TITLE
Title
DHHS-PUBLIC HEALTH BUDGET AMENDMENT: PUBLIC HEALTH INFRASTRUCTURE - LOCAL WORKFORCE DEVELOPMENT ($1,413,671)
end
SPONSOR
Sponsor
Dr. Iulia Vann
end
BACKGROUND
Background
The Centers for Disease Control and Prevention (CDC), through the North Carolina Division of Public Health, has awarded Guilford County through State Agreement Addendum 117 the amount of $1,413,671. This award can be expended over the next five (5) years. The award recognizes a history of underinvestment in the public health system and its foundational services, and supplements existing work in Clinical Services, Environmental Health and Workforce Development. In accordance with the non-supplanting provision, these state funds are intended to supplement existing funds and services rather than replace or supplant them.
This funding is to help meet the short-term critical infrastructure needs and to make strategic investments which will have lasting effects on local public health departments in North Carolina. This funding will support the foundational capabilities and the local health department workforce needed to support service areas. Investments and improvements to foundational capabilities will help rebuild and modernize public health departments, positioning local health departments to better serve their communities.
These foundational service areas are core functions of local health departments and include:
1) Preventing the spread of communicable disease,
2) Ensuring food, air and water quality are safe,
3) Supporting maternal and child health,
4) Improving access and linkages to clinical care services, and
5) Preventing chronic disease and injury.
Staff plan to use the new funding to continue one (1) existing position and establish six (6) new FTEs to expand our impact in Environmental Health - Water Quality/Food and Lodging and Clinical Services - Communicable Disease.
Funding will be used to support:
• Existing: One (1) ARPA Workforce Development Manager (partially) - NCDHHS funds will continue to support part of this position (Agreement Addendum 118)
• New: One (1) Enterprise Permitting and Licensing (EPL) Application Administrator
• New: One (1) Environmental Health Specialist - Water Quality
• New: One (1) Environmental Health Supervisor - Water Quality
• New: One (1) Environmental Health Specialist - Food & Lodging
• New: One (1) Nurse Specialist II - Communicable Disease
• New: One (1) Public Health Investigator - Communicable Disease
• Education and training opportunities for Public Health Staff
To align with the state-awarded budget of $1,413,671 for FY23-24, the anticipated spending of the award, by year, is:
• FY24 $94,700
• FY25 $640,244
• FY26 $678,727
In Fiscal Year 2027, the current funding source will be fully utilized, resulting in an estimated county expenditure of $757,435. Moving into Fiscal Year 2028, the anticipated cost to the County for maintaining the specified positions is projected to be $778,282 and in Fiscal Year 2029, the anticipated cost to the county for maintaining these positions will be $799,129.
Environmental Health-Water Quality: Three (3) Positions and Environmental Health-Food and Lodging: One (1) Position
With a fully staffed team, the onsite wait time to complete a request for a soil evaluation is 12-15 days, with an additional 5-7 days to complete all documentation and sign off on the enterprise platform.
If requested positions are not funded, Onsite Water Quality will continue to have long wait times for soil evaluations impacting residential and commercial growth, Operations & Maintenance inspections will not be completed and may impact the community's health if systems malfunction in addition to loss of revenue, new staff may unintentionally approve lots that are not approvable costing the county in tort claims, EPL maintenance/upgrades will continue to be an undue burden to existing staff.
The additional staff requested would help to reduce request times and improve overall service delivery, improve customer satisfaction, support better internal communication and integration of activities.
To address the increasing workload and ensure efficient management of future upgrades and quality improvements in our Enterprise Permitting and Licensing (EPL) operations, particularly in our EPL system, Public Health is requesting the addition of an EPL Administrator.
1. Current Workload Management: The existing team is currently operating at maximum capacity. With the growing demands in enterprise permitting and licensing, the workload has surpassed our current staffing levels. This has led to delays in project delivery and a potential decrease in service quality. Adding an Administrator for EPL will distribute the workload more effectively, ensuring timely and efficient completion of tasks.
2. Expertise in EPL: EPL is a complex system requiring specialized knowledge for optimal management. The new position will focus on EPL, bringing in-depth expertise that our current team composition lacks. This specialization will lead to better system management, fewer errors, and more efficient processes.
3. Future Upgrades and Quality Improvement: As technology evolves, our systems need to be upgraded to stay current. The Administrator will play a crucial role in managing these upgrades, ensuring they are implemented smoothly and without disrupting our operations. Additionally, this role will be pivotal in initiating quality improvement processes, leading to enhanced service delivery and customer satisfaction.
4. Cost-Effectiveness: In the long run, hiring an additional staff member will be cost-effective. It will reduce overtime costs currently incurred due to the high workload and prevent potential financial losses associated with system downtimes or errors due to overburdened staff.
5. Scalability for Future Growth: As our organization grows, our systems and processes must scale accordingly. The new Administrator position is a strategic step towards scaling our operations, ensuring we can handle increased demand without compromising on quality or efficiency.
In conclusion, the addition of the Administrator for EPL is a necessary step to enhance our operational capacity, maintain high-quality service delivery, and prepare for future growth and technological advancements.
Clinical Services-Communicable Disease: Two (2) positions
During 2020, the COVID-19 pandemic led to disruptions in STD-related prevention and care activities, including reduced screening during the initial shelter-in-place orders. STD program resources, including STD case investigations, were also redirected to COVID-19 activities. Because STDs often do not show symptoms, and screening is necessary for timely diagnosis and treatment, changes in access to sexual health care can affect the number of infections diagnosed and reported.
The pandemic has aggravated the existing challenges experienced by pregnant mothers. Lack of access to transportation and unavailability of programs supporting prenatal care have led to increasing birth rates of babies suffering from syphilis.
Syphilis Cases in the last three (3) years:
2021 - 425
2022 - 546
2023 - 446
Public Health is asking for a Public Health Investigator and a Communicable Disease Nurse Specialist II to effectively manage and mitigate the surge in communicable diseases, specifically Syphilis and other Sexually Transmitted Infections (STIs), in our county.
1. Rising Incidence of STIs: Recent data indicates a significant increase in the incidence of Syphilis and other STIs in our county. This surge necessitates a dedicated effort to investigate, track, and control these diseases. These positions will be instrumental in addressing this public health challenge.
2. Specialized Expertise: The complexity of tracking and controlling STIs requires specialized knowledge in communicable disease investigation. These roles will focus on understanding the patterns, causes, and effects of these diseases in our community, leading to more effective intervention strategies.
3. Enhanced Public Health Response: The addition of these positions will strengthen our public health response capabilities by conducting thorough investigations. This leads to identification of sources and transmission patterns of STIs which results in targeted and effective control measures. This proactive approach is essential in preventing further spread.
4. Community Education and Awareness: A key component of controlling STIs is public education and awareness. These positions will also play a vital role in developing and disseminating educational materials and programs, helping to reduce stigma and promote safe practices within the community.
5. Collaboration with Healthcare Providers: These positions will facilitate stronger collaboration with local healthcare providers. By working closely with these professionals, we can ensure timely reporting of cases, provide expert guidance on treatment and prevention, and coordinate a comprehensive response to STI outbreaks.
6. Cost-Effectiveness and Long-Term Benefits: Investing in a dedicated Communicable Disease Investigator and Nurse Specialist II is cost-effective in the long run. By controlling the spread of STIs, we can reduce the burden on our healthcare system, decrease the long-term health consequences for individuals, and prevent the high costs associated with untreated or late-treated infections.
7. Meeting Public Health Standards and Regulations: With the increase in STI cases, it is imperative that our county meets national public health standards and regulations in disease control and prevention. The new positions will ensure compliance with these standards as well as with North Carolina General Statues, thereby maintaining the health and safety of our community.
In conclusion, the creation of the Public Health Communicable Disease Investigator and Nurse Specialist II positions is a critical step in addressing the surge in Syphilis and other STIs in our county. These roles are not only essential for immediate disease investigation and control but also for the long-term health and well-being of our community.
end
BUDGET IMPACT
Budget Impact
$94,700 increase in appropriation to Department of Health & Human Services - Division of Public Health
$94,700 increase in State & Federal Revenue
NO COUNTY MATCH REQUIRED
end
REQUESTED ACTION
Requested Action
1) Accept five (5) year funding of $1,413, 671 from NCDHHS for Public Health Infrastructure-Local Workforce Development.
2) Amend the General Fund Budget Ordinance to increase State and Federal Revenue by $94,700 and increase appropriation to the FY2023-24 Health and Human Services by $94,700.
3) Approve the creation of six (6) new positions, as referenced in the multi-year funding plan.
4) Continue to fund ARPA Workforce Development Manager in future years.
5) Approve the purchase of two (2) 4-Wheel Drive trucks for use by Environmental Health positions.
end