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Frequently Asked Questions


What concepts or principles were used to develop the NPHPS instruments?

The NPHPS instruments help users answer such questions as

  • How well do we ensure that the essential public health services are provided in our system? (State and Local Instruments)
  • How can we, as a governing body, better ensure that we contribute as much as possible to the essential public health services provided in our jurisdiction? (Governance Instrument)

The NPHPS materials are based on the 10 Essential Public Health Services and examine how they are delivered by state and local public health systems, which include all public, private, and voluntary entities that contribute to public health activities within a given area. This ensures that their contributions are recognized in assessing the provision of Essential Public Health Services.

The materials are intended for use by public health governing bodies, such as boards of health, and focus only on those individual entities and their oversight for the health agency, rather than on the broader public health system.

The Standards describe optimal performance, which can guide continuous quality improvement by teaching about public health activities throughout the system and determining how to make improvements.

The NPHPS assessment process helps identify strengths and weaknesses within the system. This information can facilitate informed, effective policy and resource decisions to improve the public health system.

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How does the governing entity fit into a system assessment?

Unlike a public health agency that ensures direct provision of the 10 Essential Public Health Services within a jurisdiction, a governing entity is responsible for overseeing the health department’s work. The Governance Assessment is framed around the 10 Essential Public Health Services to be consistent with the State and Local Public Health System Assessments.

Web of connected eggs showing different components of the public health system including, but not limited to, the public health agency, non-profit organizations, nursing homes, community centers, and mental health. Outside of the web shows the direct link between the Board of Health and the Health Department.

Figure 3: The relationship between the governing entity and the health department

A public health governing entity may or may not be responsible for particular actions or oversight, depending on the role the health department takes as a member of the public health system.

The governing entity has a responsibility to understand what other community groups or organizations contribute to an Essential Public Health Service, whether or not the health department has a lead role.

In addition to the three Core Functions (assessment, policy development, and assurance) and the 10 Essential Public Health Services, the Governance Assessment is also framed around governance functions.

The Functions of Public Health Governance

This version of the NPHPS governance tool has been updated to include current information in the fields of governance and public health. The initial five functions identified in 1999 have remained essentially the same, and the oversight function has been strengthened.
Depending on their legal positions, governing entities have varying degrees of responsibility for these functions. All governing entities are responsible for some aspects of each function, however. No one function is more important than another.

What is MAPP and how does it relate to the NPHPS?

Mobilizing for Action through Planning and Partnerships (MAPP) guides communities through a health improvement process. It was developed by NACCHO and CDC.

Find MAPP resources on NACCHO’s website. See MAPP Field Guide [PDF - 1.23MB] for an overview.

The MAPP model guides system and community partners through a community health improvement planning process that includes a set of four assessments, one of which is the NPHPS Local Public Health System Assessment (LPHSA).

Local public health systems should strongly consider using the NPHPS local instrument as part of a broader MAPP process. MAPP provides the framework and process for improving upon strengths and weaknesses, and therefore assures that the results of the performance assessment are actively used.

MAPP includes three other assessments in addition to the information collected in the local public health system assessment, so the community health improvement plan truly addresses the gamut of strengths, weaknesses, challenges and opportunities that exist in the community.

MAPP has been successfully adopted at the state level. For more information, contact ASTHO.

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How do the NPHPS fit with accreditation efforts? 

The NPHPS framework for assessing public health system performance helps health departments understand their agency’s role in delivering essential public health services and their interactions with public health system partners.

This information may be beneficial to state and local health departments preparing for, or maintaining, accreditation status.

The NPHPS assessment process and results may be useful for accreditation readiness and quality improvement in the following scenarios:

  • There is an explicit connection with Public Health Accreditation Board (PHAB) accreditation where NPHPS are referenced within the standards and measures documentation guidance.

Specifically, NPHPS are provided as an example of a tool or process to meet PHAB standards

  • 1.1.1—state/community health assessment
  • 4.1.2—models of community engagement
  • 5.2.1—community health improvement plan
  • Both the NPHPS tools and the PHAB standards are based on the same Essential Services framework. Therefore, a system or governance assessment can provide valuable insights about activities, strengths, and opportunities for improvement—valuable information for a health department’s preparation activities in accreditation. 
  • Health departments may use the NPHPS process to identify potential quality improvement opportunities or solutions as part of meeting PHAB Standard 9.2, which requires that health departments “develop and implement quality improvement processes.”

Results from the NPHPS’ strengths-weaknesses-opportunities-priorities analysis may help health departments identify quality improvement projects before achieving accreditation.

NPHPS post-assessment guidance, via the NPHPS Implementation Guide, may help health department staff work through quality improvement planning and implementation.

After achieving accreditation, NPHPS assessment results, including the assessment report and discussion notes, may help health departments identify solutions to address areas of weakness noted through the accreditation process.

Finally, use of the Governing Entity Assessment can strengthen a governing body’s awareness and engagement in health department activities, which can be helpful in meeting the measures in Domain 12 (Maintain capacity to engage the public health governing entity). 

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How often should we conduct the NPHPS assessment process 

The assessment process should be repeated every few years (e.g., a 3-5-year cycle), which allows time for agencies to implement any improvements identified during the process.

Through repeated use, public health systems and governing entities will be able to track how the weaknesses or gaps identified in previous years have been addressed and celebrate the development of a truly coordinated public health system.

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Can the NPHPS be used to evaluate or assess public health agencies, programs, or organizations?

The NPHPS is not intended to serve as an evaluation of the performance or capacity of individual programs or agencies. Instead, it is an assessment of overall system performance and how current performance and capacity measure up against optimal benchmarks.

NPHPS results represent the collective performance of all organizational participants in the public health system and should not be interpreted to reflect the status of any single agency, organization, or program.

State and local public health systems should use the information as a planning tool for quality improvement.

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How do systems or governing entities get started using NPHPS? 

When deciding to undertake the NPHPS assessment, entities should

  • Become familiar with the assessment instruments and supporting tools
  • Determine what organization can serve as the lead entity
  • Establish the resources and commitment needed to support the process
  • Give careful consideration to how the process can link to concurrent or previous improvement efforts

The following national partner organizations can provide technical support throughout the process:

  • ASTHO—state public health systems
  • NACCHO—local public health systems

See Contact Us for additional information.

State and local public health systems and governing bodies may conduct a coordinated statewide assessment process using all three NPHPS instruments. The assessments can be conducted more or less simultaneously. This approach can provide more effective orientation and technical assistance activities.

In addition, assessment results will provide a picture of a consistent point in time for all respondents throughout the state. Much can be learned from analyzing the aggregate data and developing cross-cutting improvement plans.

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How is the current version (Version 3) different from previous versions of the NPHPS tools?

The 2013 NPHPS revision—Version 3—addressed four major priorities:

  • Streamlining the assessment process
  • Enhancing systems building features
  • Promoting performance improvement and quality improvement
  • Strengthening linkages with PHAB accreditation

The NPHPS were also revised to help public health systems identify areas to focus improvement efforts and develop an action plan.

The NPHPS state and local Version 3 assessments include a Strengths-Weaknesses-Opportunities-Priorities worksheet for each Essential Public Health Service to help public health systems capture valuable qualitative data (see Table 1). NPHPS state and local post-assessment materials provide guidance for identifying and implementing quality improvement activities.

Additional changes were made to the governance materials to better meet the needs of public health governing entities, including

  • Updated model standards that focus on governing entities’ responsibility for oversight of the health agency
  • Better definitions for individual scoring options
  • Further guidance on using NPHPS results to develop strategic plans and quality improvement projects
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What are the Priority and Agency Contribution Questionnaires?

These are supplemental, optional components to the state and local Version 3 instruments.

The Priority Questionnaire asks about the priority of addressing each model standard, while the Agency Contribution Questionnaire asks about the public health agency contribution to each model standard.

The state and local instruments and the appendices of the implementation guides contain more information about the Priority and Agency Contribution questionnaires. The materials for governing entities do not include these questionnaires.

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What technical assistance resources are available for NPHPS users? 

  • ASTHO and NACCHO offer technical assistance for NPHPS users.

Each partner website hosts a wide assortment of resources, including a glossary, implementation guides, and templates that can help throughout the process from planning to using results for system improvement.

  1. Public Health Improvement Training

Two-day workshop that supports health departments and governing entities engaged in performance improvement activities and includes sessions focusing on NPHPS

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Are there data limitations to NPHPS assessments?

Yes. There are a number of limitations to the NPHPS assessment data due to self-report, wide variations in the breadth and knowledge of participants, the variety of assessment methods used, and differences in interpretation of assessment questions.

Data and resultant information should not be interpreted to reflect the capacity or performance of any single agency or organization within the public health system or used for comparisons between jurisdictions or organizations.

Use of NPHPS-generated data and associated recommendations are limited to guiding an overall public health infrastructure and performance improvement process for the public health system as determined by organizations involved in the assessment.

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