditation from the Public Health Accreditation Board (PAHB), an accreditation that requires that CHAs are conducted.
Among the 5 of 18 districts that report not conducting a CHA, all districts identified financial constraints as a reason for not conducting them. One district estimated the cost of a CHA to be $10,000-$25,000. Among these districts, some report reviewing the same type of data that is used in CHAs (e.g., morbidity rates, mortality and risk factors), suggesting that at least risk factors to the population are considered as part of ongoing management even if CHAs are not completed.7

It is not clear to what degree conducting a CHA actually changes the programs and services offered by county health departments, as programs are often restricted by programmatic and general grant-in-aid requirements. As noted on page 11, county health departments largely deliver the same set of core programs and services. But at the margins, expansion of services and programs does occur and can result from CHAs. For example, one district health director indicated that 1 of 12 counties in a health district was not provided with dental services because a CHA identified that a sufficient supply of private dentists were located in the county and willing to accept Medicaid patients. In contrast, another district health director indicated that CHAs were no longer completed because prior experience showed that they did not affect health outcomes or allow for realignment of services and programs.

7 One major source of data used for surveillance is the online analytical statistical information system (OASIS) maintained by the DPH. See http://oasis.state.ga.us/oasis.

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What limits the ability of county health departments to address the basic health service needs of their local area?

County health departments are not wellpositioned to
deliver comprehensive
basic health services to the
community.

County health departments' traditional services do meet some of the basic health care needs of eligible populations. However, county health departments are not currently a viable option for serving as a patient's "medical home" where the full range of primary care services for individuals are delivered.
We identified four constraints to county health departments providing a full range of basic health services: (1) a reliance on nursing staff who have limited authority to independently assess and treat illnesses and injuries, (2) a funding model that restricts most expenditures to grant-funded programs and objectives, (3) a limited ability to collect fees for clinical services, due to patients' inability to pay and a limited ability to bill private insurers, and (4) a primary mission to deliver public health not individual health services. Each constraint is addressed below.

Reliance on Nursing Staff
County health departments mostly rely on registered nurses, instead of physicians and mid-level practitioners, to deliver clinical services. While expanded-role public health RNs can perform more services than nurses in other settings, the service range is narrower than that of a physician or mid-level practitioner. Public health RNs can only assess and treat illnesses and injuries that are part of pre-approved nurse protocols.

To provide the range of clinical services found in primary care offices, county health departments would need to increase the number of mid-level practitioners and physicians on staff. Currently, full-time physicians are employed in only six districts and services are limited to only patients eligible for existing programs, such as children or HIV/AIDS patients. Nurse practitioners provide expanded services, primarily in family planning and HIV/AIDS clinics. To provide primary care, physicians or mid-level practitioners would likely need to practice in additional areas such as family medicine, internal medicine, or pediatrics.

Hiring the mid-level practitioners and physicians necessary to significantly expand service offerings would likely be difficult. Currently, DPH wages are not competitive and the supply of providers is low in some areas of the state.

Non-Competitive Salaries According to the U.S. Bureau of Labor Statistics, the average salary for nurse practitioners in Georgia was $88,840 in 2013. The starting pay for DPH nurse practitioners is just over $52,000.

Low Supply Like other health care providers in rural areas, county health departments are faced with the challenge of staffing clinical positions without a reliable supply of qualified medical professionals. HRSA has designated large portions of the state as Health Professional Shortage Areas for primary care.

Limited Flexibility in Funding Model
Currently, county health departments are limited in their ability to redirect funds because a significant portion is restricted to the delivery of services for a specific program. While a portion of other county health department funding sources are not

14-13 SE County Public Health Departments

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contractually tied to a program, they also offer little flexibility for financing other services.
General grant-in-aid is not legally bound to the provision of a specific service; however, DPH has made counties legally responsible for providing services that fall within six program areas. The annual agreements between the state and the county boards of health require that services be provided for emergency preparedness, environmental health, epidemiology, family planning/maternal and child health, health promotion and disease prevention, and infectious disease control.
Programmatic grant-in-aid, locally generated grants/awards, and other state and federal grants are provided in exchange for specific services, per the contract between the grantor and recipient.
Unrestricted fund sources that counties have include some of the fees obtained from clients or insurance companies; however, client fees associated with federal programs generally must be spent within the program. Local governments may also provide unrestricted funding; however, funding could also be for the provision of a particular service.
Limited Ability to Obtain Payment for Services County health departments do not always obtain fee revenue for the direct care services provided. Counties provide services to patients who are unable to pay. Even when patients have insurance, the county health departments have not traditionally been successful in obtaining payment from insurance companies for all types of direct care services that they deliver.
O.C.G.A. 31-3-4(a)(6) authorizes county health departments to establish fees for the provision of public health services to supplement state and federal funding and to defray costs. However, the law states that "no person shall be denied services on the basis of that person's inability to pay." Officials in some districts stated that counties require payment for environmental health services, but they will provide most clinical services to individuals who are unable to pay. Exceptions include the limited number of dental or primary care programs, which require payment on a sliding scale.
County health departments have generally been unable to bill third party insurance companies for services, with the exception of immunizations. This restricted the amount of revenue county health departments were able to generate and discouraged them from creating a billing infrastructure.
According to DPH officials, the limited ability to bill has been partly due to the use of nurses, whom were not recognized as credentialed billers by private insurers. In recent months, some county health departments (not nurses) have become designated as credentialed billers of services. DPH reported that 13 of 18 health districts have recently become credentialed by one insurance provider to bill for services. It estimates that two additional insurance providers will expand the services billable by health departments by January 2015.

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At present, many of those served by county health departments are not likely to have private insurance, though DPH officials believe that the number of insured using health departments may increase as the departments become credentialed by insurance companies.
Mission That Does Not Focus on Delivery of Health Care Medicine8 and public health care have a common goal to improve the health of the population, but each approaches this goal differently. The focal unit for those in medicine is the individual patient, while the focal unit within public health care is the community. As a result, public health does not focus solely on medical care but instead on changes to the environment, human behavior, and lifestyles. Those in medicine specialize in types of patients (e.g., children) or organ systems (e.g., nervous system, heart), while public health professionals specialize in areas like epidemiology and policy development.
While delivery of individual health care is not the primary focus of public health, linking people to needed health services or providing those services when unavailable is considered one of the 10 essential public health services (Exhibit 14). Georgia's county health departments consider referring patients to other providers as an essential role, and we noted that several have found methods to expand their service offerings to address an unmet need (see page 29). However, the mission of many of Georgia's county health departments has been to identify public health risk factors, monitor the population's health status, and deliver targeted direct care services to eligible (often vulnerable) populations, such as children and those with communicable diseases.
Exhibit 14 Ten Essential Public Health Services
1. Monitor health status to identify community health problems
2. Diagnose and investigate health problems and health hazards in the community
3. Inform, educate, and empower people about health issues
4. Mobilize community partnerships to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable
8. Assure a competent public health and personal health care workforce
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services
10. Research for new insights and innovative solutions to health problems
Source: Centers for Disease Control and Prevention
The degree to which county health departments should deliver basic health care services in lieu of delivering other public health programs and services to citizens is not clear. Many traditional public health services are preventive and are expected to have a high return on investment (e.g., preventing unwanted pregnancies; encouraging safe food preparation in restaurants; decreasing smoking). If funds or

8 Medicine is the delivery of clinical services to patients by healthcare providers.

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staff are redirected from more traditional public health services, services delivered exclusively by a public health department may be exchanged for services available from other providers. Even if other providers are not nearby, traditional public health services may be more cost-effective than other basic health services not currently delivered.
District health directors expressed some reservation about the ability of county health departments to greatly expand services to deliver more comprehensive basic health care for citizens if the expansion would be in lieu of the primary mission of traditional public health programs and services.

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How have some county health departments expanded services to address the basic health service needs of their local area?

Although county health departments are limited in their ability to expand their basic health services to address local needs, we noted instances in which some had been successful in doing so. These occurred because of a combination of dedicated local leadership, the successful pursuit of additional funding, and occasionally the use of a new or uncommon method of service delivery. We also found counties that have partnered with other organizations for the delivery of basic health services instead of attempting to expand their own service offerings.

District leadership has expanded health services in some areas, especially regarding dentistry
and partnerships with other community health providers.

Expanded County Health Department Services
In those counties and districts where we found expanded direct care services, public health leaders identified a health need and obtained the resources to deliver the services. In some cases, initial funding was secured via federal grants. In some cases, the services were delivered in a non-traditional manner, such as telemedicine (video link to provider in another location), or with non-traditional health department personnel, such as retired physicians or dental students. Examples are below.
District 9-2 Southeast Teledentistry Program The Ware County Board of Health has received more than $1.0 million in grant funds from HRSA for the development of telemedicine and rural health development for its teledentistry program. The program provides cleaning, fluoride, x-rays, and dental education to school-aged children in southeast Georgia. A dental hygienist provides the services and also coordinates through video with dentists at Georgia Regents University School of Dental Medicine in Augusta. The service is available in select schools in Clinch, Charlton, and Brantley counties (Appendix H).

District 1-1 Northwest Floyd Dental Health Clinic Local public health managers identified a high need for dental services for low-income citizens and secured grant funding to establish a five-chair dental clinic in the Floyd County Health Department. The Floyd County Board of Health was awarded a $200,000 federal rural health care services outreach grant to help establish the Floyd County Dental Health Clinic, a full-service clinic that provides oral health care to low-income residents. The clinic works with Georgia Regents University to serve as a training facility for dental students who work under the supervision of the district dental director. According to district officials, this should be considered a best practice model.

District 1-2 North Georgia Whitfield County Medical Access Clinic The Whitfield County Health Department has delivered primary health care for adults in their Medical Access Clinic since the 1980s. It is one of few county health departments that offer comprehensive primary care to adults. It was initiated through the leadership efforts of the district health director. The county currently has one full-time physician and nine part-time (retired) physicians. In addition, Whitfield County operates a pediatric clinic staffed by nurse practitioners, who are supervised by a physician.

DPH Telemedicine Program This example is not associated with a local service expansion but a state initiative to expand certain types of services.

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Telemedicine programs utilize two-way video technology and peripherals to improve patient access to healthcare services and specialists in underserved communities. The telemedicine program initially started in District 9-2 Southeast, and DPH is working with health districts and counties to expand the presence and application of telemedicine throughout the state. Appendix I presents the location and application of telemedicine in county health departments. Examples of how telemedicine is being applied are presented below.
o HIV/AIDS Patients with compromised immune systems can be seen and treated by infectious disease specialists using mobile applications, reducing traveling requirements for both physicians and patients.
o High Risk Obstetrics Clinic Expectant mothers may have ultrasounds performed in the health department, with an OB/GYN in another location consulting in real-time.
o WIC Nutrition Patients have access to nutrition services (such as education and breastfeeding support).
o Children's Medical Services Patients may consult with specialists in cardiology, endocrinology, developmental and genetics, pediatric neurosurgery, and asthma.
Partnerships with Primary Care Providers
To improve citizen access to basic health services, several county health departments have established partnerships with organizations that deliver primary care services to low-income and uninsured populations. These partnerships are both formal and informal, and sometimes involve co-locating the partner organization within the county health department facility (Appendix G). Partnerships may involve free clinics, federally qualified health centers (FQHCs), or private physician groups.
Since the 2010 passage of the federal Patient Protection and Affordable Care Act, FQHCs have received additional federal grant funding. They are mandated to provide comprehensive primary care and preventive services to those with limited access to health care. As of October 2014, there were 156 clinical sites in 86 counties operated by 31 FQHCs (Appendix J). The potential to integrate the work of FQHCs and public health providers is being researched, and integration has occurred in some parts of the state.9 Examples of long-standing and newly established partnerships are below.
Baker County Since the 1970s a community health center has been colocated with the Baker County Health Department. Clients in need of primary health care services are referred across a waiting room lobby. This FQHC offers family medicine, internal medicine, and pediatric services.

9 This integration between the primary care and public health care systems has been emphasized in recent studies, including a report by the Institute of Medicine entitled Primary Care and Public Health:
Exploring Integration to Improve Population Health (2012). In it, the roles of each sector are highlighted and efforts to improve their integration explored. Dr. James Hotz, clinical services director of the Albany Area Primary Health Care, an FQHC, served on the committee of the report.

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Ware County Since July 2013, the county board of health has established a formal referral agreement with a community health center to ensure that clients in need of primary care are directed to a nearby FQHC.
Hall County In October 2008, the county board of health began renting clinic space to a local physicians group to operate a family medicine clinic within the health department facility. Patients in need of primary care services are referred to the on-site provider. Prior to the arrival of the on-site physician group, the health department had a standing referral system with a free clinic in the area.
Bibb County In September 2014, the county health department entered into a formal agreement to place an FQHC in its facility. The FQHC will provide primary care services to health department patients. As of December 2014, the FQHC is awaiting federal funding to establish a practice on-site.
Although not yet widely utilized by county health departments, cooperative arrangements between county health departments and these types of primary care providers may offer a feasible solution for affordable basic health care services to patients with limited financial resources.

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Appendix A: Objectives, Scope, and Methodology
Objectives
To satisfy a request submitted by the Senate Appropriation Committee, this report examines Georgia county health departments. The committee asked us to (1) identify the current scope of county health departments, with attention to current services, number and type of employees, and costs to operate; and (2) discuss the ability of county health departments to identify and tailor services to address the needs of their local area through basic health services.
Scope
We collected and analyzed data related to county health department activities for fiscal year 2014 and considered earlier/later periods as applicable. We obtained information by reviewing state law, master agreements between DPH and county boards of health, annexes between DPH and districts, interviewing state/local public health officials, analyzing financial data from the DPH uniform accounting system, and reviewing prior audits/studies related to public health. We surveyed district and county officials and conducted field visits to three public health districts and eight county health departments. Specific methods are presented below.
Methodology
To determine the cost to operate county health departments, we collected program expenditure data submitted to the Department of Public Health by county health departments in the uniform accounting system (UAS). Because all county health departments do not use the same accounting system, UAS expenditure data is the most complete and reliable single source of cost data available to track expenditures. However, the data is not sufficiently reliable to report expenditures at the county health department unit. Data is more sufficiently reliable at the health district unit. Therefore, figures presented in this report (unless otherwise noted) are at the health district unit. To ensure the accuracy and completeness of the reported UAS data, we sent figures to health district finance officials for confirmation and made adjustments as necessary to UAS figures.
To determine the current services provided by county health departments, we utilized several data sources, including (1) programmatic grant-in-aid data contained in UAS expenditure records, (2) master agreements and annexes between DPH, health districts, and county boards of health, (3) a recent cost study conducted by DPH showing clinical activities in county health departments, and (4) a survey of health districts and county health departments regarding the basic health services delivered by county health departments. We established a core set of programs and services using the master agreements, clinical activities data, and UAS program reports.
To determine the number and type of county health department staff, we surveyed and interviewed human resource personnel from health districts. Health district officials reported the number of full-time and part-time staff located in each county health department and within the district office. We applied a multiplication factor to estimate the full-time equivalent (FTE) for part-time personnel.
To determine the ability of county health departments to identify and tailor services to meet the basic health services needs of the local area, we conducted a

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literature review to establish the baseline of health services considered "basic." We reviewed state law, master agreements and annexes between DPH and county boards of health and health districts. We interviewed health district directors and DPH personnel, as well as subject matter experts in academia, the federal government, and within the private/non-profit sector.
Professional Standards
This special examination was conducted in accordance with Performance Audit Division policies and procedures for non-GAGAS engagements. These policies and procedures require that we plan and perform the engagement to obtain sufficient, appropriate evidence to provide a reasonable basis for the information reported and that data limitations be identified for the reader.

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Appendix B: District Expenditures and Staff District 1-1 Northwest

1-1
B arto w Catoosa C hatto o ga D ade F lo yd Go rdo n H aralso n P aulding P o lk Walker Total

Federal State

Fees and Ins ur ance

$ 18,216 $ 741,285

$ 397,431

$ 14,098 $ 573,562

$ 584,004

$ 6,970 $ 307,307

$ 171,830

$ 3,814 $ 188,192

$ 104,965

$ 7,072,705 $ 5,602,949

$ 866,291

$ 19,352 $ 494,206

$ 287,536

$ 6,965 $ 290,584

$ 41,291

$ 21,954 $ 658,161

$ 388,570

$ 13,897 $ 571,502

$ 310,755

$ 9,837 $ 851,716

$ 263,673

$ 7,187,808 $ 10,279,465

$ 3,416,348

Local
$ 391,179 $ 389,052 $ 160,745 $ 150,139 $ 512,462 $ 406,391 $ 135,584 $ 346,716 $ 226,936 $ 133,658 $ 2,852,861

Othe r

Total

$1 $ 39,731
$8 $ 645,860
$ 10 $1
$ 30 $ 685,641

$ 1,548,112 $ 1,560,717 $ 686,583
$ 447,117 $ 14,700,268
$ 1,207,485 $ 474,423 $ 1,415,411 $ 1,123,092 $ 1,258,914
$ 24,422,123

FTE Clinical Staff: 122 Nurses

FTE Non-Clinical Staff: 195

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist* Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict

FT 9 PT 2

1

1 1 1 4 4 1 2 18

1

B arto w

FT 8 PT

Catoosa

FT 7 PT

C hatto o ga

FT PT

3

D ade

FT 2 PT

F lo yd

FT 18 PT 1

1 1
1 1

41 1 2
2
4

Go rdo n

FT 5 1

4

PT 1

H aralso n

FT PT

1

11

P aulding

FT 6

PT

1

32 1

P o lk

FT 6 1 PT

2

Walker

FT 6 PT

2

Total FTE

74 4 3 0 1 1 1 27 10 1 2 19

*Two nutritio nists travel thro ugho ut the district M ay no t to tal due to ro unding.

1 1 19 4 1 4 1
1 1 28

13 4 1 2 8 8

16

4

35

13

3

26

1

1

11

2

1

5

27

4

56

1

9

3

23

4

1

8

9

4

25

7 1

1 1

18

9

3

20

111 4 27 2 3 17

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District 1-2 North Georgia

1-2
C h e rok e e Fannin Gilmer M urray P icken s W hitfield T otal

Federal
$6,081,370
$6,081,370

State

Fees and Insurance

$2,678,137 $1,057,796

$284,431

$221,709

$311,993

$324,116

$400,399

$150,532

$240,032

$179,506

$1,688,065 $1,927,946

$5,603,056 $3,861,604

Local
$194,069 $40,950 $147,092 $229,000 $81,457 $254,115 $946,683

Other

Total

$7,402
$597,509 $604,911

$10,018,774 $547,090 $783,200 $779,930 $500,995
$4,467,635 $17,097,624

FTE Clinical Staff: 127 Nurses

FTE Non-Clinical Staff: 135

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers * Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

District C h e rok e e Fannin Gilmer M urray P icken s W hitfield T otal FT E

FT 8

1

PT FT 10 3 1

PT 2

3

FT 2 1

PT

1

FT 2 1

PT 1 FT 3 1

PT

FT

11

PT 1

1

FT 20

4

PT 10

2

55 7 12 0

2

2

53

1

14

1

1

11 1 13

4

12 2 2 6

91

53

8.3 2.7 2 17 22

1 1
11

May not total due to rounding.

1 2
2

1

11 20 3 1

53

3

1

20 2

5 1 60

3

2

10

1

4

2

14

2

8

2

18

2

2

11

1

1 32

3

96

1

1

1 0 16 94 3 17 1 262

*Employees in these categories may rotate through multiple counties. In District 1- 2 an estimated eight employees travel. District 1- 2 does not have a district director at present.

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District 2 North

2-0

Federal State Fees and

Ins ur ance

B anks

$ 2,835 $ 160,078

$ 226,068

D a ws o n

$ 3,315 $ 141,680

$ 219,817

F o rs yt h

$ 4,540 $ 546,261 $ 834,542

F ranklin

$ 2,766 $ 179,628

$ 254,270

H abersham

$ 2,931 $ 305,833

$ 341,947

H all

$ 6,468,643 $ 2,710,972 $ 3,369,207

H art

$ 2,807 $ 223,951 $ 205,499

Lumpkin

$ 3,425 $ 215,741 $ 336,807

R abun

$ 3,164 $ 182,877

$ 200,491

Stephens

$ 2,264 $ 235,080

$ 230,472

T o wns

$ 1,607 $ 153,880

$ 196,127

Unio n

$ 1,098 $ 167,265

$ 367,321

White

$ 146 $ 183,497

$ 192,762

Total

$ 6,499,543 $ 5,406,743 $ 6,975,330

Local
$ 100,988 $ 168,462 $ 151,129 $ 101,431 $ 202,860 $ 1,999,691 $ 79,526 $ 209,199 $ 238,494 $ 107,712 $ 166,915 $ 121,841 $ 141,786 $ 3,790,034

Othe r

Total

$ 5,315 $ 495,284

$ 6,059 $ 539,333

$ 28,096 $ 1,564,568

$ 10,174 $ 548,270

$ 7,745

$ 861,316

$ 1,201,970 $ 15,750,482

$ 20,770 $ 532,553

$ 19,428 $ 784,600

$ 2,700 $ 627,726

$ 32,250 $ 607,778

$ 30,013 $ 548,542

$ 23,781 $ 681,306

$ 518,192

$ 1,388,300 $ 24,059,950

FTE Clinical Staff: 111 Nurses

FTE Non-Clinical Staff: 201

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict B anks

FT PT FT 2 PT 1

1

1

1

12

3 4 2 1 25

2

1

6

D a ws o n

FT 1 1 PT 1

1

2

3

8

F o rs yt h

FT 3 1 1 PT 1

7

5

18

F ranklin

FT 2 2 PT

1 1

1 1

7

H abersham

FT PT

2

1

5

2 1 11

H all H art Lumpkin R abun Stephens T o wns Unio n

FT 13
PT 3 FT 2 PT FT 2 PT FT 2 PT FT 3 PT FT 1 PT FT 2
PT

8

4

4

1 1
1 1 1

1

18 15

18 1

10

3 2 2 6 73

3

5

1

3

23

3

4 1 12 1 32

11 4 17 9 1

1

6

2

10

2

9

1

2

11

1

7

2 10

White

FT 2 PT

4

2

8

Total FTE

40 15 7 4 2 5 1 18 20 0 1 5

2 2 28 115 4 38 7 3 12

M ay no t to tal due to ro unding.

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Districts 3-1 Cobb/Douglas; 3-2 Fulton; and 3-3 Clayton

3-1
C o bb D o uglas Total

Fe de r al

State

Fees and Ins ur ance

$ 6,833,398 $ 9,304,226

$ 3,773,764

$ 709,030

$ 558,459

$ 6,833,398 $ 10,013,256

$ 4,332,224

Local
$ 1,513,212 $ 95,509
$ 1,608,721

Othe r

Total

$ 1,510,473 $ 157,389
$ 1,667,862

$ 22,935,073 $ 1,520,388
$ 24,455,461

3-2
F ulto n Total

Federal State
$ 12,067,173 $ 6,783,565 $ 12,067,173 $ 6,783,565

Fees and Ins ur ance
$ 2,325,260 $ 2,325,260

Local
$ 15,271,415 $ 15,271,415

Othe r
$ 260,408 $ 260,408

Total
$ 36,707,821 $ 36,707,821

3-3
C la yt o n Total

Federal State
$ 5,073,529 $ 4,002,270 $ 5,073,529 $ 4,002,270

Fees and Ins ur ance
$ 894,431
$ 894,431

Local
$ 424,287 $ 424,287

Othe r

Total

$ 404,471 $ 10,798,988 $ 404,471 $ 10,798,988

FTE Clinical Staff: 124 Nurses

FTE Non-Clinical Staff: 177

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers &Case Manager s Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict

FT 2 PT

1

1

3

6

7

1

1

1

14 2

96 1

19 2

65

C o bb

FT 30 2 P T 21 2

5

17 21 1

3 2 3 4 12 3

2

6 1

52 27

19 2

2 2 15

D o uglas

FT PT

5 1

1

1

1 3

7 1

2 1

21

Total FTE

53 4 1 5 4 1 2 20 30

34

9

8 10 15 89 6 24 12 3 0 1

Clinical Staff: 100

F ulto n

FT 29 2 12 10 5 3

14 13

PT 1 1

5 1 12 4

Total FTE

30 3 12 10 9 4 1 15 16

1 1 11

No n-Clinical Staff: 180

25 3 15 60

1

15

1 25 3 15 71

4 30 14 280
23 4 30 31 2 8 0

Clinical Staff: 39

No n-Clinical Staff: 104

C la yt o n

FT PT

8 10 2

4 2

1 11

4 91

19 3

3 9 16 3

36 7

3

6

6 8

14 3

Total FTE

9 10 5 0 2 1 0 7 5 0 1 11 3 11 16 41 3 6 12 14 3

M ay no t to tal due to ro unding.

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Districts 3-4 East Metro and 3-5 DeKalb

3-4

Fe de r al

State Fees and

Ins ur ance

G winne t t

$ 9,299,113 $ 7,106,858 $ 5,687,342

N e wt o n

$ 416,610 $ 545,703

$ 926,888

R o ckdale

$ 402,745 $ 497,036

$ 570,249

Total

$ 10,118,468 $ 8,149,597 $ 7,184,479 $

Local
$ 1,055,890 $ 186,252 $ 146,574 1,388,716

Othe r

Total
$ 23,149,203 $ 2,075,453 $ 1,616,604 $ 26,841,261

3-5
D eKalb Total

Fe de r al

State Fees and Ins ur ance

$ 8,203,191 $ 9,855,734 $ 6,100,425

$ 8,203,191 $ 9,855,734 $ 6,100,425 $

Local

Othe r

Total

$ 3,687,375 $ 2,175,387 $ 30,022,112 3,687,375 $ 2,175,387 $ 30,022,112

FTE Clinical Staff: 107 Nurses

FTE Non-Clinical Staff: 196

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict

FT 11 1 2

PT

1

G winne t t

FT 10 15 PT

5 1

N e wt o n

FT 4 3 PT

1 1

R o ckdale

FT PT

3

2

1

Total FTE

28 21 11 0

11 3 1
14

4 1 19 10 11 4
4
1 32 10

5 1
15

1 7 1 21 25 5 1 5 9 8 2 51

62

22

1 4

14 9

1 13

1 1 28

1 13 1

2

1 2

29

1 7 1 24 116 6 26 11 3 0 3

Clinical Staff: 188

No n-Clinical Staff: 227

D eKalb

FT 29 8 PT 2 1 9

4 1 4 26 42

16

81

11

18

4 24 11

80 4

5 2

35 43 14 2

4 15

Total FTE

30 9 7 0 5 5

4 26 101 1 1

0

18 5 25 83 6 45 44 4 15

M ay no t to tal due to ro unding.

14-13 SE County Public Health Departments

39

District 4 Four

4-0
B utts C arro ll C o we t a F a ye t t e H eard H enry Lamar M e riwe t he r P ike Spalding T ro up Upso n Total

Federal State Fees and Ins ur ance

$ 0 $ 202,737

$ 165,599

$ 26,676 $ 667,167

$ 943,062

$ 77,858 $ 587,985

$ 642,922

$ 9,821 $ 465,664

$ 667,932

$ 3,843 $ 137,540

$ 115,441

$ 43,407 $ 793,330

$ 721,763

$ 13,309 $ 173,299

$ 198,584

$ 63,360 $ 293,226

$ 300,714

$ 21,815 $ 120,686

$ 146,390

$ 20,217 $ 611,891 $ 602,072

$ 8,715,629 $ 2,502,207 $ 1,323,114

$ 0 $ 338,828

$ 594,486

$ 8,995,937 $ 6,894,560 $ 6,422,078

Local
$ 63,166 $ 28,036 $ 233,238 $ 172,545 $ 43,281 $ 276,509 $ 100,000 $ 152,500 $ 70,000 $ 134,232 $ 637,937 $ 77,112 $ 1,988,555

Othe r

Total

$ 284,525 $ 284,525

$ 431,502 $ 1,664,940 $ 1,542,003 $ 1,315,962
$ 300,106 $ 1,835,010
$ 485,192 $ 809,800 $ 358,892 $ 1,368,412 $ 13,463,412 $ 1,010,426 $ 24,585,656

FTE Clinical Staff: 117 Nurses

FTE Non-Clinical Staff: 171

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist* Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers * Communicable Disease & STD Specialists* Public Health Educator * Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict B utts

FT 8 PT FT 1 1 PT

2

14 1

21

11

1

1 2 1 13 18 5 1

63

1

3

3

1

8

C arro ll

FT 4 1 1

PT

1

42

1

11 2

5

31

C o we t a

FT 4 2 PT 2

34

1

1

8 2

5

31

F a ye t t e

FT 2 1 1

PT

1

11 3

1

1

7

4 1

23

H eard

FT 1 PT

1

2

H enry

FT

PT

Lamar

FT

PT

M e riwe t he r FT PT

P ike

FT PT

42
21 31 1
1

53 2

2

1 12

7

39

2

1

3

1

9

1

11

1

3

2

1

12

2

1

5

Spalding T ro up

FT 5

PT

1

FT 5

PT

52

1

1

1

31

1

9

2

28

3

10

3

23

FT 2 1 1

1

Upso n

PT

1

1

6

1

1 14

Total FTE

43 14 3 0 3 1 1 36 16 0 1

8

2 1 18 104 5 33 0 2 8 8

M ay no t to tal due to ro unding. *Emplo yees in these catego ries may ro tate thro ugh multiple co unties o r co ver the who le district. In District 4-0 there are an estimated 35 full-time emplo yees and 21part-time emplo yees that travel.

14-13 SE County Public Health Departments

40

District 5-1 South Central

5-1

Federal State Fees and

Ins ur ance

B leckley

$ 16,543 $ 131,808

$ 174,242

D o dge

$ 29,465 $ 253,132

$ 124,063

Jo hnso n

$ 10,707 $ 158,356

$ 87,374

Laurens

$ 4,428,282 $ 2,615,270 $ 1,052,244

M o ntgo mery

$ 11,530 $ 164,408

$ 101,099

P ulaski

$ 13,161 $ 162,806

$ 87,345

T elfair

$ 20,951 $ 198,945

$ 140,611

T reutlen

$ 11,882 $ 137,703

$ 78,024

Wheeler

$ 9,590 $ 144,419

$ 81,701

Wilco x

$ 13,766 $ 133,073

$ 79,812

Total

$ 4,565,877 $ 4,099,921 $ 2,006,513

Local
$ 15,180 $ 22,513 $ 13,233 $ 90,766 $ 11,928 $ 84,335 $ 19,950 $ 49,524 $ 12,916 $ 10,417 $ 330,762

Othe r
$ 10,546 $ 6,542 $ 14,938 $ 45,342 $ 6,605 $ 8,944 $ 22,318 $ 9,282 $ 3,669 $ 6,729 $ 134,915

Total
$ 348,318 $ 435,715 $ 284,608 $ 8,231,904 $ 295,571 $ 356,591 $ 402,775 $ 286,415 $ 252,295 $ 243,796 $ 11,137,989

FTE Clinical Staff: 50 Nurses

FTE Non-Clinical Staff: 85

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Manager s Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict

FT 10 2 1

PT

1

B leckley

FT PT

1

1

D o dge

FT 2 1 PT

Jo hnso n

FT PT

1

Laurens

FT 5 1 PT

M

o ntgo mery

FT PT

1

1111 1

1

1

1
1
2 1
1

17 9

P ulaski

FT 1 1 PT

T elfair

FT 2 1

1

PT

T reutlen

FT 1 1 PT

Wheeler

FT 1 1 PT

Wilco x

FT 2 PT

Total FTE

27 9 2 0 2 1 1 7 2 0 1 12

M ay no t to tal due to ro unding.

19 6 1
1

16 4 1 4

72

2 1

5

2 3

1 1 10

1

2

1

5

7

4 1 22

2

1

5

2

1

5

29 7

1 1 1 40 4

4 3 4 1 3 9 2 13 5

14-13 SE County Public Health Departments

41

District 5-2 North Central

5-2
B a ldwin B ibb C ra wf o rd H anco ck H o usto n Jasper Jo nes M o nro e P each P utnam T wiggs Washingto n Wilkinso n Total

Fe de r al

State Fees and Ins ur ance

$ 12,592 $ 565,315

$ 291,483

$ 15,238 $ 2,173,290 $ 1,813,026

$ 3,577 $ 137,905

$ 130,440

$ 1,678 $ 236,748

$ 121,221

$ 7,594,818 $ 4,387,305 $ 1,204,047

$ 7,483 $ 219,135

$ 63,235

$ 2,525 $ 194,678

$ 167,960

$ 5,703 $ 260,882

$ 145,998

$ 7,571 $ 275,762

$ 162,504

$ 11,454 $ 209,934

$ 237,702

$ 4,548 $ 134,381

$ 85,078

$ 5,764 $ 344,501

$ 152,238

$ 9,021 $ 162,985

$ 119,248

$ 7,681,974 $ 9,302,821 $ 4,694,180 $

Local

Othe r

Total

$ 89,815 $ 391,576 $ 47,000 $ 36,072 $ 191,600 $ 38,850 $ 65,536 $ 120,539
$ 52,113 $ 205,067
$ 58,587 $ 44,794 $ 151,620 1,493,168 $

$ 959,205

$ 5,500 $ 4,398,630

$ 318,922

$ 395,720

$ 479,965 $ 13,857,734

$ 328,704

$ 430,699

$ 533,123

$ 5,205

$ 503,155

$ 664,157

$ 13,219

$ 295,813

$ 547,297

$ 442,874

503,889 $ 23,676,032

FTE Clinical Staff: 105 Nurses

FTE Non-Clinical Staff: 190

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict B a ldwin B ibb C ra wf o rd H anco ck H o usto n

FT 10 2 1

PT 1

1

FT 3

PT

FT 7 6

PT

FT 2

PT

FT 2

PT

FT 13 2

PT 1

1

1

12 1

19 5

15 26 5 3 1 8 9

4

1

1

2

2 1

1

15

3 1 16

1 16 1 1

1

2 2 31 1

9 2 70

>1

11

1

1

6

>1 1

2

>1

1

6

61

1 1 13

8

3

48

Jasper

FT 1

>1

PT

2

1

Jo nes

FT 2 1

1

PT

M o nro e

FT 1

1

PT 1

1

P each

FT 2 1

PT

1

11

1

6

1

1

1

7

11

2

2

7

1

3

2

8

P utnam

FT 4 PT

T wiggs

FT 1 PT

FT 2 Washingto n PT

1

4

2

12

1

1

>1

2

1

4

1

3

2

8

Wilkinso n FT

11

>1

PT 1

3

>1

7

Total FTE

52 14 3 0 3 1 2 23 5 1 1 11 5 4 22 104 5 35 4 2 9 5

M ay no t to tal due to ro unding.

14-13 SE County Public Health Departments

42

District 6 East Central

6-0

Federal State Fees and

Ins ur ance

B urke

$ 19,723 $ 286,207

$ 181,849

C o lumbia

$ 45,939 $ 505,071

$ 484,018

Emanuel

$ 29,949 $ 297,918

$ 544,342

Glasco ck

$ 3,247 $ 69,590

$ 28,789

Jefferso n

$ 14,663 $ 235,126

$ 170,632

Jenkins

$ 9,685 $ 167,512

$ 86,383

Linco ln

$ 5,573 $ 111,370

$ 78,185

M cduffie

$ 17,531 $ 235,907

$ 135,921

R ic hm o nd $ 6,565,022 $ 3,621,472 $ 2,552,108

Screven

$ 12,661 $ 201,355

$ 172,578

T aliaferro

$ 1,732 $ 88,655

$ 25,942

Warren

$ 4,410 $ 105,696

$ 29,411

Wilkes

$ 9,550 $ 158,371

$ 78,512

Total

$ 6,739,685 $ 6,084,251 $ 4,568,672 $

Local

Othe r

$ 224,821 $ 101,685 $ 137,884 $ 22,852 $ 150,763 $ 36,185 $ 38,880 $ 103,090 $ 1,465,976 $ 50,331 $ 21,599
$ 18,819 $ 58,897 2,431,782 $

$ 39,188 $ 1,200 $ 240
40,628 $

Total
$ 712,600 $ 1,136,714 $ 1,010,093 $ 124,479
$ 571,185 $ 299,765 $ 234,008 $ 492,449 $ 14,243,765 $ 438,125 $ 138,169 $ 158,336 $ 305,330 19,865,018

FTE Clinical Staff: 104 Nurses

FTE Non-Clinical Staff: 168

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician* Dentist Dental Hygienist Nutritionis t Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict

FT PT

B urke

FT PT

C o lumbia

FT PT

Emanuel FT PT

Glasco ck FT PT

Jefferso n FT PT

11
4 2 32 1 51
1
21

11

Jenkins FT 2 PT

Linco ln

FT 1 PT 1

M cD uffie

FT PT

2

1

R

ichmo nd

FT PT

23 16

4 3

2 1

1

1 10 8 2 12

18

Screven FT 2 1 PT

T aliaferro

FT PT

1 1

Warren

FT PT 1 1

Wikes

FT 2 PT

Total FTE

60 13 4 0 1 1 2 11 14 0 1 8

M ay no t to tal due to ro unding.

31
3 3 15 13
6 5 17

3

1

12

5

1

2

12

7

4

3

18

6

1

14

1

2 1

5

1

9

1

1

1

1

3

1

47 5 10

21

4

2

1

4 3 7 6 17 8 7 1 2

1

1

1

1

96 5 24

2 5 7 272

14-13 SE County Public Health Departments

43

District 7 West Central

7-0

Federal State Fees and

Ins ur ance

C hat t aho o chee

$ 96,627

$ 16,672

C lay

$ 781 $ 121,173

$ 17,341

C risp

$ 326,162

$ 205,441

D o o ly

$ 169,804

$ 63,471

H arris

$ 195,811 $ 255,776

M acon

$ 170,336

$ 36,318

M ario n

$ 114,522

$ 32,570

M us c o ge e $ 6,592,052 $ 4,942,433 $ 1,361,826

Quitman

$ 91,374

$ 5,595

R ando lph

$ 180,780

$ 43,565

Schley

$ 104,924

$ 27,699

S t e wa rt

$ 3,406 $ 146,073

$ 14,220

Sumter

$ 407,134

$ 255,098

T albo t

$ 99,798

$ 31,162

T a ylo r

$ 140,759

$ 36,282

Webster

$ 78,892

$ 29,130

Total

$ 6,596,238 $ 7,386,602 $ 2,432,167

Local
$ 12,647 $ 33,065 $ 98,179 $ 127,284 $ 177,739 $ 97,943 $ 43,753 $ 38,783 $ 10,360 $ 31,032 $ 28,563 $ 39,801 $ 276,960 $ 48,442 $ 143,582
$ 39,595 $ 1,247,726

Othe r
$ 79,367 $ 79,367

Total
$ 125,946 $ 172,360 $ 629,782 $ 360,559 $ 629,326 $ 304,597 $ 190,845 $ 13,014,461 $ 107,328 $ 255,377 $ 161,186 $ 203,500 $ 939,192 $ 179,401 $ 320,623
$ 147,617 $ 17,742,101

FTE Clinical Staff: 151 Nurses

FTE Non-Clinical Staff: 106

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician* Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict

FT 16 PT 1

C

hattaho

o

chee

FT PT

C lay

FT PT 1

C risp

FT 4 PT 1

D o o ly

FT 2 PT

H arris

FT 3 PT

M acon M ario n M usco gee Quitman R ando lph Schley S t e wa rt

FT 1
PT FT 1 PT 1 FT 10 PT FT PT 1
FT 2 PT FT 1 PT FT 1
PT

Sumter T albo t

FT 4 PT
FT 1 PT

T a ylo r

FT 2 PT

Webster

FT 1 PT

5 1 1
1 31 14

21
2 1

19 2 18
1 1
4
1
2 1 2

1

13

1

4

1

1

1 2

6

1

1

1

1

1

1

1

7

3

13 49 4 1

14 1

5

1

2

3

1

11

1

5

3

9

4

2

2

14

50

2

3

2

3

2

13

2

3

2

Total FTE

53

5 10 0 8 1 0 2 0 5 4 0 1

7

3 0 18 5 1 4 2 2 0 2 5 6

* includes six co ntracted physicians M ay no t to tal due to ro unding.

14-13 SE County Public Health Departments

44

District 8-1 South

8-1
B en Hill B errien B ro o ks Cook Echo ls Irwin Lanier Lo wnde s T ift T urner Total

Fe de r al
$ 500 $ 300 $ 2,000 $ 500 $ 23,406 $ 176,724
$ 6,260,202 $0
$ 6,463,631

State Fees and Ins ur ance

$ 229,595

$ 210,046

$ 177,881

$ 120,098

$ 217,473

$ 102,472

$ 214,010

$ 143,635

$ 112,927

$ 47,512

$ 176,422

$ 101,966

$ 117,975

$ 60,580

$ 3,256,128

$ 1,281,189

$ 477,691

$ 439,749

$ 145,306

$ 90,022

$ 5,125,408 $ 2,597,271

Local
$ 66,671 $ 55,506 $ 33,231 $ 70,032 $ 22,042 $ 71,749 $ 20,829 $ 500,749 $ 154,424 $ 26,214 $ 1,021,447

Othe r

Total

$ 395
$0 $ 7,500 $ 7,895

$ 507,207 $ 353,784 $ 355,176 $ 428,178 $ 205,887 $ 526,861 $ 199,384 $ 11,298,267 $ 1,071,864 $ 269,043 $ 15,215,652

FTE Clinical Staff: 87 Nurses

FTE Non-Clinical Staff: 141

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Program Managers & Administrative Support Environmental Health Other Total FTE

D istrict

FT 6 2 1

PT 1

2

1

11 4

B en H ill

FT 2 PT

1

1

B errien

FT 2 PT

B ro o ks

FT 1 1 PT

Cook

FT 2 1 PT

1

1

Echo ls

FT 1 1 PT

Irwin

FT 2 1 PT

Lanier

FT 1 PT 1

Lo wnde s

FT 14 4 P T 11

1 2

2

1
43 2

T ift

FT 6 3 PT

2

T urner

FT 1

PT 1 1

Total FTE

46 15 4 0 3 0 1 11 7 0

M ay no t to tal due to ro unding.

1 1 1
1
8 1 3
1 15

2 3 14 2

8 61 31

56

2 3

1

10

1

4

2 1

1

6

2 1

1

8

1 1

4

3

1

8

2

1

34

2 10

7

1

4

2

1

6

5

1 3

94

2

1 2

28

4

2 4 16 78 7 13 5 2 2 8

14-13 SE County Public Health Departments

45

District 8-2 Southwest

8-2

Federal State Fees and

Ins ur ance

Baker

$ 17,576

$ 158,814

$ 77,421

C alho un

$ 14,325

$ 142,952

$ 23,753

C o lquitt

$ 211,818 $ 1,193,884

$ 574,885

D ecatur

$ 91,966 $ 1,035,967

$ 329,584

D o ughe rt y $ 6,009,292 $ 5,043,066 $ 1,073,211

Early

$ 48,995 $ 250,053

$ 168,498

Grady

$ 101,048 $ 364,684

$ 263,818

Lee

$ 73,917

$ 245,887

$ 244,730

M iller

$ 17,346

$ 193,871

$ 67,939

M itchell

$ 65,445

$ 338,180

$ 156,139

Semino le

$ 33,691 $ 236,212

$ 144,839

T errell

$ 36,644 $ 206,294

$ 108,316

T ho mas

$ 183,434

$ 855,424

$ 532,959

Wo rth

$ 64,451 $ 314,211 $ 141,868 $

Total

$ 6,969,948 $ 10,579,499 $ 3,907,960 $

Local

Othe r

Total

$ 92,000 $ 57,166 $ 231,471 $ 113,801 $ 1,218,785 $ 101,490 $ 85,039 $ 247,325 $ 87,671 $ 117,500 $ 90,659 $ 81,516 $ 467,001 106,044
3,097,467 $

$ 345,811

$ 238,196

$ 12,781 $ 2,224,839

$ 3,300 $ 1,574,617

$ 146,841 $ 13,491,196

$ 569,036

$ 814,589

$ 811,859

$ 366,827

$ 24,499

$ 701,763

$ 505,401

$ 42,037

$ 474,807

$ 13,712 $ 2,052,530

$ 626,574

243,170 $ 24,798,045

FTE Clinical Staff: 118 Nurses

FTE Non-Clinical Staff: 194

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict

FT 15 5 5

PT

1

1

Baker

FT 2 PT

C alho un

FT 1 PT

1

C o lquitt

FT 7 3 PT

D ecatur

FT 4

PT

1

D o ugherty

FT PT

16

5

1

1

9

1 14

1 2

Early

FT 3 PT

Grady

FT 5 PT

Lee

FT 3 1 PT

M iller

FT 1 PT

M itchell FT 3 1 PT

Semino le

FT PT

3

T errell

FT 2 1 PT

T ho mas

FT 10 3 PT

Wo rth

FT 2 1 PT

Total FTE

77 22 7 0 2 0 0 9 0 2 1 14

M ay no t to tal due to ro unding.

7 1 15 32 3 1 1

110

1 1

1

4

1 1

1

4

29

3

24

15

3

14

2 21 3

10

3 5

63

1

7

16 13 11
4 11
2

1 1

14

3 1

12

1

4

1

10

1

1

6

5

1 12

3

29

12

2

8

7 1 27 104 3 32 6 3 12

14-13 SE County Public Health Departments

46

District 9-1 Coastal

9-1
Brya n Camden C h a th a m E f f in g h am Glynn L i b e rty L on g M cIntosh T otal

Federal
$79,912 $206,352 $4,899,711
$112,116 $6,940,570
$440,880 $58,756 $36,920
$12,775,216

State
$224,042 $330,875 $4,128,884 $325,614 $3,546,628 $607,479 $152,195 $160,806 $9,476,524

Fees and Insurance
$353,975 $558,789 $2,190,836 $280,573 $998,442 $311,665 $176,962 $144,020 $5,015,263

Local
$14,000 $63,984 $1,066,996 $55,667 $1,929,489 $117,008 $11,542 $14,000 $3,272,686

Other
$34,000
$34,000

Total
$671,929 $1,160,000 $12,320,427 $773,970 $13,415,129 $1,477,032 $399,456 $355,747 $30,573,690

FTE Clinical Staff: 130 Nurses

FTE Non-Clinical Staff: 213

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

District

FT 11

2

1 1 15 1

1

PT 1

1

1

Bryan

FT 4 PT

Camden

FT 4 3 PT

C h a th a m

FT 25 13 4 1 2

PT

2

3

55 1

19

14

E ffingham FT 3 2 PT

Glynn

FT 9 PT

11

3

4

L i b e rty

FT 3 5

3

PT

L on g

FT 2 1 PT

M cIntosh

FT 2 PT

T otal FT E

64 25 9.2 1 5.9 1 1 10 10 4 1 26

May not total due to rounding.

6 1 16 2

21 5 2

82

6

4

2

10

8

3

19

1

2

1 40

14 4 144

1

5

3

13

2 13 1
1 10 1
1
2

4 1 39 1
3 1 27

5 1

1

5

8 3.2 20 106.2 5 33 11 344

14-13 SE County Public Health Departments

47

District 9-2 Southeast

9-2
Appling A tk i n s on B a c on B ra n tl e y B u l l oc h Candler C h a rl ton Clinch C of f e e E van s Jeff Davis P ierce T attnal T oombs W are W ayne T otal

Federal
$77,498 $49,543 $56,034 $56,489 $186,309 $58,843 $40,898 $30,110 $184,444 $57,570 $76,592 $292,050 $116,803 $123,862 $9,822,437
$103,070
$11,332,552

State
$280,819 $163,245 $162,923 $171,122 $598,965 $169,978 $192,402 $148,146 $486,393 $189,569 $200,740 $244,469 $296,265 $372,344 $2,858,340

Fees and Insurance
$169,805 $70,483 $195,269 $138,703 $516,826 $87,847 $117,356 $116,485 $418,512 $95,747 $155,505 $213,477 $207,133 $247,968 $753,275

$392,365

$238,236

$6,928,085

$3,742,626

FTE Clinical Staff: 132 Nurses

Local
$84,361 $33,150 $54,000 $82,391 $120,739 $33,627 $108,498 $68,718 $135,047 $54,335 $112,025 $83,494 $93,672 $111,640 $3,089,476
$109,246
$4,374,419

Other
$140 $12,046
$15 $102,686
$274 $3
$205,816 $320,980

Total
$612,483 $316,421 $468,226 $448,844 $1,434,885 $350,310 $561,840 $363,459 $1,224,396 $397,221 $545,135 $833,493 $713,873 $855,814 $16,729,344
$842,917
$26,698,662

FTE Non-Clinical Staff: 161

Employee Type Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist* Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

District

FT 26 3 7

1

PT 3 1 3

1

Appling

FT 4 PT

Atkinson FT 2 PT

B a c on

FT 3 PT

B ra n tl e y

FT 2 PT

B u l l oc h

FT 6 2

PT

1

Candler

FT 2 PT

C h a rl ton

FT 3 1 PT

Clinch

FT 2

PT 1

1

C of f e e

FT 6 1 PT 1

E van s

FT 3 PT

Jeff Davis

FT PT

3

P ierce

FT 8 PT

T attnall

FT 4 PT 1

T oombs

FT 4 1 PT

W are

FT 8 3 PT

W ayne

FT 4 1 PT

6

12

2

1

1

4

4

1

T otal F T E 93 13 9 0 2 0 0 6 8

21 2

1 26

2

1

20 4 1 1 122 33

5

1

10

2

4

2

5

2

4

8

3

20

2

1

5

2

1

7

2

5

7

1 1 18

2

1

6

3

1

7

4

1

13

5

1

11

5

1

12

10

4

34

3

2

4

2

11

1 1 27 103 4 20 2 293

*District 9-2 contracts with a local dentist and GA Regents University Dental School to provide dental services. May not total due to rounding.

14-13 SE County Public Health Departments

48

District 10 Northeast

10-0

Federal State Fees and Ins ur ance

B arro w

$ 217,132 $ 427,007

$ 362,801

C larke

$ 6,400,523 $ 2,238,204 $ 1,324,774

Elbert

$ 79,014 $ 252,065

$ 108,543

Greene

$ 57,515 $ 212,364

$ 167,228

Jackson

$ 152,359 $ 413,039

$ 340,469

M adiso n

$ 81,848 $ 293,886

$ 221,281

M o rgan

$ 45,210 $ 217,557

$ 169,493

Oco nee

$ 40,302 $ 226,539

$ 393,006

O gle t ho rpe $ 60,349 $ 143,177

$ 109,055

Walto n

$ 229,938 $ 521,007

$ 656,586

Total

$ 7,364,190 $ 4,944,845 $ 3,853,236

Local
$ 292,555 $ 1,976,806
$ 41,465 $ 123,744 $ 278,027 $ 181,677 $ 168,128 $ 78,355 $ 106,998 $ 475,332 $ 3,723,087

Othe r

Total

$ 2,138
$ 37 $ 140
$ 22 $ 41 $ 148 $ 2,525

$ 1,299,495 $ 11,942,444
$ 481,087 $ 560,852 $ 1,183,931 $ 778,832 $ 600,389 $ 738,224 $ 419,619 $ 1,883,011 $ 19,887,883

FTE Clinical Staff: 83 Nurses

FTE Non-Clinical Staff: 150

County Full-Time or Part-Time RN LPN APRN Physician's Assistant Physician Dentist Dental Hygienist Nutritionist Allied Health & Techs Pharmacist Epidemiologist Social Workers & Case Managers Communicable Disease & STD Specialists Public Health Educator Accounting/IT/Billing/HR Program Managers & Administrative Support Emergency Preparedness Environmental Health Other Total FTE

D istrict

FT 8 PT

2

1

113

B arro w

FT 4 PT

1

2

C larke

FT 11 3 3

PT

1

3

Elbert

FT 2 PT

1

1

Greene

FT 4 PT

Jackson

FT 3 PT

2

14 7

M adiso n FT 2

1

1

PT

M o rgan

FT 1 PT

1

1

Oco nee

FT 3 PT

Ogletho rpe FT 1

1

1

PT

Walto n

FT 7 2 1 PT

21

1

Total FTE

46 5 12 0 1 0 1 14 4 0 1 12

M ay no t to tal due to ro unding.

3 4 16 1 2 1 1
1 1
1 1 1
1 12 3 6 27

21 4 1

70

5

3

16

18

6 2 56

1

1

7

2

1

8

5

2

13

4

1

11

2

1

7

4

2

10

2

1

7

10

2

29

74 4 21 2 2 3 2

14-13 SE County Public Health Departments

49

Appendix C: Programmatic Grant-In-Aid Expenditures

Program Name Purpose

State

Children 1st
Early Intervention

To identify, screen, and link at-risk children to appropriate public health or community services.
To provide early intervention services and supports to infants and toddlers with special needs and their families.

Tuberculosis Case Mgmt.

To prevent and control the transmission of TB.

Breast and Cervical Cancer Health Promotion Initiative State Cervical Cancer Screening
EPI Capacity
Oral Health
Other Federal

To provide breast and cervical cancer screening to women in Georgia who are low income, under-served, uninsured, and rarely/never screened.
To promote healthy behaviors throughout Georgia via health promotion strategies that increase physical activity, increase citizens access to healthy foods, and reduce Georgians' exposure to second-hand smoke.
To provide cervical cancer screening to women in Georgia who are low income, under-served, uninsured, and rarely/never screened.
To support a full-time MPH-level Epidemiologist position in each of the 18 health districts to conduct disease surveillance, investigation, data analysis, and control activities. To serve vulnerable populations, without access to private practice oral health services, with oral health preventive services and literacy education. Remaining programs and district services funded by PGIA.

WIC Personal Services2
Children's Medical Services WIC Direct2

To provide wholesome foods and nutrition education to pregnant, breastfeeding women and to infants and children.
To improve the health status of children and youth with special health care needs.
To provide wholesome foods/education to pregnant/breastfeeding women and children.

Family Planning Program

To assist individuals in determining the number and spacing of their children.

Public Health Emergency Prep. HIV Care/ Support Ryan White (B) Early Intervention (C)

To support local public health jurisdictions' preparedness for and response to biological, chemical, or nuclear terrorism and other public health threats and disasters.
To coordinate the needs assessment, planning, development and delivery of essential health and support services for individuals living with HIV/AIDS.
To provide early intervention services and supports to infants and toddlers with special needs and their families.

Family Planning To assist individuals in determining the number and spacing of their children.

Immunization
Breast and Cervical Cancer

To provide vaccines to Georgians of all ages and reduce the incidence of vaccine preventable diseases through education, training, and vaccinating at-risk populations.
To provide breast and cervical cancer screening to women in Georgia who are low income, under-served, uninsured, and rarely/never screened.

Peer Counseling To promote breastfeeding.

WIC Visual Collaboration Healthcare Community Prep.

To provide support to DPH's 159 county health departments and 18 health districts while working to increase access to healthcare across Georgia by expanding the visual collaboration network.
To improve healthcare system surge capacity and strengthen healthcare system ability to mitigate, prepare for, respond to, and recover from public health emergencies, by facilitating the integration of public and private healthcare preparedness planning, training, and exercise.

Other

Remaining programs and district services funded by PGIA.

1 Excludes $84.6 million in non-programmatic infrastructure expenditures 2 Combined into a single administrative annex by DPH

Source: DPH program annexes

Amount $23,246,0661
$4,419,901 $4,389,226 $3,743,545 $1,637,137
$1,153,528
$1,139,205 $1,047,715 $1,020,345 $4,695,465 $111,450,881 $39,806,254
$11,181,481 $9,106,071 $7,483,086
$7,413,923
$6,806,369
$3,663,326 $3,379,594 $2,722,386 $2,673,946 $1,883,112 $1,588,245
$1,511,061 $12,232,027

14-13 SE County Public Health Departments

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Appendix D: Expenditures by Health District
The table presents fiscal year 2014 expenditures by health district. Health districts report expenditures to the state via the uniform accounting system (UAS), and DPH does not maintain a record of the operating costs of individual county health departments. These records disproportionately assign expenditures to "lead counties" in the 14 districts with more than one county. As a result, expenditures for lead counties are significantly over-reported while expenditures from other county health departments are under-reported. This makes expenditure data for many individual county health department misleading.

District
1-1 Northwest 1-2 North Georgia 2-0 North 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton 3-4 East Metro 3-5 DeKalb 4-0 Four 5-1 South Central 5-2 North Central 6-0 East Central 7-0 West Central 8-1 South Central 8-2 Southwest 9-1 Coastal 9-2 Southeast 10-0 Northeast
Total

District Expenditures by Fund Source, FY 2014

Federal

State

Fees & Insurance

Local

$ 7,187,808 $ 10,279,465 $ 3,416,348 $ 2,852,861 $

$ 6,081,370 $

5,603,056 $ 3,861,604 $

946,683 $

$ 6,499,543 $

5,406,743 $ 6,975,330 $ 3,790,034 $

$ 6,833,398 $ 10,013,256 $ 4,332,224 $ 1,608,721 $

$ 12,067,173 $

6,783,565 $ 2,325,260 $ 15,271,415 $

$ 5,073,529 $

4,002,270 $

894,431 $

424,287 $

$ 10,118,468 $

8,149,597 $ 7,184,479 $ 1,388,716

$ 8,203,191 $

9,855,734 $ 6,100,425 $ 3,687,375 $

$ 8,995,937 $

6,894,560 $ 6,422,078 $ 1,988,555 $

$ 4,565,877 $

4,099,921 $ 2,006,513 $

330,762 $

$ 7,681,974 $

9,302,821 $ 4,694,180 $ 1,493,168 $

$ 6,739,685 $

6,084,251 $ 4,568,672 $ 2,431,782 $

$ 6,596,238 $

7,386,602 $ 2,432,167 $ 1,247,726 $

$ 6,463,631 $

5,125,408 $ 2,597,271 $ 1,021,447 $

$ 6,969,948 $ 10,579,499 $ 3,907,960 $ 3,097,467 $

$ 12,775,216 $

9,476,524 $ 5,015,263 $ 3,272,686 $

$ 11,332,552 $

6,928,085 $ 3,742,626 $ 4,374,419 $

$ 7,364,190 $

4,944,845 $ 3,853,236 $ 3,723,087 $

$ 141,549,730 $ 130,916,204 $ 74,330,067 $ 52,951,192 $

Other
685,641 $ 604,911 $ 1,388,300 $ 1,667,862 $ 260,408 $ 404,471 $
$ 2,175,387 $
284,525 $ 134,915 $ 503,889 $
40,628 $ 79,367 $
7,895 $ 243,170 $
34,000 $ 320,980 $
2,525 $ 8,838,874 $

Total
24,422,123 17,097,624 24,059,950 24,455,461 36,707,820 10,798,989 26,841,261 30,022,112 24,585,656 11,137,989 23,676,032 19,865,018 17,742,101 15,215,652 24,798,045 30,573,690 26,698,662 19,887,883 408,586,066

14-13 SE County Public Health Departments

51

Appendix E: Location and Purpose of Programmatic Grant-in-Aid
DPH distributes programmatic grant-in-aid (PGIA) to districts through program annexes. Annexes provide a description of services to be delivered by districts and/or county health departments. Below is a list of programs from fiscal year 2014, their purpose, and availability throughout the state. This table is not a complete list of programs available in each district or county health department, as not all programs are funded by PGIA. In addition, PGIA funds may not be used to provide services in all counties within the district.

Annex 1-1 Northwest 1-2 North Georgia
2 North 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton 3-4 East Metro 3-5 DeKalb 4 Four 5-1 South Central 5-2 North Central 6 East Central 7 West Central 8-1 South 8-2 Southwest 9-1 Coastal 9-2 Southeast 10 Northeast

Program Name

Fund Source

Purpose

Emergency Preparedness

The SNS Law Enforcement Summit

Cities Readiness

provides a venue where Federal, State,

133

Initiative- Law Enforcement

Federal

District and Local partners are afforded an opportunity to discuss roles and

x x x x

Summit

responsibilities to ensure an efficient and

effective response.

x x x x

x

x

To support state and local public health's

273

Cities Readiness Initiative

Federal

ability to receive, distribute and dispense medical countermeasures to the affected

x x x x x x x x x

x

population.

x

x

To support local public health jurisdictions'

270

Public Health Emergency Prep

Federal

preparedness for and response to biological, chemical, or nuclear terrorism,

x x x x x x x x x x x x x x x x x x

other public health threats and disasters.

Emergency 498 Preparedness
Program (EPP)

Federal

To provide public health emergency

preparedness activities associated with planning, equipping, training, and evaluating

x

x

x

x

readiness.

x x

x x x x x x x x x x

To support state and local public health's

501

Cities Readiness Initiative (CRI)

Federal

ability to receive, distribute and dispense medical countermeasures to the affected

population.

x

x

To improve healthcare system surge

capacity and strengthen healthcare systems

566

Healthcare Community Prep.

Federal

ability to mitigate, prepare for, respond to, and recover from public health emergencies, by facilitating the integration

x x x x x x x x x x x x x x x x x x

of public and private health preparedness

planning, training, and exercise.

567

Hospital Resources Deployment Cache Storage

Federal

To store and maintain medical surge caches, costs associated with hosting the CHEMPACK, and modify existing builds to meet CDC antidote requirements in Public Health Districts throughout the state.

x

x x

x x x x x x x x x x x x

Environmental Health

Childhood Lead

To provide and coordinate a regional

11

Base Poisoning

Federal healthy homes program including lead

Prevention

poisoning prevention and abatement.

To identify people at risk for health

40

Environmental Health Risk Assessment/Com munications

Federal

problems from exposure to hazardous substances in the environment, determine relationships between exposure to hazardous substances and human diseases, and reduce or eliminate

x

exposures of health concern.

Healthy Homes

265

and Lead Poisoning

Prevention

State

To provide and coordinate a regional healthy homes program including lead poisoning prevention and abatement.

x

To protect the well-being of citizens and GA

visitors through surveillance, education,

assessment and enforcement programs

354

Environmental Health Services

State

designed to identify, prevent and abate the biological, physical and chemical conditions

that adversely impact human health and

thereby reduces morbidity and premature

death related to environmental hazards.

x

x

x

x

x x

x

x

14-13 SE County Public Health Departments

52

Appendix E: Location and Purpose of PGIA (continued)

Annex Northwest North Georgia Nort h Cobb-Douglas Fulton Clayto n East Metro DeKalb Four South Central North Central East Central West Central South Southwest Coastal Southeast Northeast

Program Name

Fund Source

Purpose

Epidemiology

20

GA Cancer Registry

25

Federal Cancer Registry

245

Epidemiology Capacity

Epidemiology 280 Capacity
Additional

State Federal State State

To hire and maintain full-time Regional Cancer Registry Coordinators to provide technical assistance to all cancer reporting facilities in the region and perform medical record abstractions for any newlydiagnosed cancer cases in small facilities with less than 50 licensed beds.
To hire and maintain full-time Regional Cancer Registry Coordinators to provide technical assistance to all cancer reporting facilities in the region and perform medical record abstractions for any newlydiagnosed cancer cases in small facilities with less than 50 licensed beds.
To support a full-time MPH-level Epidemiologist position in each of the 18 Health Districts to conduct disease surveillance, investigation, data analysis, and control activities.
To support a full-time MPH-level Epidemiologist position in each of the 18 Health Districts to conduct disease surveillance, investigation, data analysis, and control activities.

x

x

x x

x

x

x x

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

Health Promotion and Disease Prevention

56

Breast and Cervical Cancer Screening

Federal

To provide breast and cervical cancer screening to women in Georgia who are low income, under-served, uninsured, rarely/never screened.

x x x x x x x x x x x x x x x x x x

108

Enhancing Breast

and Cervical

Federal

Cancer Screening

To provide breast and cervical cancer screening to women in Georgia who are low income, under-served, uninsured, rarely/never screened.

x x x x

x

x

x x x x x x x x

111

Ovarian Cancer Study - UTN

Federal

To support treatment, sub-specialist care and outcomes of ovarian cancer.

x

x

118

Worksite Wellness

Federal

To support the nurse consulting services for the Worksite Wellness program.

x

GA Personal 166 Responsibility
Education

State

Implement the Personal Responsibility Education Program which provides evidentbased programming to prevent HIV/STIs and teen pregnancy among Georgia's most vulnerable youth.

x

x x x

x x

x x

170

Hypertension

Management &

Federal

Outreach Initiative

To provide case management and clinical services to uninsured and underinsured adults with a primary diagnosis of hypertension.

x

x

x

x

x

To support efforts to improve healthy

237 AH&YS Outreach Federal physical and social development among

x

Georgia adolescent population.

Improve the health status of Georgia's

adolescents and establish health behaviors

238

Teen Center Youth Develop

Federal

among youth, including making good choices about sexual behavior and reduce behaviors

x

that result in illness, death, chronic disease,& etc.

GA Nutrition &

To implement strategies for healthful nutrition

300 Physical Activity Federal habits to improve obesity and other related

x

x

Initiative

chronic diseases.

Adolescent 306 Health & Youth
Development

Federal

To provide evidence-based programs and strategies to prevent pregnancy, HIV/STIs and chronic disease among Georgia's adolescents.

x x x x x

x x

x x

14-13 SE County Public Health Departments

53

Appendix E: Location and Purpose of PGIA (continued)

Annex Northwest North Georgia Nort h Cobb-Douglas Fulton Clayto n East Metro DeKalb Four South Central North Central East Central West Central South Southwest Coastal Southeast Northeast

Program Name

Fund Source

Purpose

330

GA Asthma Control

Federal

Youth

333

Development Coordinator

Salary

State

405

State Cervical Cancer Screening

State

417

Tobacco Use Prevention

Federal

Cervical Cancer

424 Education &

Federal

Prevention

453

State Community Improve

Federal

464

Breast and Cervical Cancer

State

466

Health Promotion Initiative

State

Special Rape 471 Prevention &
Education

Federal

Approaches to

549

Increase Physical Activity & Healthy

Federal

Eating

Adolescent Health

589 & Youth

Federal

Development

To improve asthma control and reduce its

burden among those with pediatric asthma

ages 0 - 17 in GA by focused commitment to policy and environmental change,

x

x

x

asthma management education, and an

integrated care delivery system.

For securing and/or maintaining a Youth Development Coordinator Position.

x

To provide cervical cancer screening to women in Georgia who are low income, under-served, uninsured, and rarely/never screened.

x xxxxxxxxxxx xxxxxx

To reduce the use of tobacco and the burden it causes from related illness and disease in Georgia by coordinating strategies in tobacco use prevention and control, provide technical assistance and x training on policy development, program interventions, communications strategies and serve as a resource center for tobacco issues.

x x x x x x

x x

x x x

To help reduce the impact of cancer on the

lives of Georgians, the GBCCP strives to

address 2020 Healthy People National Objectives by providing access to timely

x

breast and cervical cancer screening and

diagnostic services to eligible women.

To provide support for community development activities

x

To provide breast and cervical cancer screening to women in Georgia who are low income, under-served, uninsured, rarely/never screened.

x xxxxxxxxxxx xxxxxx

To promote healthy behaviors throughout Georgia via health promotion strategies that increase physical activity, increase citizens access to healthy foods, and reduce Georgian's exposure to second hand smoke.

x xxxxxxxxxxx xxxxxx

To collaborate with the State Sexual

Violence Prevention Program to provide

evidence-based opportunities to promote healthy relationships and prevent teen

x

x

x x

pregnancy among Georgia's most

vulnerable youth.

To fund public health districts to carry-out

strategies, to increase the number of

community, worksite, school, and Early

Care Environment (ECE) environments that

promote and reinforce healthful behaviors

and practices across the life span related to diabetes, cardiovascular health, physical

x

x

x

activity and healthful foods and beverages,

obesity, and breast feeding through

systems, policy and environmental

changes, particularly in school and early

care settings

x x

x

x x

To provide evidence-based programs and

strategies to prevent pregnancy, HIV/STIs and chronic disease among Georgia's

x

x

adolescents.

x x

14-13 SE County Public Health Departments

54

Appendix E: Location and Purpose of PGIA (continued)

Annex Northwest North Georgia Nort h Cobb-Douglas Fulton Clayto n East Metro DeKalb Four South Central North Central East Central West Central South Southwest Coastal Southeast Northeast

Program Name

Fund Source

Purpose

Immunization

66

Immunization

Federal

To provide vaccines to Georgians of all ages, and work to reduce the incidence of vaccine preventable diseases throughout the state through education, training, and vaccinating at-risk populations.

x x x x x x x x x x x x x x x x x x

69

School based flu project

Federal

To provide for ancillary costs incurred by contractors coordinating with the Immunization program.

x x x

x x

x x x x x x

To prevent HPV associated cancers by

186

Increasing HPV Coverage rates

Federal

educating parents about the importance of having their adolescents receive 3 doses of

x

x x

x x x x x x x x

x

HPV vaccine.

GA Public Health

To provide Georgia Public Health

425

Laboratory Immunizations &

State

Laboratory employees with immunizations and other preventive health services as

x

Screenings

needed.

Infectious Disease

Tuberculosis

31

Case

Management

34

Tuberculosis Pharmacists

State Federal

To prevent and control the transmission of TB.

x x x x x x x x x x x x x x x x x x

To provide for a pharmacist position to

direct, manage, and provide pharmaceutical

x

x

services.

44

Enhanced Comprehensive HIV Prevention

Federal

To implement comprehensive human immunodeficiency virus (HIV) prevention programs to reduce morbidity, mortality, and related health disparities.

x x x

x x

x x x x x x x x x x

To coordinate the needs assessment, planning, development and delivery of

53

HIV Care/Support Ryan White (B)

Federal

essential health and support services for individuals living with HIV/AIDS. Funds

x

associated with this program may only be

used for the payments of salaries.

Tuberculosis

72

Case Management -

State

Special Allocation

To prevent and control the transmission of TB.

x x

To coordinate the needs assessment,

75

HIV Care/Support Ryan White (B)

State

planning, development and delivery of essential health and support services for

x

x

individuals living with HIV/AIDS.

To support the expansion of HIV related mental health services at Ryan White satellite clinics, to include comprehensive

91

Mental Health Services for HIV Infected Individuals

Federal

mental health assessment and diagnosis; individual level mental health therapy and supportive services; psychopharmacological services and medication management; mental health and coping skills education;

x

individual level mental health treatment

planning; crisis intervention; and mental

health community referrals.

To coordinate the needs assessment,

94

HIV Care/Support Ryan White (B)

Federal

planning, development and delivery of essential health and support services for

x x x x

individuals living with HIV/AIDS.

x x

x x x x x x x x x x

14-13 SE County Public Health Departments

55

Appendix E: Location and Purpose of PGIA (continued)

Annex Northwest North Georgia Nort h Cobb-Douglas Fulton Clayto n East Metro DeKalb Four South Central North Central East Central West Central South Southwest Coastal Southeast Northeast

Program Name

Fund Source

Purpose

104

"Test, Link, and Care" Network

Federal

125

Routine Opt-Out HIV Screening

Federal

141

HIV/AIDS Surveillance

Federal

Gonorrhea Isolate

160 Surveillance

Federal

Project

243

West Nile Virus EPI

Care and 267 Prevention in the Federal
US

Ryan White Part 271 B Minority AIDS Federal
Initiative

283

STD Preventive Clinical Services

Federal

304

Tuberculosis Data Management

State

Immunization 313 Allocated
Facilities

Federal

Tuberculosis 336 Directly Observed State
Therapy

367

Comprehensive STD Program

Federal

440

HIV Care/Support Ryan White (B)

Federal

To implement the "Test-Link-Care" Network. This model will identify and promptly link to care persons who are living with HIV but not receiving treatment (including those who are unaware of as well as, those who are aware of their HIVpositive status) and improve patient retention in HIV primary care, through the use of trained Linkage Coordinators and systemic networking among HIV care providers, HIV testing providers and the health department.
To implement and routinize opt-out HIV testing in health care settings, that provide primary and/or specialty care in health districts that have ten percent of HIV incidence in Georgia.
To support the expansion of HIV/AIDS Surveillance activity into the local district.

x x x

x

x

x x

x x

x

x x

x

To provide Gonorrhea Isolate Surveillance

Project specimens for the identification of

x

Neisseria gonorrhea from culture.

To support West Nile Virus surveillance activities.

x

To improve HIV testing, linkage to and

retention in care, and antiretroviral adherence, specifically targeted toward

x

x

x x

x

x x x x x x x

highest risk minority populations.

To implement a linkage to care model that

will identify and promptly link to care

minorities who are living with HIV but not

receiving treatment (including those who

are unaware of, as well as those who are aware of their HIV positive status), improve

x x

x x

x x

minority retention in HIV primary care and

increase minority participation in and

access to the AIDS Drug Assistance

Program (ADAP).

To provide STD clinical services for low income, uninsured and underinsured patients and their partners.

x x x x x x x x x x x x x x x x x x

To hire a data manager for the DeKalb tuberculosis (TB) Program.

x

To provide funding for office space and associated costs for Immunization Program Consultants (IPC) to the following local boards of health for the benefit of counties located within indicated districts.
To provide personnel that will deliver directly observed therapy to tuberculosis (TB) patients for the purpose of ensuring completion of TB treatment and latent TB infection treatment as well as provide TB educational messages to the public.
To implement comprehensive programs that includes the Infertility Prevention Project, Syphilis Elimination Efforts and Partner Counseling and Referral Services.
To coordinate the needs assessment, planning, development and delivery of essential health and support services for individuals living with HIV/AIDS.

x

x

x

x

x x x

x

x x

x

x x

x

14-13 SE County Public Health Departments

56

Appendix E: Location and Purpose of PGIA (continued)

Annex Northwest North Georgia Nort h Cobb-Douglas Fulton Clayto n East Metro DeKalb Four South Central North Central East Central West Central South Southwest Coastal Southeast Northeast

Program Name

Fund Source

Purpose

To modify the Fulton County electronic

medical records system to enable

HIV Health 459 Information
Exchange

Federal

synchronous clinician alerts by the Department of out-of-care HIV positive patients who are presenting for health services and implement an alert system

that provides these out-of-care patients

with referral and linkage to HIV treatment.

544

Tuberculosis Nurse

Federal

To provide nursing services that supports the operation of county-wide tuberculosis services.

x

x

Enhanced 588 Comprehensive
HIV Prevention

Federal

To implement comprehensive human immunodeficiency virus (HIV) prevention programs to reduce morbidity, mortality, and related health disparities.

x

Injury Prevention

The Byrne Criminal Justice Innovation

(BCJI) launched in 2012 and was created to

150

Byrne Criminal Justice Injury

Federal

develop and implement place-based, community-oriented strategies to transform

x

distressed communities into communities of

opportunity.

Maternal and Child Health

7

WIC Nutrition Education

Federal

x x x x x x x x x x x x x x x x x x

7

WIC Dietetic Internship

Federal

x x x x x x x x x x x x x x x x x x

To provide wholesome foods/education to

7

WIC Direct

Federal pregnant/breastfeeding women and

x x x x x x x x x x x x x x x x x x

children.

9

WIC Breastfeeding

Federal

x x x x x x x x x x x x x x x x x x

To provide support to DPH's 159 county

14

WIC Visual Collaboration

health departments and 18 health districts while working to increase access to healthcare across Georgia by expanding the

x

visual collaboration network.

To identify, screen, and link at-risk children

24

Children 1st

State

to appropriate public health or community

x x x x x x x x x x x x x x x x x x

services.

Children's

To provide medical genetic services that

27

Medical Services Genetics

State

include evaluation, treatment and disease management for children diagnosed with

x

x x

x x

Services

heritable disorders.

To serve vulnerable populations, without

76

Oral Health

State

access to private practice or oral health services, with oral health preventive

x x x x x x x x x x x x x x x x x x

services and literacy education.

Implementing

More Positive

86

Alternative

Choices for

Teens

Federal

To assist at- risk adolescents 17 and under make positive lifestyle choices through education, leadership opportunities and clinical reproductive health services.

x

101

Expanded Family Planning Services

Federal

To assist individual determining the number and spacing of their children.

x x

To provide early intervention services and

112 Early Intervention State

supports to infants and toddlers with special x x x x x x

needs and their families.

To support the Georgia Infant Mortality

115

Perinatal Health Initiative

Federal

Strategic Plan, the initiative is a targeted intervention in one of the 6 cluster areas identified in our Infant Mortality Periods of

Risk report.

x x x x x x x x x x x x

14-13 SE County Public Health Departments

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Appendix E: Location and Purpose of PGIA (continued)

Annex Northwest North Georgia Nort h Cobb-Douglas Fulton Clayto n East Metro DeKalb Four South Central North Central East Central West Central South Southwest Coastal Southeast Northeast

Program Name

Fund Source

Purpose

To provide early identification and parent-

Children 1st

child interaction training to families and

131

Promoting Safe & Stable Families

Federal

children, ages birth to three years, who are at risk of developmental delays and have

x

Pilot

experienced incidents of child

maltreatment.

To improve birth outcomes by providing

152

Perinatal Health Partners

State

case management to high risk pregnant/postpartum/inter-conceptional

x

women and their babies.

301

WIC Personal Services

Federal

To provide wholesome foods and nutrition education to pregnant, breastfeeding women and to infants and children.

x xxxxxxxxxxxxxxxx x

329 Peer Counseling Federal To promote breastfeeding.

x xxxxxxxxxxxxxxxx x

332

Richmond County Dental

Federal

To provide dental services to low income children in the North Health District.

x

385

Baby Lowndes Unique Victories Infant Mortality Reduction Initiative

Federal

To improve birth outcomes by promoting preconception and interconnection health, promoting early access to prenatal and postpartum women, and identifying issues to help reduce health disparities among maternal and child health populations.

x x

409

Children Medical Services

Federal/ State

To improve the health status of children and youth with special health care needs.

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

401

Family Planning Program

Federal

To assist individual determining the number and spacing of their children.

x xxxxxxxxxxxxxxxx

x

415

CP Babies Born Healthy

State

To promote healthy babies in Georgia by assisting women with access to comprehensive, quality perinatal services

x

To improve birth outcomes by providing

449

Perinatal Health Partners

State

case management to high risk pregnant/postpartum/inter-conceptional

x

women and their babies.

Universal

460

Newborn Screening and

Intervention

State

To maintain and support a comprehensive,

coordinated, statewide screening and

referral system promoting hearing

screening and appropriate follow-up for all newborns through education, technical

x xxxxxxxxxxxxxxxx x

assistance and training regarding

implementing and maintaining a quality

newborn hearing screening program.

Universal

461

Newborn Screening and

Intervention

Federal

To maintain and support a comprehensive, coordinated, statewide screening and referral system promoting hearing screening and appropriate follow-up for all newborns through education, technical assistance, and training.

x xxxxxxxxxxxxxxxx x

To improve birth outcomes in Northeast

Perinatal Health

Health District 10 by promoting

502 Planner and

Federal preconception and inter-conception health

Partners

and promoting early access to prenatal and

postpartum care for women.

x

x

Partnership to 514 Improve Birth
Outcomes

State

To improve birth outcomes by promoting early prenatal care, preconception and interconception health, and promoting early access to prenatal and postpartum women.

x

To provide the single point of entry

infrastructure, including receiving and

522

Great Start Georgia Central Intake

Federal

processing of all referrals for all expectant mothers, children birth to five in selected counties, and ensuring a coordinated service delivery system for families to

x

access prevention-based, evidence-based

home visiting, and child health services .

x

x

x

x

x

14-13 SE County Public Health Departments

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Appendix E: Location and Purpose of PGIA (continued)

Annex Northwest North Georgia Nort h Cobb-Douglas Fulton Clayto n East Metro DeKalb Four South Central North Central East Central West Central South Southwest Coastal Southeast Northeast

Program Name

Fund Source

Purpose

To provide early intervention services and 543 Early Intervention Federal supports to infants and toddlers with special x x x x x x
needs and their families.

x x x x x x x x x x x

559

Family Planning Program Realignment

Federal/ State

To assist individual determining the number and spacing of their children.

x

x

x

x

Male 562 Reproductive
Health Initiative

Federal

To increase the number of males who utilize family planning services.

Foster Care

Funding provided for the closeout of the

587

Nurse Liaison Coordination

Federal

program. To support coordination and consultation for children in out of home

x

Program

placement.

x x x x x x x x x x x x x x

Unclassified

To increase access to healthcare across

Georgia and reduce health care access

Telemedicine

gaps by delivering state purchased

341 Equipment

State

telemedicine equipment to identified

Deployment

districts, training necessary district staff on

proper equipment usage, and expanding

the telemedicine network.

This project will serve to continue the work

District Quality

of the Customer Service workgroup

Improvement and

through the application of Quality

418 Accreditation

Federal Improvement methodologies in order to

Readiness

meet the long-term goal, which is to

(SEHD)

change the culture of customer service

agency-wide.

x

x x x

x x

14-13 SE County Public Health Departments

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Appendix F: Basic Health Services Provided by County Health Departments
The table presents the results of a survey we conducted to determine the extent to which basic health services are provided by health districts and county health departments. The results indicate whether the service is available to eligible patients in the county health department, but results should not be interpreted to indicate that the service is available broadly to all citizens in the community. Program eligibility requirements determine whether services are delivered.

% OF COUNTIES % OF DISTRICTS

Rx

DENTAL1

PHYSICAL

PREVENTIVE 1. Standard immunizations 2. Birth control 3. Education for lifestyle choices & health risks
SCREENINGS - GENERAL 1. Eye and ear 2. Comprehensive biometric
SCREENINGS - CANCER 1. Breast and cervical cancer 2. Colon cancer 3. Testicular 4. Skin
DIAGNOSE 1. Sexually Transmitted Diseases 2. Acute Conditions (e.g., infections and injuries)1 3. Chronic Conditions (e.g., diabetes, high blood pressure)
TREATMENT 1. Sexually Transmitted Diseases 2. Acute Conditions (e.g., infections and injuries)1 3. Chronic Conditions (e.g., diabetes, high blood pressure)
LAB TESTING 1. Pregnancy 2. Sexually Transmitted Diseases 3. Cholesterol 4. Other (e.g., Liver, Thyroid, Kidney)
XRAY 1. Chest 2. General (i.e., fractures)
PREVENTIVE 1. Cleaning 2. Sealants
SCREENINGS 1. Basic screening 2. Comprehensive examination
TREATMENT 1. Fillings 2. Dentures 3. Oral surgery
PRESCRIBE 1. Limited formulary (e.g., birth control, STD meds) 2. Extensive formulary (e.g., similar to a primary care physician)
DISPENSE 1. Limited formulary (e.g., birth control, STD meds) 2. Extensive formulary (e.g., similar to a pharmacist)
1. Often restricted to either pediatric or HIV patients.

100% 100% 100%
100% 84%
100% 36% 28% 28%
100% 36% 26%
100% 36% 26%
100% 100% 97% 72%
53% 0%
39% 37%
100% 27%
26% 2% 4%
100% 4%
100% 3%

100% 100% 100%
100% 83%
100% 50% 33% 28%
100% 50% 56%
100% 50% 50%
100% 100% 100% 72%
67% 0%
89% 83%
100% 78%
72% 22% 33%
100% 17%
100% 6%

14-13 SE County Public Health Departments

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Appendix G: Primary Care Service Case Studies
Below are examples of county health departments where citizens can attain comprehensive primary health care services on-site from either health department personnel or partnering primary care facilities. These providers offer services for low-income families.

Whitfield County Since the 1980s, the health department
has operated an internal medical access clinic that offers primary health care for adults. The clinic employs 1 full-time and 9 part-time (retired) physicians. The county has a separate pediatric clinic staffed with nurse practitioners.

Hall County In October 2008, the county board of
health began renting clinic space to a local physicians group to operate a family medicine clinic within the health department facility.

Dade

Catoosa

Fannin

Walker

Whitfield

Murray
1-2

Gilmer

Union

Lumpkin

Chattooga

Gordon

Pickens

Dawson

Towns

Rabun

White Habersham

2-0

Stephens

1-1
Floyd

Bartow

Hall

Cherokee

Forsyth

Banks Franklin

Jackson

Madison

Hart Elbert

Bibb County
In September 2014, the health department entered into an agreement to co-locate a primary care community health center
within the health department.

Cobb County Since the early
1990s, the health department has provided pediatric primary health care.

Polk Haralson

Cobb

Gwinnett

3-1 Paulding

3-4

Douglas

3-2

3-5
Dekalb

Barrow Walton

Clarke

Oglethorpe

10-0 Oconee

Wilkes

Rockdale

Carroll

Fulton Clayton
3-3

Newton

Morgan

Greene Taliaferro

Lincoln Columbia

McDuffie

Heard

Coweta

Fayette

Henry

Spalding

Butts

Jasper

Putnam

Warren

Hancock

Glascock

Richmond

Troup

4-0
Meriwether

Pike Lamar Upson

Monroe

Jones
5-2

Bibb

Harris

Talbot

Crawford

Baldwin Wilkinson

Washington

Jefferson

Johnson

6-0 Burke Jenkins

Muscogee

Taylor

Peach

Twiggs

Laurens

Emanuel

Screven

Chattahoochee

Baker County Since 1979 a
community health center has been co-located in the health department. Clients may receive internal/ family medicine and pediatric services on-site.

Marion Schley

Macon

7-0
Stewart Webster

Sumter

Quitman

Clay

Randolph

Terrell

Lee

Houston Bleckley

5-1 Treutlen

Montgomery

Dooly

Pulaski

Dodge

Wheeler

Crisp

Wilcox

Telfair

Turner

Ben Hill

Jeff Davis

Candler

Bulloch

Effingham

Toombs

Evans

Bryan

Tattnall Appling

Liberty
9-1
Long

Chatham

Calhoun

Dougherty

Early Miller

Baker

Mitchell

8-2

Worth Colquitt

Irwin Tift

Coffee

Berrien Cook

Atkinson

Seminole Decatur

Grady

Thomas

Brooks

Lanier
8-1

Clinch

Lowndes

Echols

Bacon

Wayne

Ware

Pierce

9-2

Brantley

McIntosh Glynn

Charlton

Camden

Source: DOAA interviews and analysis

14-13 SE County Public Health Departments

61

Appendix H: Dental Services
A significant percentage of county health departments provide expanded clinical services for dental care, especially pediatric dental care. Approximately one-third of county health departments report offering preventive and diagnostic dental care such as cleaning (39%) and sealants (37%). However, fewer county health departments offer more intensive clinical care such as fillings (26%), oral surgery (4%), and dentures (2%). Below is a map with a sample of case studies we identified.

Floyd County A full-service
dental clinic provides care to low income residents (adults and children). Serves as a training clinic for Georgia Regents University (Richmond Co.). Students work under the supervision of a district dental director. The clinic was stablished with help of a federal grant.

Dade

Catoosa

Fannin

Walker

Whitfield

Murray
1-2

Gilmer

Union

Lumpkin

Chattooga

Gordon

Pickens

Dawson

Towns

Rabun

White Habersham

2-0

Stephens

1-1
Floyd

Bartow

Hall

Cherokee

Forsyth

Banks

Franklin Hart

Cleanings and Sealants
Fillings, Cleanings, and Sealants

Jackson

Madison

Elbert

Polk Haralson

Cobb

Gwinnett

3-1 Paulding

3-4

Douglas

3-2 3-5 DDeekkaalblb

Barrow Walton

Clarke Oglethorpe
10-0 Oconee

Wilkes

Rockdale

Carroll

3-3 Fulton
Fulton

Clayton

Newton

Morgan

Greene Taliaferro

Lincoln

Oral Surgery, Fillings, Cleanings, and Sealants

Columbia

McDuffie

Heard

Coweta

Fayette

Henry

Spalding

Butts

Jasper

Putnam

Warren

Hancock

Glascock

Richmond

Troup

4-0
Meriwether

Pike Lamar Upson

Monroe

Jones
5-2

Bibb

Harris

Talbot

Crawford

Baldwin Wilkinson

Washington

Jefferson

Johnson

6-0 Burke Jenkins

Muscogee

Taylor

Peach

Twiggs

Laurens

Emanuel

Screven

Chattahoochee

Marion Schley

Macon

7-0
Stewart Webster

Sumter

Quitman

Clay

Randolph

Terrell Lee

Houston Bleckley

5-1 Treutlen

Montgomery

Dooly

Pulaski

Dodge

Wheeler

Crisp

Wilcox

Telfair

Turner

Ben Hill

Jeff Davis

Candler

Bulloch

Effingham

Toombs

Evans

Bryan

Tattnall Appling

Liberty
9-1
Long

Chatham

Calhoun

Dougherty

Early Miller

Baker

Mitchell

8-2

Worth Colquitt

Irwin Tift

Coffee

Berrien Cook

Atkinson

Seminole Decatur

Grady

Thomas

Brooks

Lanier
8-1

Clinch

Lowndes

Echols

Bacon

Wayne

Ware

Pierce

9-2

Brantley

McIntosh Glynn

Charlton

Camden

District 9-2 Teledentistry program uses telecommunication technology in
clinics established in elementary schools within Clinch, Charlton, and Brantley Counties. A contracted hygienist provides cleaning, fluoride, x-rays, during school hours and coordinates via video with dentists at Georgia Regents University (Richmond Co.) for diagnosis and referrals. The project was developed using a federal HRSA grant and is designed to establish basic dental care to the student population in rural areas where access is limited by cost barriers or shortage of providers.
1 Clinch, Charlton, and Brantley County (all located in District 9-2) offer cleanings but not sealants
Source: DOAA survey and analysis

14-13 SE County Public Health Departments

62

Appendix I: Telemedicine Case Studies
There are a number of county health departments where citizens can attain select services using telemedicine technology. The telemedicine program initially started in District 9-2 Southeast, which continues to serve as the hub for the state. Telemedicine incorporates two way video and peripherals to allow patients to communicate with health professionals in another location. Examples are presented below.

Cherokee County HIV Clinic

Hall County* HIV Clinic

Cobb County HIV Clinic
Clayton County* HIV Clinic
Muscogee County* HIV Clinic
Dougherty County Centering
Pregnancy (High Risk OB)
Lowndes County Genetics Asthma-Allergy Endocrinology Cardiology HIV Clinic

Dade

Catoosa

Walker

Whitfield

Murray
1-2

Fannin Gilmer

Union

Chattooga

Gordon

Pickens Dawson Lumpkin

Towns

Rabun

White Habersham

2-0

Stephens

1-1
Floyd

Bartow

Cherokee

Forsyth

Hall

Hart Banks Franklin

Jackson

Madison

Elbert

Legend
Current TeleMedicine Site
Future TeleMedicine Site

Polk Haralson

Cobb

Gwinnett

Barrow

3-1 Paulding

3-4

3-2 3-5 Douglas

Dekalb

Walton

Clarke Oglethorpe
10-0 Oconee

Wilkes

Lincoln

Rockdale

Carroll

Fulton Clayton
3-3

Newton

Morgan

Greene Taliaferro

Columbia

McDuffie

Heard

Coweta

Fayette

Henry

Spalding

Butts

Jasper

Putnam

Warren

Hancock

Glascock

Richmond

* Sites with technology deployed but may not be fully operational.

Troup

4-0
Meriwether

Pike Lamar Upson

Monroe

Jones

Baldwin

5-2

Bibb

Wilkinson

Harris

Talbot

Crawford

Muscogee

Taylor

Peach

Twiggs

6-0 Jefferson Burke

Washington Johnson

Emanuel

Jenkins

Screven

Chattahoochee

Marion Schley

Macon

7-0
Stewart Webster

Sumter

Quitman
Randolph Clay

Terrell

Lee

Montgomery

Houston Bleckley

Laurens

Treutlen

5-1

Pulaski

Dooly

Dodge

Wheeler

Crisp

Wilcox

Telfair

Turner

Ben Hill

Jeff Davis

Candler

Bulloch

Effingham

Toombs

Evans

Tattnall

Appling

Bryan

Chatham

Liberty
9-1
Long

Calhoun

Dougherty

Worth

Irwin Tift

Coffee

Bacon

Wayne

McIntosh

Early
Miller Seminole

Baker Decatur

Mitchell

Berrien Atkinson

Ware

Pierce

8-2

Colquitt Cook

Grady

Thomas

Brooks

Lanier
8-1

Lowndes

Echols

9-2

Brantley

Clinch

Charlton

Glynn Camden

Glynn County* Genetics HIV Clinic
Brantley County School Teledentistry
Site

Charlton County School Teledentistry Site

Source: DPH

Clinch County School Teledentistry
Site

Ware County Genetics Teledentistry Pediatric Neurosurgery HIV

14-13 SE County Public Health Departments

63

Appendix J: Federally Qualified Health Centers
Specially designated community health centers called federally qualified health centers or FQHCs receive federal grant funding to provide comprehensive primary care and preventive services in medically underserved communities. The federal Patient Protection and Affordable Care Act (ACA) has served as a catalyst for this expansion with additional funding allocated to the expansion of these health centers. As of October 2014, there were 156 clinical sites in 86 counties operated by 31 FQHCs.

Dade

Catoosa

Walker

Whitfield

Murray

Fannin

1-2 Gilmer

Union

Towns

Rabun

White Habersham

Chattooga

Gordon

Pickens

Lumpkin Dawson

2-0

Stephens

1-1
Floyd

Bartow

Hall

Cherokee

Forsyth

Banks Franklin

Hart

Counties with a FQHC location.

Jackson

Madison

Elbert

Polk

Cobb

Gwinnett

Barrow

Clarke

Oglethorpe

3-1 Paulding

3-4

Haralson

3-5

Walton

10-0 Oconee

Wilkes

Carroll

3-2 Douglas
3-3 Fulton

Dekalb Clayton

RockdaleNewton

Morgan

Greene

Taliaferro

Lincoln Columbia

Heard

Coweta

Fayette

Henry

Spalding

Butts

Jasper

Putnam

Warren

Hancock

Glascock

Richmond

Chattahoochee McDuffie

4-0

Pike

Lamar Monroe

Jones

Baldwin

6-0 Jefferson Burke

Troup

Meriwether

5-2

Washington

Upson

Bibb

Wilkinson

Jenkins

Harris

Talbot

Crawford

Johnson

Muscogee

Taylor

Peach

Twiggs

Laurens

Emanuel

Screven

Marion Schley

Macon

7-0
Stewart Webster

Sumter

Quitman

Clay

Randolph

Terrell Lee

Houston Bleckley

5-1 Treutlen

Candler

Bulloch

Effingham

Montgomery

Dooly

Pulaski

Dodge

Wheeler

Crisp

Wilcox

Telfair

Turner

Ben Hill

Jeff Davis

Toombs

Evans Tattnall

Appling

Bryan

Chatham

Liberty
9-1
Long

Calhoun

Dougherty

Worth

Irwin Tift

Coffee

Bacon

Wayne

McIntosh

Early Miller

Baker

Mitchell
8-2

Colquitt

Berrien Cook

Atkinson

Seminole Decatur

Grady

Thomas

Brooks

Lanier
8-1

Clinch

Lowndes

Echols

Pierce

Ware

9-2

Brantley

Charlton

Glynn Camden

Source: Georgia Association for Primary Health Care, Inc.

The Performance Audit Division was established in 1971 to conduct in-depth reviews of state-funded programs. Our reviews determine if programs are meeting goals and objectives; measure program results and effectiveness; identify alternate methods to meet goals; evaluate efficiency of resource allocation; assess compliance with laws and regulations; and provide credible management information to decision-makers. For more information, contact
us at (404)656-2180 or visit our website at www.audits.ga.gov.