[Archived] Why invest in Health Department staffing?

Alexandria Health Department (AHD) has experienced numerous long-term, difficult to fill vacancies, as well as excess turnover in recent years. These vacancies are to the extent that AHD is not expected to be able to reach many of its FY 2016 AlexStat performance targets. Addressing these vacancies is critical to assure the provision and delivery of essential public health services to City residents including: appropriate preparation for, response to, and recovery from public health emergencies; clinical and case management services to reduce teen pregnancies, improve birth outcomes, and prevent childhood nutrition-related diseases and developmental delays; investigation and case management of sexually transmitted infections (STIs); and immunizations for children and teens. Analysis revealed that AHD has difficulty recruiting and retaining staff due to compensation that is not competitive, particularly for the State temporary and grant funded positions that have not receive City salary supplementation in the past. Additionally, another City position, which is not full-time, has been difficult to fill. Five local jurisdictions, including the City of Alexandria, provide various supplements to their local-state health departments. Additionally, the Fairfax and Arlington County health departments are locally administered and their salaries are determined by their respective general salary schedules. The FY 2017 budget (excluding this initiative) contains $4.7 million in City funded salary supplement for State Health employees. 

As a result, the following pay adjustments were included in the City Manager’s FY 2017 Proposed Budget:

1. Extend salary supplementation to eighteen non-supplemented AHD positions (in Public Health Emergency Management; Maternal & Childcare Services; Nutrition Program for Pregnant Women, Infants and Children; Immunizations; and Communicable Disease) 

2. Convert one Maternal & Childcare Services part-time, direct service position (nurse practitioner) from 0.8 full-time equivalent to a full-time position 

Providing a City salary supplement to eighteen non-supplemented state positions and converting one part-time City position to a full-time position will cost approximately $190,000 of the $200,000 proposed in the budget for FY 2017. Attachment I details these expenditures.

The following is a summary of services provided in the programs affected by this proposal as well as the anticipated impacts that salary supplementation will have on services:

• AHD’s Public Health Emergency Management Program: 
  Based on data through February 2016, AHD estimates that only 60-70% of the FY 2016 AlexStat targets for Public Health Emergency Planning and Response (including number of volunteers recruited, number of partners trained, and number of organizations participating in exercises) will be met. Providing a salary supplement for the Public Health Emergency Management positions will enable AHD to successfully recruit and retain staff and subsequently meet these measures going forward. 
  
• AHD’s WIC Nutrition Program:
  AHD estimates that it will fall short of its FY 2016 AlexStat target for the WIC Program by reaching less than 80% of its target of 3,100 participant visits per month. Additionally, because of staff shortages, AHD recently closed two WIC satellite clinics (at Casey Health Center Prenatal Clinic and at Neighborhood Health’s 2 E. Glebe Pediatric Clinic); therefore AHD anticipates that performance for WIC-related AlexStat targets will suffer even more. Restoration of normal staffing will enable AHD to reopen the satellite WIC clinics. 
  
• AHD’s Immunization Program:
  Recent higher rates of pertussis reported in AlexStat is reflected by national, regional and state trends; the only method to prevent this is effective immunization programs and collaborations among partner organizations. The position proposed to receive City salary supplementation provides direct services via registration of clients and also provides administrative, insurance processing, data entry and management support to ensure that immunization services are provided safely and efficiently.
  
• AHD’s Communicable Disease Program:
  The Alexandria rates for STIs and HIV far exceed the rates for Northern Virginia overall; for HIV and syphilis, Alexandria rates exceed those of Virginia as well. The position proposed to receive City supplementation are direct service providers and are critical to stopping the spread of STIs, including HIV, by identifying and counseling persons exposed to STIs, assuring clinical treatment, and providing follow up case management. 
  
• AHD’s Teen Wellness Center (TWC):
  Based on data through February 2016, AHD estimates that it will conduct fewer than 3,500 medical visits at the TWC in FY 2016, considerably short of its AlexStat target of 5,300. AHD has had three unsuccessful recruitments for its vacant, 0.8 FTE nurse practitioner position; applicants offered, but not accepting, the position cites compensation and lack of full-time employment as reasons. AHD’s proposal seeks to convert a TWC direct service position (nurse practitioner) from 0.8 to 1.0 FTE. Conversion to a full-time position will increase AHD’s ability to attract a nurse practitioner candidate and subsequently increase the number of appointments available for teens.
  
  

ATTACHMENT:
Attachment I – Alexandria Health Department – FY 2017 Budget Proposals – Impact on Positions, Programs and City Budget