Background:
Michigan needed to ensure the quality, availability and effectiveness of services of its 45 local health departments (LHD).

Objective:
Illustrate the Local Public Health Accreditation Program's ability to evaluate LHD, to meet standards based on Michigan's Public Health Code, state administrative rule or policy, and/or professionally accepted standards of practice.

Method:
Michigan provides LHD a self- assessment tool and an on-site STD evaluation tool to determine the successful delivery of STD services.

Result:
: Michigan's extensive on-site review process allows participants to exchange information, share practices, and seek clarification. Michigan conducts site visits every 3 years, sending one reviewer per visit. The state is in its third cycle, having conducted more than 100 site visits to LHD. Michigan is developing a model that incorporates the NACCHO Operational Definition of a functional LHD into the organizational capacity review. The model increases LHD accountability, and capacity to deliver core public health functions and essential public health services. To illustrate accountability, agencies must meet measurable standards and demonstrate improved performance. There are 9 STD program requirements and 11 indicators used to evaluate an organizations capacity.

Conclusion:
An LHD survey, reported that 86 % of respondents agreed self-assessment useful for identifying areas needing improvement. 84 % respondents reported self-assessment useful preparing on-site review, and 76 % reported self-assessment a catalyst for prereview consultation. The on-site review serves as the catalyst for quality improvement and a venue to evaluate conformance with standards and measures. This mandatory program evaluates overall organizational capacity and individual program performance of the core functions of assessment, policy development, and assurance.

Implications:
This system helps public health agencies improve the protection of the public, assuring accountability, and building and maintaining public health capacity.