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COUNTY HEALTH DEPARTMENT INTEGRITY
<br />The Florida public health system can be likened to a confederation of units,
<br />known as County Health Departments, all having similar and different character-
<br />istics in their health services programs and funding sources. These programs
<br />and the funding are governed by many state laws and regulations that require
<br />® oversight of the entire system to be centralized at the state level. In
<br />addition, each is governed by county laws, ordinances and regulations, which
<br />in many cases contain safeguards for the public health over and above those
<br />required by the state. This system has existed since 1931 under a partner-
<br />ship arrangement between the state and the counties in the basic law known
<br />as Florida Statutes, Chapter 154.
<br />This system has worked exceedingly well. In fact, in the fiscal year ended
<br />June 30, 1973, the DHRS Division of Health (which included the County Health
<br />Departments) delivered 7,211,200 direct services to Florida citizens with
<br />2,628 personnel, out of total services of 8,335,274, and total personnel of
<br />32,863 for the entire Department of Health and Rehabilitative Services.
<br />To state it another way, 88 of the personnel delivered 86.5% of the total
<br />HRS services in FY 73. Nowhere in government can one find a better value
<br />per dollar expended than in public health, be it a federal, state, county,
<br />or provately contributed dollar. Conversely, the rest of DHRS delivered
<br />only 13.58 of total services with 928 of total personnel. Nowhere can
<br />you find a poorer value per dollar expended.
<br />As stated previously, the CND's are similar, yet the whole system is flexible.
<br />It provides for differences in public health programs offered in the various
<br />counties due to local geography, population, custons, funding. Coastal
<br />counties are involved in shellfish programs while interior counties are not.
<br />Some CHD's are intimately involved with their county governing authorities
<br />while others are not. A few even have their own laboratories. Others have
<br />extensive environmental health programs. Yet all are involved in statewide
<br />programs such as tuberculosis and venereal disease control.
<br />The funding, administration and professional direction of CHD's is a complex
<br />and intricately balanced process. It calls for local day-to-day and on -the -
<br />spot guidance and decision making. In addition to local direction, and the
<br />state -level coordination of statewide health programs, it calls for overall
<br />coordination and evaluatiion of funds, budgets, and personnel at the state
<br />level. It calls for a single agency that can provide overall, equitable
<br />allocation of state funds to the CND's; that can provide direct, fast
<br />reaction and turnaround time between the CHD's, the state comptroller and the
<br />division of personnel, or any other agency whose rules and regulations affect
<br />the daily operations of the CHD's. The shorter, the more direct this
<br />coordinative line can be, then the more efficiently and quickly can the CHD's
<br />respond to local health needs. This coordinative state agency that can deal
<br />directly with the CND's and with other agencies is needed regardless of the
<br />fact that the state contribution annually to the total CHD funds is as low
<br />as 28% in some cases.
<br />The funding and administration of the CHD is a very complex process that is,
<br />unfortunately understood by comparatively few persons outside of the public
<br />health professionals. The operation of a County Health Department is not
<br />something that can be learned vicariously. It is something that must be
<br />experienced! The large daily voulme of services delivered, the sources of
<br />funds and the management of those funds requires very fast reaction time
<br />on the part of the CHD's and the coordinative agencies upon whom they must
<br />depend. Some CND's may have as many as ten or more "operating budgets" and
<br />some of these may be incorporated in the CHU Trust Fund Budget. Some have
<br />general fund budgets supplied by their county governments in addition to funds
<br />from ad valorem taxes. In addition, the counties have many millions of
<br />dollars invested in the public health facilities and equipment used by the
<br />CND's. The interrelationships between programs and between budgets often
<br />result in a management process akin to that of a finely woven fabric.
<br />Any reorganization, which could ultimately result in less services to Florida
<br />citizens at a much greater cost to the taxpayers, should be closely observed
<br />and carefully evaluated. A system that calls for CHD personnel actions,
<br />payrolls, travel vouchers, physician vouchers, vender invoices, etc., to be
<br />processed through the HRS maze of district, secretariat, central personnel,
<br />consultants, analysts, specialists, health program office, etc., before they
<br />can ever get out of HRS to the division of personnel, the comptroller, or
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