State plan for public health services

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STATE PLAN FOR PUBLIC HEALTH SERVICES
Fiscal Year 1968
(Section 314(d) Public Health Services Act
as Amended)
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C.ON TEN T S
1. Request for Approval • • • • • • • • • • • • . • • • • • • • • • • • 1
II. Description of Specified Standards, Methods, Policies, and
Procedures. • • • • • . • . • • . •• . . • • • • 1-3
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V.
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Narrative Description of Programs in the State Plan. • • • • •
150 Direction. . . .. • . . • . . • • . . . . . • .
151 Overall Direction. • • • • • • •
152 Local Health Services. • • • •••••••
I. Development of Local Health Departments.
II. Development of State-Local Relationships •
III. Development of Local Health Programs • •
IV. Development of Minimum Standards of Performance in
Connection with the Activities of Local Health
Departments. • • • • • • • • • • • • • • • • •
Development of State-Local Health Department
Funding Mechanisms • • • • • • • • • • • • •
VI. Development of Local Health Department Facilities. •
VII. Provision of Administrative and Program Coordination
and Support to Counties. . • ••••••
153 Health Mobilization. • • • • • • • •
I. Training Programs. • • • • • • • • •
II. Medical Stockpiling. • • • • • • •
III. Emergency Health Service Planning••••••••
154 Accident Prevention. • • • • • • • • • • • • • • • •
155 Residency Program in Preventive Medicine •
160 Administration. • • • • • • • • • • • • • •
161 Fiscal. • • • • • • • • • • • • • • • • •
162 Personnel. • • • • • • • • • • • • • • •
170 Planning and Technic~l Support. • • • • • • • • •
171 Planning. • • • • • • • • • • • • • ••••
I. Depart~ental System for Program Planning and
Budgeting. . . . . . . . . . . . . ......
II. Organitation for Comprehensive Health Planning •
172 Management Advisory Services • • • • • • • • •••••
173 Health Education .and information Services. • •••
174 Training. • • • • • • • • • • • • • • • • • •
Vital Statistics, • • • • • • • • • •
181 Administration.. ••••••••••••••
182 Registration " • • • • • • • • •
183 Certification. • • • • • • • • • • • • • •
184 Accounting • • • • • • • • • • •
Public Health Nursing • • • • • • • • • •
Laboratory Services and Support • • • • •
201 Laboratory Direction • • • • • • • • • • • • • • •
I. Legislation...... • •••••••••
II. Laboratory Facilities. • • •••••••
III. Staff Capability • • • • • • • . • • • •
IV. Up-grading Clinical Laboratories ••••••••
V. Program Costs. . • • • • • . • • • • •
VI. Retrieval and Analysis of Laboratory Information
III.
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Chemistry. • • • .•••
I. Air Pollution. • • • • • •
II. Water Quality•••••••••••••
III. Adulteration of Dairy Products
IV. Pesticide Residues ••••••.••••
V. Clinical Chemistry •••••••••••••••
Microbiology • • • • • • • • • • • • • • •
I. Deficiencies............
II. Laboratory Safety. . • • • •
Virology . . . . • . . . . • . . . . . .
I. Use of Laboratory Facilities
II. Laboratory Safety. • • • • • • • • • • . • • •
202
203
204
205 Serology. . • • • • • • • • • • •
I. Use of Laboratory Facilities • • • •
II. Evaluation of Procedures and Reagents ••
206 Tucson Branch. • .". • • • • • • • • • •
207 Flagstaff Branch . . • • •• •
Environmental Health. • • • • • • • • • • • • • • • •
211 Sanitation. • • • • • •
212 Water Supply • • • • ••••••••
213 Radiological Health. • •••••••
214 Air Pollution Control. • ••••••
215 Waste Water. • • • ���• •• • • ••.
Medical Services and Facilities • • • • • •
221 Chronic Illness and Aging. • • •
222 Survey and Planning. • • ••••••
223 Construction. • • . • • •
224 Certification. . • • • • . • •
225 Licensing. • • • • • • • • • • •
226 Migrant Health .
227 Health Referral Service. • • • • • . • • • • • • • •
Preventive Medical Services • • • • •
231 Tuberculosis Control • • • • • •
232 Venereal Disease Control •• • • • • • • • .
233 Acute Communicable Disease • • • • • • • •
234 Dental Health. • • • • • • • • • • •
235 Health Evaluation. • • • . • • . • •
250 Maternal. and Child Health. • •••
210
230
220
IV. Budget • . . . . . . . . 1
V. Additional Information 1
EXHIBITS
1 Forms and Attachments for Fund Accountability
2 Time Record Form
3 Organization Chart
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I. REQUEST FOR APPROV~L
The Depa~tment of Health of the State of Arizona
(State agency)
Hereby agrees and assures that the attached State plan for public health services
and budget describe its operations for which Federal participation is requested for
the fiscal year ending June 30, 1968, and that these operations will be carried out
in Accordance with Section 3l4(d) of the Public Health Service Act, as amended, the
Regulations and Information and Policies issued pursuant to that Section, the pro~
visions of this plan which include the following specific provisions:
1. The activities described in the plan and carried out with Federal partici~
pation will be administered, or supervised in their administration, by the
undersigned State authority.
2. Federal funds paid under this allotment will be used to make a significant
contribution toward providing and strengthening public health services in
the political subdivisions of the State in order to improve the health of
the people.
3. Federal funds paid under this allotment will be made available to other
public or non~profit private agencies, institutions, and organizations in
accordance with criteria which are designed to secure maximum participa~
tion of local, regional, or metropolitan agencies, and groups in the
provision of such services.
4. Federal funds paid under this allotment will be used to supplement, and to
the extent practical, to increase the level of funds that would otherwise
be made available for the purposes for which Federal funds are provided
and not to supplant such non-Federal funds; similar assurances will be
required of other public or non-profit private agencies, institutions, and
organizations to which Federal funds are made available for participation
in the furnishing of health services under this plan, except that this
requirement may be waived in accordance with the conditions and limita~
tions set forth in Regulations 5l.l04(e) (1) issued pursuant to
Section 314(d) of the Public Health Service Act, as amended.
5. Personnel standards on a merit basis will be established and maintained
for persons employed by the State authority and by official local health
and mental health departments, to provide or supervise the provision of
public health services under the approved State plan.
6. The fee schedules and other bases for payment of individuals, agencies,
institutions, and organizations (not under a merit system) will be in
accord with the usual and customary practices in the State.
7. The services supported under the State plan is in accordance with such
plans as have been developed by the State Planning Agency designated pur­suant
to subsection 3l4(a) of the Public Health Service Act, as amended.
Regional Office Approval
Approved by
Date
Signature of Responsible Official
Commissioner
Title
Date
II. DESCRIPTION OF SPECIFIED STANDARDS, METHODS, POLICIES, AND PROCEDURES
A. Programs to be supported under the State Plan were selected on the
basis of:
1. Statutory requirement.
2. Maximum effect on morbidity, disability) and mortality for
the money to be expended.
The adequacy of the statistical basis for the second criterion
listed above admittedly varies as between programs selected. A
significant improvement in this area, both for future program
selection and for evaluation, is expected to result from the work
of the Health Evaluation Section of the Preventive Medical Serv­ices
Division, described in Section III (Narrative) below.
B. Supervision of administration of health services provided by other
agencies will be accomplished primarily through:
1. Contract execution
a. Fiscal audit
b. Program audit
2. Consultation
Money is subvented to other agencies by means of formal contract
documents, which include attachments containing a complete pro­gram
narrative and a budget. Expenditure reports are submitted
regularly from these other agencies for fiscal audit, and informal
program audit is made on site by out consultant staff on a con­tinuing
basis. Deviations from the written program are usually
resolved by our consultant staff, but administrative supervision
is definitely retained by us in that serious deviation from pre­set
standards and activities is a legal basis for cancellation of
the funding. In this, we are following much the same pattern as
applies to us as recipients of Federal to State funding.
Exhibits I-A through I-E (attached) contain the forms and attach­ments
used when funds are advanced to agencies. A slightly
different form than Exhibit l-B is used when funds are subvented
on a reimbursement basis.
Exhibit l-A is a route slip for internal use only to
assure that proper departmental clearances
are made.
Exhibit I-B contains the standard terms and conditions
under which the funds are subvented.
Exhibit l-C is the civil rights attachment.
Exhibit l-D is the program narrative attachment.
Exhibit l-E is the program budget attachment.
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C. With reference to the participation of other public or private
non.profit agencies in the delivery of health services:
1. Our policy is to avoid fragmentation of services.
2. Our procedure is to channel funds through official local
health departments.
Both the policy and the procedure are subject to possible future
modification, but at this point in time they represent what we
feel to be the only realistic approach to the effective use of
funds.
As you may know, Arizona does not yet have a state-wide Compre­hensive
Planning Agency designated, nor does it have any areawide
planning agencies in the sense of P.L. 89·749. It follows, of
course, that there are no State or Area Advisory Councils and no
State or Area Comprehensive Health Plans. We hope, of course,
to develop all this as rapidly as possible. In the interim, we
will rely on the official local health departments, which have,
by their very nature, been most intimately aware of, and involved
in, the full range of health concerns in their respective com·
munities. They, in turn, will subvent monies to private non.profit
agencies in ways best designed to overcome deficiencies in the
broad range of health services. For example (although not reflect­ed
in the attached Budget Form because the amounts were not needed
to reach the required total of federal and non-federal dollars),
Maricopa County Health Department will subvent, out of funds re­ceived
from uS in fiscal year 1968, some $5,500 to Memorial Hospi­tal
for a cancer detection clinic. Pima County Health Department
wil1subvent some $15,000 to the Arthritis Foundation for
specialized work. And, although they are not equipped to handle
the fiscal procedures, Yavapai County Health Department will be
coordinating a direct· from-us contract with the Prescott Community
Hospital concerned with rehabilitation of stroke patients.
In brief, in the absence of a fully developed comprehensive health
plan which would prevent duplication or fragmentation, we feel
that local health departments inevitably play the key role in the
effective use of limited health funds. Participation in funding,
therefore, will be made dependent on local health department
discretion and judgment~
D. As indicated in item A. above, the measurement of health status of
the general population is far from adequate. The identification
of high risk sub groups within the general population, and the
subsequent measurement of these sub groups' health status, is
even further from having been accomplished. Pending the develop­ment
of the work of the Health Evaluation Section's work, also
mentioned in item A. above, we have to rely on professional judg­ment,
mixed with such data as are available, to determine specific
activities, which vary from program to program (as described in
III • Narrative below). Indigency, of course, with its attendant
environmental and health educational deficiencies, is a factor in
most of our activity determinations.
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E. Support costs are not prorated and charged against specific
programs. _ Rather, separate identification is made on the attached
budget form for Administration, Laboratory, etc.
F. We do not anticipate personnel working less than full time in
their assigned program area, but, if such situations develop, we
will use the time record form as approved by the Public Health
Service for prior years (See sample attached as Exhibit 2).
G. Qualifications required of health personnel are reflected in for­mal
job descriptions, approved by Federal Merit System with review
by the Public Health Service Regional Office, and administered
autonomously from this department by the Arizona Merit System
Board.
H. ~o Public Health Service personnel in lieu of cash are anticipated
in fiscal year 1968 for the Public Health Services Program.
I. See Exhibit 3, attached.
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III. NARRATIVE DESCRIPTION OF PROGRAMS IN THE STATE PLAN
150 DIRECTION
Direction consists of the immediate Office of the Commissioner, including
the Deputy Commissioner for Local Health Services, which is accountable to
a five-member Board of Health for the translation of policy into proper,
effective and efficient action consistent with and responsive to State and
Federal laws in the overall management of the Department.
The Deputy Commissioner serves as Deputy to the Commissioner of Health in
all departmental affairs and acts as agent for the Commissioner of Health
in the Commissioner's absence.
The Commissioner's basic legislated responsibilities are listed under
ARS 35-136, 137. Several other specific responsibilities are determined
by the State Board of Health.
151 Overall Direction
Today, public health administration is a complex, dynamic expanding enter­prise.
Technological advances and scientific achievements through research
coupled with changing social philosophies and concepts tempered by the
practicalities of political and economic considerations at all levels
of government impose upon direction a whole host of problems, some of which
may be clearly defined, but many of which will require definitive identi­fication
if there is to be proper and effective action toward raising and
sustaining the highest possible level of personal, mental and environmental
health of all the people. This is the administration environment in which
overall direction of the State Department of Health must function. Detailed
specifications in terms of problems, objectives, action plans and evalua­tion
are reflected in the following pages of the two separate plan sub­missions,
i.e., that for public health services and that for mental health
services.
152 Local Health Services
I. Development of Local Health Departments -- Under legal mandate and
authorization of ARS 36-161 and ARS 36-183 authorizing development
of local health departments, this office will be responsive to needs
and mandates by developing local health departments under Article 3
and/or 4 of ARS Title 36.
A. Problem
Currently, Arizona has five Article 4-type local health depart­ments
with full-time medical health directors, three Article
4-type local health departments with part-time medical health
directors, five Article 3-type local health departments with
superintendents of public health and one county of over 12,700
people has no official health organization. All local health
departments need additional staff.
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B. Objectives
1. Long-term
The improvement of the health of the people of Arizona.
2. Interim
a. The establishment of an Article 4-type local health
department in every county in Arizona.
b. The employment of adequate numbers and types of well­trained
staff with full-time medical direction.
c. The provision of public health services by the local
health department for all cities and towns and the un­incorporated
area within the county.
d. The establishment of a five-member board of health in
each county by local ordinance.
e. The establishment of a public health fund in each county
which meets requirements of Article 4.
3. Short-term for Fiscal Year 1968
a. Establish an Article 3-type local health department in
Greenlee County.
b. Develop an Article 4-type local health department in
Yavapai County.
c. Establish an Article 4-type local health department in
Mohave County by local ordinance.
d. Establish an Article 4-type local health department in
Santa Cruz County by local ordinance.
e. Set up a system of county public health budget and program
plan submission.
4. Objective for State Health Department District Offices During
Fiscel Year 1968
Strengthening Tucson and Flagstaff offices by adding additional
personnel in Environmental Health.
C. Methods
1. Development of the Article 4-type local health department in
Yavapai County will be done by this office consulting with
the Yavapai County Board of Supervisors, their county medical
society, their County Attorney, the present Superintendent of
Public Health, and the Mayor and City Council of Prescott.
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2. Establishment of an Article 3-type local health department in
Greenlee County will be encouraged of the Greenlee County
Board of Supervisors. This office will provide consultation,
recommendations and contacts with the local medical society,
County Attorney, County Comptroller and Board of Supervisors
as indicated. Financial support and program consultation will
be made available to the county.
3. Establishment of Article 4-type local health departments in
Mohave and Santa Cruz Counties will be done by: developing
a model ordinance for such action at the state level. Having
same approved by the Attorney General's Office, Commissioner
of Health and State Board of Health, then presenting the model
ordinance to the respective boards of health and boards of
supervisors and provide consultation and advice on passage of
the ordinance with those groups and the County Attorney if
needed.
4. Records and Reports
a. Nursing Activity Reports
b. Sanitation Reports
c. Yearly Budget
d. Quarterly Expenditure Reports
e. Quarterly Reimbursement Request for Home Care and for
Institutional Care Tuberculosis
D. Evaluation
The accomplishment of each 1968 fiscal year goal by the end of
1968 fiscal year will be used as the criteria for complete suc­cess
in each category. Partial success will be defined as partial
accomplishment of the goals specified.
E. Collaborative and Cooperative Action
Appropriate cooperative action and support will be required as
indicated from every division and section of the Arizona State
Department of Health.
Cooperative support will also be requested from appropriate bodies
of local government, officers of local governmental units, state
medical association and local medical societies, Arizona Associa­tion
of Local Health Officers, etc.
II. Development of State-Local Relationships -- Under legislative mandate
of ARS 36-105 and ARS 36-132, the State Board of Health is responsible
for promulgation of state-wide health rules and regulations. Each
local board of health is responsible for enforcing these rules and
regulations. The State Board of Health cannot, however, limit the
right of any local board of health or county board of supervisors to
adopt such ordinances, rules and regulations as authorized by law
within its jurisdiction, provided that such ordinances do not conflict
with state law and are equal to or more restrictive than the provisions
of the regulations of the State Board of Health.
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A. Problem
Until fiscal year 1967 no official policy statement on state-local
health department relationships had ever been formalized by the
Arizona State Department of Health. No organization of local
health officers existed in Arizona and routine state-county com­munications
of a specific nature were somewhat sporadic and no
smooth system of coordination at the state level existed in re­lationship
to state staff making visits to the counties. The
responsibilities and role of local health departments in mental
health activities and comprehensive health planning has not been
clarified adequately and local requests for clarification of other
areas of responsibility at state and local level have been receive~
particularly in the area of environmental health.
B. Objectives
1. Ongoing and Long-term
a. The establishment of a smooth and effective system of ex­change
of information between state and local heelth
departments.
b. The maintenance of effective and cordial working relation­ships
between state and local departments of health.
c. In cooperation with Division of Planning, develop a com­pilation
of functions and programs which the State Depart­ment
of Health must be legally involved in. Identify
legal separation of those areas of state responsibility
from those of local responsibility.
2. Short-term for 1968 Fiscal Year
a. To have developed, a constitution and bylaws for effective
operation of the Arizona Association of Local Health
Officers.
b. To explore desirability of incorporation of the above
mentioned organization.
c. To explore the desirability of establishing a health
officer section in the Arizona Public Health Association.
d. To develop a smooth and effective method of coordinating
visits of State Department of Health personnel when visit­ing
local communities.
e. To develop a policy statement pertaining to State Depart­ment
of Health relationships with other state agencies,
with voluntary agencies and if necessary. modify the exist­ing
policy statement affecting State Department of Health
relationships with local health departments
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f. Develop a routine communication schedule between this
office and local health departments.
g. Channels for proper written communication with counties
will be clarified.
C. Methods
1. Constitution, bylaws and articles of incorporation will be
studied in conjunction with the Arizona Association of Local
Health Officers. Approval of such documents will be done by
the Association.
2. The desirability of incorporation will be encouraged of this
group by requesting the officers to make such a study and of­fering
assistance from this office. If adequate study indi­cates
a desirability, then incorporation will be encouraged;
if such a study indicates this action is unnecessary, no in­corporation
will be encouraged.
3. Members of Arizona Public Health Association and Arizona
Association of Local Health Officers will be invited to meet
with this office in exploring reasons for or against such
action. If indicated, encouragement to establish such a
section will be given.
4. The complaints of counties of disjointed state staff visits
will be studied and an improved method developed and presented
to the Department's division directors for necessary revision
and approval.
5. Relationships between the State Department of Health and other
state departments and voluntary agencies will be studied in
light of P.L. 89-749, Arizona Public Health Association policy
statements and the current state-local relationship policy
statement. Appropriate policy statements will be prepared for
board consideration.
6. The reporting systems of the local departments to the State
will be studied regarding: written reports, telephoned reports,
routine letters of information, etc. Indicated improvements,
if any, will be discussed with the division directors for ap­proval
and necessary action. This office will also develop
a manual of communication procedures for intraoffice use.
7. Reminders on channels for proper written communication with
counties will be distributed to ijivision directors and in­corporated
into this office's procedure manual.
D. Evaluation
Successful accomplishment of short-term goals for fiscal year 1968
by July 1, 1968 will be used as the criteria of complete success
in each category. Partial success will be defined as partial ac­complishment
of the goals specified.
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E. Cooperation and Collaborative Action
1. In this activity it will be necessary to have cooperation from
all division directors, all local health directors, super­intendents
of public health and chief sanitarians of counties
organized under Article 3.
2. In development of policy statements, the Mental Health, Plan­ning
and Medical Services Divisions especially will need to
be involved.
III. Development of Local Health Programs -- Under legal mandate of
ARS 36-104-4 the State Board of Health must prescribe what are recog­nized
public health activities as well as minimum standards of per­formance
in connection with the activities of local health departments
with which the State participates through grant-in~aid or other finan­cial
assistance.
A. Problem
1. The State Board of Health has never prescribed a list of
recognized public health activities and related minimum stand­ards
of performance in connection with the activities of local
health departments.
2. Several isolated standards are thought to exist in scattered
form throughout the Department but have never been compiled
and organized.
3. A study and compilation of State laws requiring certain pro­gram
activities has never been made. Further, a differentia­tion
of responsibility between State and local functions or
a clarification of shared functions has not been done.
4. Program content differs in every local health department.
Data input systems are weak, program manuals are virtually
nonexistent and no overall plan is available for carrying
out specific programs.
5. Program planning activities in several small rural health de­partments
are weak or virtually nonexistent.
B. Objectives
1. Long- term
a. Develop, in cooperation with the Division of Preventive
Medical Services, a data input system of adequate pro­portion
to utilize computergraphics in connection with
health problems.
b. Complete a compilation and study of Federal and State
health laws and indicate the legal responsibility of State
and local health departments in each case.
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c. Develop a list of recognized public health activities and
minimum standards pertaining to activities of local health
departments.
2. Short-term to be completed during 1968 Fiscal Year
a. Compile and undertake a review of recognized public health
programs and minimum standards affecting local health de­partments
prescribed by other states.
b. Develop, in draft form, a list of programs being partici-pated
in by the State Department of Health which ..
have significant impact on local health departments.
c. Develop, in draft form, a list of programs with appropriate
narratives of each, being conducted at the local level.
d. With the assistance and consultation of all division direc­tors
complete and compile and initial review of all pro­grams
being conducted by all county health departments in
Arizona.
e. Compile a complete annual report from all counties for
1966 calendar year and complete an initial review of the
report in light of a proposed plan for 1967-1968 fiscal
y.ear.
f. Require a local health department program plan and budget
from every county for the 1967-1968 fiscal year and com­plete
review of each with each division director to deter­mine
areas of greatest need for consultation to the coun­ties
for the coming fiscal year.
C. Methods
1. 2-a. will be accomplished by sending an appropriate pretested
questionnaire to the State person responsible for local health
services, by compiling them into an easily accessible sequence
and by perusing the information received.
2. 2-b. will be accomplished in cooperation with and consultation
from the Division of Planning and "Technical Support using in­formation
submitted by all division directors in program plan­ning
for the 1967-1968 fiscal year budget.
3. 2-c. will be accomplished in cooperation with every county
health director in Arizona. Requests will be sent for each
county to submit a program plan and budget for the 1967-1968
fiscal y.ear. Part of each county plan will include a roster
of local programs and an appropriate descriptive narrative
of each.
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4. 2-d. will be accomplished by routing the compilation of county
budgets to each division and discussing same with each divi­sion
director.
5. 2-e. will be compiled by the secretary in this office. Re­view
of the reports and comparison with previous years will
be done by the Deputy Commissioner. Consultation with coun­ties
will then follow and include appropriate discussion of
activities as they compare with plans, etc.
6. See 3, 4 and 5 above.
D. Evaluation
The accomplishment of each 1968 fiscal year goal by the end of
the 1968 fiscal year will be used as the criteria for complete
success in each category. Partial success will be defined as
partial accomplishment of the goals specified.
E. Cooperative and Collaborative Activities
Throughout this activity, a great deal of coordination and close
cooperation will be necessary between this office, the Arizona
Association of Local Health Officers, the State Commissioner of
Health, the various division directors of the State Department of
Health and individual local health officers. Frequent guidance
from the State Board of Health and Commissioner of Health must
be received in preparation of material required by law which is
in the best interest of the public, and acceptable to those pro­viding
and coordinating the services.
IV. Development of Minimum Standards of Performance in Connection with the
Activities of Local Health Departments --Under legal mandate of
ARS 36-104-4 the State Board of Health must prescribe recognized pub­lic
health activities and minimum standards of performance in connec­tion
with the activities of local health departments receiving finan­cial
assistance from the State.
A. Problem
1. The State Board of Health has never prescribed a comprehensive
set of minimum standards of performance in connection with the
activities of local health departments, nor is there a defined
measuring or grading mechanism in use by which to determine if
the minimum standards are being met even if such existed.
2. Three general sizes of county health departments are in exis­tence
in Arizona at the present time. Two different types
also exist which are established under different laws. A
single set of minimum standards would probably not be appro­priate
for all sizes and types because of the significant
differences between them.
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3. The three general sizes and two different types of county
health departments in Arizona are:
a. Relatively sophisticated, large and capable departments
organized under ARS 36-182, Article 4, which serve metro­politan
populations (e.g., Pima and Maricopa).
b. Developing county health departments of intermediate capa­bility
which are also organized under ARS 36-182, Article
4 (e.g., Mohave, Pinal, Cochise, Santa Cruz, Yuma and
Coconino).
c. Rural county health departments with very limited staff
and resources which are organized under ARS 36-161,
Article 3 (e.g., Gila, Graham, Greenlee, Apache, Navajo
and Yavapai).
B. Objectives
1. Long-term
a. Develop standards for programs conducted in local health
departments.
b. Upgrade all local health departments to at least the level
of compliance with such minimum standards.
2. Short-term
a. Request support and obtain cooperation from: The Arizona
Association of Local Health Officers, Arizona Public Health
Association, Arizona Sanitarians' Association, Arizona
State University College of Nursing and other related
groups, in consulting with this Department in the develop­ment
and future acceptance and support of said standards
of performance.
b. Organize committees of appropriate State Department of
Health and other public health personnel to collect refer­ences,
peruse the literature and draft modern standards
pertaining to local health activities for presentation to
this office.
C. Methods
1. Discuss overall activity with division directors of the Depart­ment
and receive their recommendations. Appropriate individuals
and groups will be contacted by personal contact and letter
from this office to request their assistance in this activity.
2. Appropriate ad hoc study committees will be established, their
responsibility designated and request made of them to establish
a time schedule for completion of their own committees' work.
One or more State Department of Health staff will be assigned
as liaison to the committees and to serve as secretary of the
committees.
- 9 -
3. Staff work of the committees will be done through the State
Department of Health representatives in cooperation with ap­propriate
division staff.
4. When recommended standards are submitted, they will be for­warded
to this office for further deliberation and if recom­mended
for approval, will be forwarded to the Commissioner
for Board of Health study and action. If further study is
indicated, the ad hoc committees will be requested to further
study and clarify any question which remains uncertain.
D. Evaluation
1. The criteria of success for this activity will be:
a. The participation of key groups in developing appropriate
standards.
b. The development of appropriate standards during 1967-1968
fiscal year.
E. Cooperating Groups and Collaborating Agencies
The successful outcome of this activity depends heavily upon
cooperation of at least the following groups (and preferably
others):
Division Directors and staff - Arizona State Department of Health
Arizona Public Health Association
Arizona State College of Nursing
Arizona Association of Local Health Officers
Specific individuals from local health departments
Others
V. Development of State-Local Health Department Funding Mechanisms -­Under
legal mandate and authorization of ARS 36-187 B, the local
health departments organized under ARS Title 36, Chapter 1, Article 4
(36-181 through 36-191) shall have a health department fund to which
shall be credited any appropriated city, county, state or federal
funds, or other grants or donations for local health purposes.
A. Problem
Arizona has eight local health departments with five-member boards
of health and full or part-time medical directors. Minutes re­cording
action by local boards of supervisors or local ordinances
creating such local health departments are not on file with the
State Department of Health. Thus documentation of the creation
of local health departments under Article 4 is not on file with
this department. Only two of the eight local health departments
are known to have had a public health fund established. The
status of the other six is questionable.
- 10 -
B.Objectives
1. Determine when each of the eight county health departments
organized under ARS Title 36, Chapter 1, Article 4 was
organized and receive documentation from authorized sources
concerning such action.
2. Have county treasurer establish a public health fund in each
county that has a local health department established under
this law.
C. Methods
1. Ascertain by written inquiry to each county clerk the date
of organization of local health department under Article 4
and request a copy of minutes of Board of Supervisors' action,
or copy of ordinance if one was passed.
2. Collate responses to serve as index for future consultation.
3. In those counties where such a department was organized,
determine the existence of a public health fund by sending
a representative of the State Department of Health to confer
with the county on the subject. Where no public health fund
exists, assist with the establishment of such.
D. Evaluation
1. The ascertainment of organization dates of Local Health
Departments (organized under Article 4) and receipt of
minutes documenting same by September 30, 1967 will be con­sidered
as the criteria for complete success for this objective.
2. Establishment of local public health funds in one third of
those counties which have an organized health department will
be considered as criteria for success this fiscal year. This
office will endeavor to have established these funds in all
counties with organized health departments within three years.
E. Cooperating Groups
Success of this activity will depend upon the cooperation of the
State Department of Health Division of Administration, local
boards of supervisors, local boards of health, local health
directors, and local clerks of the boards of supervisors in each
county where an "Article 4-type" health department exists and in
which no public health fund has yet been put into effect.
VI. Development of Local Health Department Facilities -- Local boards
of health have the opportunity to spearhead activities leading to
provision of suitable offices, facilities and equipment for local
health departments organized under ARS Title 36, Chapter 1, Article 4.
All but three of the 14 counties in Arizona are eligible to receive
- 11 -
up to 51% of Federal funds providing the costs
equipment through Hill-Harris funds. The same
an "A priority" under Hill-Harris legislation.
health departments have auxiliary centers.
of construction and
eleven counties have
Several local
"A Public Health Center is a publicly owned facility, utilized by
a local health unit for the provision of public health services,
including related publicly owned facilities such as laboratories,
clinics and administrative offices operated in connection with
public health centers."
In Arizona, a local full-time public health service means a ful1­time
service utilizing local, state, Federal and other funds, or
any combination thereof, employing qualified personnel working
under the direction and supervision of a qualified director ap­pointed
by the local health department and conducted in conformity
with the rules, regulations and policies of the State Department
of Health. If the population of the county is 100,000 or more,
based on the last official U. S. Census, the director shell be a
fu11- time M. D.
These local health units provide public health services through
organized community effort providing services in six basic areas,
and" through several other programs. The six basic functions are;
1. Communicable Disease Control
2. Public Health Laboratory
3. Health Education
4. Environmental Sanitation
5. Vital Statistics
6. Maternal and Child Health
In analyzing Arizona's status concerning public health centers,
at least four steps are involved;
1. What do we have?
2. What do we need?
3. Where do we need it?
4. Who will pay for it?
If we look at Arizona today in the light of these four basic
questions, we can readily see what we have. We have seven exist­ing
Public Health Centers of which four are nonconforming as to
physical structure.
The picture as related to Auxiliary Public Health Centers is more
critical. Of 20 existing facilities, 19 are nonconforming as to
physical structure.
If the facility endangers public safety because of the physical
condition of the building or similar criteria as developed by the
Public Health Service plant evaluation standards it is classed
- 12 -
as nonconforming. This is no reflection on the quality of service
being delivered. It is a direct reflection on the 1) fire resis­tivity
of each building, 2) fire and other safety factors of each
building, and 3) design and structural factors affecting the
function of the center.
Of the 27 Public Healtp Centers or Auxiliaries, 13 share quarters
with some other organization. Three are in basements of court­houses,
one located in the courthouse hall, three located on the
second floor of old high schools, one in a community center build­ing,
three in city halls, two in old buildings adjacent to court­houses.
Needless to say these facilities are nonconforming.
Nine of the 20 Auxiliaries are programmed for modernization. In
light of proposal for state-wide plan, reevaluation is needed
here. This means a total of ten will be conforming in the future.
Of the seven Public Health Centers, four are programmed for modern­ization
and then it is assumed all seven Public Health Centers will
be conforming. Reevaluation is indicated. Seven new Public Health
Centers are programmed for the future. From the inventory sheet
we can also see that two new Public Health Centers are under actual
construction in Coconino and Pima Counties.
Actually the Public Health Center in Coconino County has been
substantially completed. The one in Pima County is about 20%
complete.
Utilizing the 1967 State Plan we can see we need seven additional
Public Health Centers and a redistribution of Auxiliaries. All
of these facilities are currently programmed. Now it is a matter
of time, money, and establishing priorities.
Apache, Gila, Graham, Mohave, Navajo, and Santa Cruz Counties are
in need of Public Health Centers. If all seven of these health
centers could be funded they would only serve some 9.8% of the
total state population. Since all seven can't be funded at the
same time some priority system will have to be established.
There were a total of 1,101 projects completed in the United
States between 1947 and 1966. Of this total, only 100 were
additions or alterations. The remaining 1,001 were new construc­tion
projects. Of this total of 1,001 new projects completed in
the last 20 years Arizona had three Public Health Centers completed.
This represents only .3% of total new projects. The 1,101 projects
totaled $209,680,000.~rizona'sportion represented $3,059,000
or 1.87% of the total.
There has been some talk of new Public Health Centers being pro­moted
in Bisbee, Douglas, Yuma, and Holbrook. There is still
talk and interest in developing new Public Health Centers in
Douglas and Yuma but very little progress has been made beyond
that stage. Holbrook is expected to submit their proposal for a
new Public Health Center before the end of the year.
- 13 -
In view of P. L. 89-749 it would be most desirable to have a
public health representative on the Advisory Council. Justifi­cation
is cited from Part 23-2, B., 2, Public Health Service
Heal th Grants Manual which reads, "Membership shall be drawn
from each of the following categories: Representatives of public
agencies concerned with the operation, construction, or utiliza­tion
of hospitals or other facilities for diagnosis, prevention,
or treatment of illness or disease, or for provision of rehabili­tation
services."
B. Objectives
1. Long-term
Develop adequate and appropriate facilities for each local
health department in Arizona.
2. Short-term
a. Increase the Advisory Survey and Construction Council
membership by two people who represent public he~lth
centers; one of these to be a representative from Arizona
Association of Local Health Officers, the other to be a
public health consumer.
b. Revise the state-wide plan for construction and moderni­zation
of local public health centers and include it as
a separate section in the 1967-1968 state plan for hospital
and facilities construction.
c. Develop at least one construction project for a local
health department during 1967-1968 fiscal year.
C. Methods
Request the State Commissioner of Health to:
1. Move favorably on the recommendation of the Advisory Survey
and Construction Council that the council be increased by
two members.
2. Request to Commissioner to refer the Council's recommendations
to the Governor along with a recommended list of appropriate
names from which the appointment could be made.
3. Set up a meeting with these two appointees, with Doctor
Spendlove and appropriate Medical Services Division staff to
orient them regarding their function and the past history
of the council's activities, purposes and procedures.
4. In collaboration Yith the Arizona Association of Local Health
Officers and the State Division of Medical Services, re­evaluate
the State Plan for construction of public health
centers -- especially in the areas of modernization.
- 14 -
5. Through written and telephone communication with County Boards
of Health and County Boards of Supervisors, inform them of the
availability of Hill-Harris funds and the procedure involved
in obtaining these funds.
6. Encourage development of Navajo County construction of new
health department facilities with Hill-Harris funds.
D. Evaluation
1. Criteria for success of B-2-a. above will be the appointment
of two people on the council during the 1967-1968 fiscal year.
2. The criteria for success of B-2-b. above will be completion
of revision of State Plan.
3. The criteria for success of B-2-c. above will be the filing
with this department of at least first phase plans for con­struction
of local health center in Navajo County.
E. Collaboration and Cooperative Activities
1. To accomplish B-2-a. above will require cooperation of the
State Health Commissioner, State Advisory Survey and Con­struction
Council, State Division of Medical Services, the
Arizona Association of Local Health Officers and the Governor
of the State.
2. The accomplishment of B-2-b. above depends upon close coopera­tion
of the State Division of Medical Services and every local
health department in the State.
3. The successful achievement of B-2-c. above depends upon the
cooperation of Navajo County Board of Supervisors, Board of
Health and Director, State Department of Health Division of
Medical Services and its counterpart consultant in the Regional
Office of the U. S. Public Health Service.
VII. Provision of Administrative and Program Coordination and Support to
Counties -- Under mandate of ARS 36-104-4, 36-132-2, 6, 7, 8, 9, 10,
15, and others, the State Department of Health has the responsibility
and authority to assist counties and coordinate many local health
programs and activities.
A. Problem
Several attempts have been made to coordinate the activities of
the various State Department of Health divisions in their corres­pondence
and field visits to the counties. No single system or
set of systems has been successful to date.
- 15 -
B. Objectives
1. Long-term
Develop an effective efficient and inexpensive coordinating
system within the State Department of Health pertaining to
all types of communication with local health departments.
2. Short-term
a. Develop and document appropriate lines of official com­munication
with local health departments in regard to:
1) Use of telephone
2) Written correspondence
3) Personal field visits by state staff
b. Develop and document appropriate lines of official com­munication
from counties with regard to the State Depart­ment
of Health.
C. Methods
1. By discussion with state division directors and local health
officers.
2. By consultation with telephone personnel and state building
director.
3. By consultation with communication consultants and regional
office consultants (as necessary).
D. Evaluation
Criteria for success will be the development of two effective
systems of communication: one within the Department as pertains
to local health departments; the other, between the state and local
health departments.
E. Cooperating Groups and Agencies
All local health officers, all state division directors, key
State Department of Health secretaries and various consultants
will be involved in this activity.
153 Health Mobilization
I. Training Programs
A. Medical Self-Help
At present 40)000 individuals have completed Medical Self-Help
Training. Expect to train 15,000 persons during fiscal year 1968.
- 16 -
Procedures -- The Medical Self-Help Training Course will be ex­panded
from the present 50 schools participating to 75 schools
participating for fiscal year 1968. Even with this anticipated
increase in schools participating the total number of students
trained will be reduced due to the fact that the larger high
schools presently involved will be presenting the course mainly
to freshman students rather than to the entire student body, as
has occurred this past year.
It is anticipated that adult training will be more than doubled
during fiscal year 1968 and should produce approximately 2,000
graduates. This will be accomplished through improved community
organization. Also, efforts will be directed toward Medical Self­Help
Training for industrial employees.
Financial Cost -- The program is 100% Federally financed by a
fixed priced contract.
B. Community Hospital Disaster Drills
Approximately one-third of the hospitals in Arizona are presently
holding one or more disaster drills per year. During fiscal year
1968 expect to maintain the present status.
Procedures,-- By working in close cooperation with the Arizona
Hospital Association and the State Medical Association and other
agencies it is expected that the present level of cooperation and
participation can be maintained.
Financial Cost -- No financial cost involved other than travel
expenses.
C. Health Mobilization and Disaster Preparedness Symposiums
Expect to hold at least two symposiums at county or district level
during the year.
Procedures -- This will be accomplished by working in close co­operation
with the professional health disciplines in their re­spective
districts or counties.
Financial Costs -- Costs other than travel expenses may be borne
by State Civil Defense or the University of Arizona, Division of
Continuing Education.
II. Medical Stockpiling -- At present 18 Packaged Disaster Hospitals in
the State, not necessarily affiliated with an ongoing facility.
Expect to affiliate approximately 10 Packaged Disaster Hospitals
and Hospital Reserve Disaster Inventory Units with ongoing facilities
during 1968.
- 17 -
Procedures -- With the advice of State professional associations this
will be accomplished by working directly with county health departments,
county civil defense directors, and the respective health facility to
which the unit will become affiliated.
Financial Cost One hundred percent Federally financed excluding
travel expenses.
III. Emergency Health Service Planning -- At present State Emergency Health
Service Plan completed and one satisfactory County Plan completed.
Expect to review and update State Plan and develop three County
Emergency Plans during fiscal year 1968.
Procedures -- This will be accomplished by providing guidance and
assistance to those counties involved. In particular, working with
county health departments, local medical societies and local civil
defense agencies.
Financial Costs -- No financial cost involved other than travel ex­penses.
154 Accident Prevention
Under mandate of ARS 36-132-1, the State Department of Health is to protect
the health of the people of the State. One of the greatest modern menaces
to life and limb is accidents. Accidents which can be prevented should be
prevented.
A. Problem
At the present time the Arizona State Department of Health has no
accident prevention staff, no accident prevention funds and hence
no accident prevention program.
B. Objective
1. Long-term - .. Develop an efficient program of accident preven­tion
in, the State Department of Health.
2. Short-term
a. Obtain a U. S. Public Health Service assignee for place­ment
with the State Department of Health.
b. Explore grant funds from whatever appropriate sources to
begin activities in health aspects of a state-wide ac­cident
prevention program.
c. Develop the beginnings of administrative procedures in­volved
with the proposed highway safety standards and
their effect on the State Department of Health.
- 18 -
d. Organize an intra-departmental safety committee.
(Tuberculosis Sanatorium has such a committee
functioning).
e. Begin the medical coordination activities of a state­wide
study on passenger deaths and injuries occurring
on Arizona's State highways.
C. Methods
1. Correspondence will be undertaken with U. S. Public Health
Service for placement of a person in Arizona to explore
currently operating accident prevention activities, determine
available resources and conduct studies in order to compile
appropriate county profiles.
2. When county profiles are developed, needs and resources docu­mented
and authority groups and individuals identified, a
demonstration grant project will be written up in such a way
as to request appropriate funds from appropriate sources to
provide for demonstration of the effectiveness of a proposed
program developed to meet demonstrated needs -- including,
but not limited to State Department of Health participation
in activities related to the proposed highway safety standards.
3. Discuss organization of safety committee with division direc­tors
and get approval of establishing same. Rotate membership
on the committee and obtain staff services on the committee
from those other than division directors.
4. Activities to accomplish B-2-e above can begin by starting a
cooperative research effort with the following agencies or
groups:
a' Cornell University )
b. Arizona Highway Patrol )
c. Arizona Medical Association)
d. Arizona Hospital Association)
D. Evaluation
All have approved
participation in
this activity.
1. The criteria for complete success will be the satisfactory
achievement of all goals specified.
2. The criteria for partial success will be the achievement of
less than all goals specified within the 1967-1968 fiscal year.
- 19 -
155 Residency Program in Preventive Medicine -- Under the provisions of the
Public Health Traineeship Program (Section 306, Public Health Service Act),
traineeship grants are available for complete funding of three year resi­dency
programs leading to certification in Preventive Medicine. Such sup­port
will be provided to institutions or agencies offering approved residency
2rograms through grants for support of specific individuals.
A. Problem
At the present time the Arizona State Department of Health has no
approved residency program. Physicians assigned to the Department
receive no formal residency credit although they receive signifi­cant
training. Establishment of an approved training program would
assure such credit.
B. Objective
1. To obtain approval for and institute a rotating three-year
residency program to include one year of experience in a
qualified county health department, one year in study at a
school of Public Health leading to a Master of Public Health
Degree, and a third year of assignment to a specific division
of the State Department of Health.
2. To obtain approval of a five-year program to permit enrollment
of successive trainees for the three-year residency.
C. Methods
1. Develop a program for approval by the Council on Medical
Education and the American Board of Preventive Medicine.
2. Arrange for cooperation of qualified county health departments.
3. Arrange for admission to candidacy for the M.P.H. degree.
4. Select qualified candidates.
5. Apply for Residency grants for qualified candidates.
- 20 -
160 ADMINISTRATION
To provide an adequate and innovative administrative structure which will
enable the Commissioner to translate Board of Health policy into proper,
effective and efficient action.
161 Fiscal
A. Problems
1. To ensure that funds available to the Department are spent in
conformity to the conditions under which they were granted to
the Department. These conditions vary from State appropriation
riders to Federal project and formula terms, guidelines, and
standards. Expenditure record requirements vary from one
funding source to the next in terms of scope and detail for
audit, and all must fit within the framework of applicable,
and not always harmonious State and Federal statutes.
2. To develop tools (contracts, agreements, disbursement pro­cedures,
pre-audit procedures, etc.) by means of which
subventees (local health departments) may more readily and
flexibly obtain and expend subvented funds for approved
purposes.
3. To ensure maximum return on money expended in areas under
Fiscal Section control i.e., choice as to vendors of supplies
and materials, etc.
4. To ensure an adequate level of General Services (negotiation
of rental contracts, moving, telephone installations,
duplicating services, etc.).
5. To provide staff support for development of fiscal year 1969
appropriations request in a Program Budget format.
B. Objective~
1. To achieve comprehension of, and competence in the execution
of, Federal guidelines for the five kinds of funding sources
under P.L. 89-749, the revised conditions of the Federal
C.B. funds, and the specialized usage of State air and water
pollution control funds.
2. To review and revise present formats for agreements and/or
contracts under which primary and secondary subventions are
made.
3. To develop standard written specifications on items represent­ing
at least 25% of our total expenditures for supplies and
materials.
4. To establish a satellite mail supply and reproduction facility
in the Goodrich Building having the capability of handling all
General Services demands other than multilith printing.
- 21 -
5. To develop standard costing factors which can be applied to
each element identified in the fiscal 1969 program budget
request.
C. Methods
1. In-service training: distribution of Federal guidelines and
regulations; divisional discussions; seminars; supervisory
review and correction of work performed.
2. Discussions with subventees, legal counsel, departmental
program heads, etc., leading to contract drafts to be
reviewed and adopted.
3. Discussions with other purchasing agents, including the
central purchasing office of the State, analyses of existing
comparable written specifications, etc.
4. Identification and utilization of suitable space; recruitment,
training, and assignment of a stock and mail clerk.
5. Analyses of actual Departmental experience records to date on
average support costs per employee by category and function.
D. Evaluation
1. Absence of Federal and/or State audit exceptions.
Timely and accurate "status of funds" reports to Commissioner,
division directors, etc.
2. Initiation, review, and approval of formal subvention
contracts completed in less than 10 working days.
Absence of audit and/or program exceptions taken to expend­itures
made by subventees.
3. Twenty-five percent (or more) of category 200 and 300
expenditures made under written specifications.
4. Survey of units served to determine adequacy and quality of
services provided by satellite station.
5. Production and validation of documentable standard cost factors
in time to comply with 1969 budget submittal due date of
September 1, 1968.
162 Personnel
A. Problems
1. Incompleteness of effective personnel regulations for both
state and county health departments.
- 22 -
2. Incompleteness of an effective performance evaluation
system at both state and county levels.
3. Lack of thoroughly systematic salary administration at state
level, and inadequate salary structure at county levels.
4. Need to improve preparation and maintenance of job
specifications.
5. Need to reduce the number of merit system exceptions taken
against the state and county health departments.
6. Need to develop improved procedures for general personnel
administration at state and county levels.
B. Objective~
1. To publish a document that conveys to all employees the
basic merit system personnel regulations, the associated
state level internal regulations and to ensure that county
health departments either adopt state internal regulations or
publish formally in a specified manner applicable local
regulations.
2. To improve the existing performance evaluation system by
inclusion of specific instructions to supervisors concerning
methods for removal of unsatisfactory employees and by
shortening from 90 to 30 days the time in which a supervisor
may act constructively.
3. To develop a regular input of salary data from IffiW, local
and national SOilrces for greater lead time purposes in
studying aud making recommendations as they pertain to cost
of living index increases or significant changes in various
disciplines.
4. To rewrite all job specifications in order to include current
studies concerning titles, minimum qual:i.fications, regional
critique items and other corrections criginating in the
personnel office; to give increased emphasis to preparation
of new job specifications by more detailed work analysis and
other preliminaries such as job descriptions and extension of
coordinative actions with merit system personnel analysts.
5. To establish direct activity and feedback between the merit
system and the county health departments and the Tuberculosis
Sanatorium on recruiting and certification matters while
requiring state review of all personnel actions from the
counties and the Tuberculosis Sanatorium as a check point for
reducing potential exceptions; to visit and sample personnel
recorda at counties and Tuberculosis Sanatorium in order to
ascertain adequacy of record keeping on all subjects covered
by merit system regulations.
- 23 -
6. To train administrative personnel at state and to
provide training to local administrative personnel; to work
with regional continuing education or state training officer
in order to bring administrative training to state and
county professionals for improvement of their administrative
techniques and management of employees; to develop guides
for county use in improving their development of compensation
plans and to offer close liaison with merit system in solution
of difficult personnel problems at county level.
c. Methods
1. Personnel Regulations
a. In the light of experience to date, to revise and expand
the Personnel Manuals for Board approval.
b. Distribute copies of revised manual to counties for
specific action. This requires state personnel office
to make consultative and staff supervisory visits to
all necessary locations.
2. Performance Evaluation System
a. To conduct in-service training to ensure compliance with
all pertinent instructions concerning content and rules
pertaining to methods of marking, typing and processing
time; to identify and correct inaction or failure to
use system for elimination of unsatisfactory employees;
to provide increased motivation for supervisor develop­ment
of employee and self-development by employees.
b. By on-site visits, to encourage the establishment of
complete performance evaluation systems at each county
health department and document staff supervisory visits
for sampling and follow-up consultation.
3. Salary Administration
a. Develop regular input of salary data and extensive,
accurate salary survey data response as a service and
make timely reports concerning any potential upgrading
requirements for new budget preparation or execution of
the appropriations.
b. Documented staff supervisory visits should indicate
action taken to promote or encourage local salary surveys
in order to keep a current and continuous impetus at
local levels to improve salary administration.
4. Job Specifications
a. To establish a systematic schedule whereby each job
description is reviewed at least once annually. For
- 24 -
fiscal 1968, this review will be performed with particular
emphasis on academic minimum qualifications.
b. Revised or new specifications should be supported by
written record that all practical coordination has
occurred prior to publication and installation.
5. Personnel Records
a. At state level, there should be available a quick digest
summary on the academic and experience qualifications of
each employee and personnel actions that have occurred
during employment including a running index of performance
efficiency.
b~; There should be a record of staff supervisory visits to
counties to sample and advise concerning the adequacy
of personnel record keeping in the county.
6. General Personnel Administration
a. Each new clerical employee should have a record showing
the amount of training received prior to assuming actual
duties in assigned office.
b. County submittal of budget proposals should reflect
continuing progress toward standardization of classifi­cation
schedules and use of salary ranges with decreasing
amount of errors in administration of reclassification,
salary advancement and promotions.
c. There should be a measurable tendency of county health
departments to rely less and less on State for oral
instructions or liaison with merit system concerning
routine preparation and handling of personnel actions.
D. Evaluation
1. Personnel Regulations
a., Revision of Personnel Manual completed through Board
approval stage and officially established by
October 1, 1967.
b. All counties should be on record as officially adopting
the revised Personnel Manual, with such exceptions as
they choose to make, by June 30, 1968.
2. Performance Evaluation System
a. Plotting of all performance evaluations made during the
year should produce a curve within two standard
deviations of a normal (bill curve) pattern.
- 25 -
b. All counties should be able to document at least one
formal performance evaluation made on each employee
during the year.
3. Salary Administration
a. Ability to document that salary recommendations are
within 5% of prevailing competitive ratio, local or
national.
b. Since counties vary in economic circumstance and fiscal
resources, it will be difficult to get the counties to
do the kind of leg work that may be necessary and,
necessarily by them. Ability to document that we have
offered discussion, guidance and persuasion will probably
be our only criteria here.
4. Administration of Job Specifications
a. Ability to document review of each job description
during the year.
b. Ability to demonstrate that counties have been required
to participate actively in preparation of specifications
that are primarily applicable to them.
5. Administration of Personnel Records
Reduction of Merit System payroll audit exceptions below
preceding year's level.
6. General Personnel Administration
Analysis and evaluation by Deputy Commissioner for local
health services.
GENERAL NOTE
No distinction has been made in the material above between the Department and
the Tuberculosis Sanatorium. It is assumed that, as a component of the Depart­ment,
the Sanatorium is subject to Departmental fiscal and personnel procedures.
While not necessarily identifiable by primary points of focus, a considerable
investment in time and effort is planned for fiscal 1968 in the continuing
attempt to help the Sanatorium administration apply Departmental policies.
- 26 -
170 PLANNING AND TECHNICAL SUPPORT
171 Planning
I. Departmental System for Program Planning and Budgeting
A. Problem
There exists within the Department deficiencies in all areas of
program planning and budgeting o Program budgeting is a new and
only partially understood concept.
B.. Objectiv.£.!
1. Identifiable and measureable improvements in overall program
management.
2. Development of the Department's formal budget requests on a
program basis.
3. Preparation of plans designed to obtain the block grant for
health services under Section 314(d) of Public Law 89-749.
C. Methods
1. Cooperate with the Division of Administration to develop and
refine guidelines for use of the Department in preparing work
programs with realistic objectives subject to progress
evaluation ..
2. Assist Departmental personnel in documenting program plans
in standard and comprehensive format.
3~ Consolidate all Division programs to complete the Departmental
budget for submission to the Legislature and for use in
obtaining the block grant under Public Law 89-749.
4. Provide consultative assistance, on request, to county health
departments and other public and non-profit organizations,
throughout Arizona in development of program, budget and
project requests to complete the State Comprehensive Health
Plan.
D.. Evaluation
This program is continuous and evolutionary and can be evaluated
by progress toward a uniform, comprehensive and creditable plan
for reaching definitive health objectives, program-orientedo
- 27 -
II. Organization for Comprehensive Health Planning
A. Problem
The impending implementation of Public Law 89-749 will require
extensive organization, both internal and external to the Health
Department, to provide an effective and integrated vehicle for
state-wide comprehensive health planning. The exact nature,
responsibilities and interrelationships within these organiza­tional
patterns must await final designation of a single State
agency.
Deficiencies exist in such organization at all levels to respond
to the newly-developing requirements of comprehensive health
planning. A primary function of this Section during fiscal year
1968, and beyond, will be to assist and advise the Commissioner
and the Board of Health in developing and implementing the
Department's responsibilities in organizing for health planning.
B. Objectives
1. To establish, or to assist in the establishment of organiza��tional
groups for planning at State and community levels as
required by Public Law 89-749.
2. To establish, or to assist in the establishment of such other
organizational groups, not required by Public Law 89-749, as
may be necessary to implement comprehensive health planning
in Arizona.
3. To provide leadership and information necessary to assist
these organizations in carrying out their missions.
C. Method,!
1. Assist in the organization and orientation of the Governor's
Health Advisory Council required by Section 3l4(a) (2) (B)
of the Public Health Service Act as amended by Public Law
89-749. At least during the formative stages, a member of
the Division staff may serve as Executive Secretary to the
Councilor may provide staff support to the Executive Secre­tary.
2. Assist in the formation and orientation of an Inter-Agency
Committee for Coordination Planning consisting of represen­tatives
of all State and Federal agencies having legally
vested responsibilities in the provision, supervision or
financing of health services and health oriented programs
in Arizona.
3. Assist in the formation, orientation and operation of an
interdivisional permanent committee within the State De­partment
of Health to advise and assist the Commissioner
in developing and implementing the Department's responsi­bilities
in health planning.
- 28 -
4. Assist and encourage county health officers to assume
leadership in community health planning and action. By
definition, comprehensive health planning must be com­munity-
based.
5. Creation of an information service to collect, analyze and
digest data, directives and resource material from all
available sources and to make this information available to
all health planning organizations.
6. Develop departmental technical support proficiencies to sup­ply
consultative services to all health planning organizations
in Arizona. Such services will include orientation to health
planning, organizational assistance, instruction in basic
planning techniques, assessment of problem areas, identifica­tion
of resources, objectives and deficiencies and planning
to overcome deficiencies, including the determination of pri­orities.
In addition to individual expert consultation,
formal and informal training courses will be developed as
necessary.
D. Evaluation
The effectiveness and efficiency of organization and technical
support activities will be measured by progress made during the
year to obtain effective organization for informed health plan­ning.
The ultimate evaluation criterion will be the degree of
excellence developed in the Arizona Comprehensive Health Plan.
172 Management Advisory Services
A. Problem
The scope and operation of the State Department of Health depends
on the authority and responsibility granted or delegated to it
by State law. The effective and efficient operation of the
Department within its authorized sphere, in turn, depends to a
large extent upon the adequacy, propriety, and clarity of the
departmental rules and regulations~ Similarly, the effective and
efficient operation of the Department requires that managerial
personnel within the Department and within the several local
health departments have knowledge of and understanding of the
statutes, regulations, policies, and procedures which affect their
respective programs; it requires, also, the proper implementation
of new or revised programs and the prompt identification and
resolution of deficiencies or suspected deficiencies in the day
to day operation of the Department.
The problem to which this program is directed is to identify and
minimize or eliminate the legal and administrative deficiencies
encountered or anticipated in the operation of the Department.
- 29 -
B. Opjectives
The program objectives are as follows:
1 0 To assist personnel in the Department and in local (county)
health departments to identify and resolve legal implica­tions
and administrative problems encountered or anticipated
in the operation of the Department.
2. To draft, review or assist in the drafting or review of pro­posed
legislation to be supported by the Department during
the forthcoming legislative session.
3. To assist in preparing or reviewing contracts to which the
Department is to be a party.
4. To effect liaison between the Department and the Office of
the Attorney General and, when requested, to assist his office
to resolve problems having public health implications.
5. To analyze, and where needed, to recommend changes and draft
revisions of the rules and regulations of the Department.
6. To assist in the identification of grant resources available
to carry out the activities of the Department and to assist
in the preparation of grant applications.
c. M~thods
This activity is conducted by oral and written response to requests
for assistance and to observations of legal misconceptions of,
or administrative deficiencies in, program operations e Analytical,
investigative and research techniques are utilized as may be
required to best resolve or accomplish the matter under consid­eration.
D. Evaluation
The progress of this program toward meeting its objectives will
be evaluated on a short term basis by assessing the backlog of
assignments in terms of the estimated hours or days for comple­tion
and in terms of the priority of the matters involved. On a
long term basis the program can be evaluated by observing the
measurable benefits to the Department and to the local health
departments in terms of decreasing the legal and administrative
deficiencies encountered in their operationso
173 Health Education and Information Services
The purpose of this activity is to gain better understanding, support,
cooperation and responsible participation by the general public and a
variety of special publics, in launching and carrying out public health
programs.
- 30 -
A. Problem
The philosophy, value and need for public health programs and
services are not adequately or uniformly well understood. This
office will provide the supportive educational-informational ser­vices
needed in the various programs.
B. Objectives
1. Plan, develop and implement educational-informational programs
for specific Department projects and activities.
20 Plan, develop and publish Department publications.
3. Publish Arizona's Health, official bi-monthly publication of
the Department.
4. Supervise the Department's film library.
5. Provide direct service to the press and other communication
media.
6. Provide writing and editorial assistance to Department staff.
7. Develop exhibit materials.
8. Identify and meet unmet problems.
c. Methods
1. These activities--planning, developing and implementing edu­cational-
informational programs--will be carried out by asses­sing
the scope and nature of the problem with the involved
Department staff, reviewing the project's basic objective,
and then mapping and carrying out a health education and
informational support program tailored to accomplish the ob­jective.
This office will develop brochures, speeches, radio��TV
spots, news releases and other materials designed to pro­mote
public understanding, support, cooperation and responsible
involvement.
2. Department publications will be planned, written and published
in cooperation with interested staff. Generally, each publi­cation
will be produced as one of a number of supportive
actions to promote a new or existing specific program or
activity.
3. The year 1967-68 begins the second year of publication for
Arizona's Health. Improvements will be made by assessing the
effectiveness of the first six issues. Future issues will be
aimed at subject areas needing most attention. Present for­mat
will be evaluated to determine improvements if needed.
- 31 -
4. Supervision of the Department's film library will include the
preparation and publication of an updated film catalogue.
Existing films will be reviewed and, subject to fiscal limi­tations,
additions will be made and obsolete films taken out
of circulation.
5. Direct service to the press and other communications media
is provided mainly through the production of news releases
distributed to all media; and responding to follow-up queries
and to requests for radio) television and press interviews
with responsible Department officials. Priorities are based
on the relative urgency and importance of the subject matter.
The material is produced with the cooperation of the interested
Department staff.
6. Writing and editorial assistance is given on request, and may
include writing a complete speech for the Commissioner, assis­tance
or editing of a speech for other professional staff;
help in producing pamphlets or other materials.
7. Development of exhibit materials is carried out on req~est of
Department staff. Sometimes it will be in response to an
outside invitation to exhibit.
8. Identification and meeting of unmet problems is carried out
by a review of specific programs and activities, assessment
of public responses and reactions to various public health
programs and activities, and other kinds of continuing
surveillance.
D. Evaluation and Time Deadlines
Some activities and objectives will be judged on an annual basis.
The amount of the total job done at year's end in the immunization
project will provide a ready yardstick for measuring degree of
success. In the case of comprehensive health planning, a year's
time span may be less adequate, since the program is still in its
embryo stage.
E. Collaborative and Cooperative Action
Since this is a "supportive" activity by nature, collaboration
and cooperation with interested staff is an integral part of the
approach. Such collaborative and cooperative action will also be
established and strengthened with private and voluntary groups.
This process has already begun through the use of the departmental
magazine and other vehicles and techniques.
- 32 -
174 Training
A. Problem
Arizona has no organized statewide program to develop, establish
and implement continuing education programs for professional
public health workers at all jurisdictional levels, special train­ing
programs for lay leaders involved in comprehensive health
planning and other programs that relate to identified training
needs.
B. Objectives
To organize and staff a training section competent to develop
training plans and to obtain training resources to meet identified
training needs.
C. Methods
A comprehensive training program responsive to this need is being
planned to include the following elements:
1. Consultative and advisory assistance to departmental program
staff, county health officers, representatives of voluntary
and health related agencies, heads of professional organiza­tions,
members of ad'visory councils and committees and others
on request in the identification of training needs and in
investigating and developing resources, programs, methods and
approaches responsive to those needs.
2. Investigate, develop and obtain special resources necessary
to support or otherwise make possible the implementation of
training programs and projects. Resources include short-term
training grants, courses of continuing education programs,
individual trainee scholarships, special courses in university
and junior college curricula and vocational training courses.
3. Plan and conduct for lay persons and organized community
groups training courses that lead to effective involvement
in the planning process.
4. Review, pre-evaluate and post-evaluate training programs,
seminars, institutes, workshops, etc. to determine appropri­ateness
of control and effectiveness of techniques.
5. Develop training materials, questionnaires, evaluation forms
related to training activities.
6. Provide staff services to the formal Residency Program for
Physicians to be conducted under the auspices and direction
of the Deputy Commissioner.
- 33 -
D. Evaluation
The degree of success in the Department's efforts to establish and
sustain a state-wide coordinated training program will involve
assessment of many interrelated elements. Definitive identification
of these elements including designs of appraisal methods and tech­niques
will be incorporated into the planning of the training pro­grams.
These evaluation elements will be formed in several areas,
such as, for example:
1. Identification of training needs in terms of adequacy and clarity
of definitions as basis for determinations of responsive actions.
2. Resources development and utilization necessary to support plan­ning
and implementation of actions.
3. Training methods and techniques employed.
4. Quality and quantity improvements in health services.
- 33A -
180 VITAL STATISTICS
The Bureau of Vital Statistics (statutory title) is set up by law and as­signed
the duty of registering all births and deaths occurring in the
State. It is also obligated to furnish certified copies of these documents
to any eligible applicant upon request. In carrying out this task, the
activities are divided into four sub-programs.
181 Administration
This includes supervision and monitoring of the overall mission toward the
end that, (1) every birth and death is registered, (2) a complete and cor­rect
certificate is obtained for every event. This will involve prepara­tion
of regulations, devising new forms and procedures, training personnel,
furnishing consultation, and possibly the preparation of statutory changes.
A. Problems
1. Provisions of the new State vital statistics legislation to
be effective January 1, 1968, requires extensive revision
of policies, methods, procedures, forms, and the est£blish­ment
of a state-county partnership in registration activities.
2. Unsafe and inadequate space and facility for the housing of
operations and records storage jeopardizes employees, ex­poses
vital records to damage and possible loss, adds to
the cost of operation, and is adverse to employee morale.
B. Objectives
1. To effect a smooth transition of operations from the present
to the many new and different operational requirements of
the State Statute which goes into effect January 1, 1968.
2. To obtain remedial action on the unsafe and inadequate hous­ing
of the vital statistics operations.
C. Methods
1. Operational transition to requirements of the new State
Statute will involve:
a. Completion of revised rules and regulations with the
assistance of the Division of Planning and Technical
Support;
b. Designing, testing and installing new registration and
operational forms and procedures;
c. Providing consultative services to County Health Depart­ment
personnel, including preparation of written in­structions,
guidelines, etc.;
- 34 -
d. Planning for and conducting on-the-job training of state
and county personnel in new procedures;
e. Preparing and disseminating new guidelines to local
registrars, hospitals, physicians, funeral directors,
local officials, etc.; and
f. Maintaining close observation over all operations under
the new rules and regulations, particularly documenting
all situations which suggest necessity for changes in
the statute or the rules and regulations, and preparing
revisions where required and when needed.
2. Continue to effect accurate documentation of specific in­cidents,
such as result from flooding of quarters due to
heavy rains (this will happen), employee accidents, and
specific conditions adverse to eff.icient production, which
can be used to strengthen requests and justifications for
remedial action on the problem of unsafe and inadequate hous­ing
and facility.
D. ~luation
1. Evaluation of all methods employed to achieve smooth transi­tion
of operations to the requirements of the new State
Statute on vital statistics is an inherent element in the
methods themselves, with overall evaluation to be found in
the degree to which the operational transition is accomplished
without impairment of service, decrease in productivity and
increase in costs.
2. The securing of safe and adequate housing and facility for
the vital statistics operations will be the basis for evaluat­ing
achievement of this objective.
182 Registration
This sub-program requires a myriad of interrelated procedural activities.
Advice, instructions, and guidance must be continuously furnished to
hospitals, doctors, morticians, coroners, and the public on the proper
completion of vital records.
A. Problem
The law requires that every single registration be complete and
accurate, rules and regulations to implement the law specify
this completeness and accuracy, and a myriad of procedures in­volving
many people must be fully responsive to the specifics
of the rules and regulations. There is a deficiency in the
supervision and direction the Division is presently able to
provide these operations.
- 35 -
B. Objective
To effect a demonstrable improvement in the supervision of the
registration operations to the end that maximum completeness
and accuracy of individual records is assured.
C. Methods
1. Incomplete records must be made complete, errors must be
corrected when correctable, new certificates must be made
to show changes of civil status, etc.
2. The newly authorized positions of Assistant Director of the
Division with primary responsibility for registration opera­tions
will be filled.
3. New forms will be devised tc simplify completion and still
retain all essential information.
4. Improved response to requests for consultation from the
field will be provided.
5. Will continue to furnish hospitals, doctors, morticians,
coroners, the public, and others, with accurate answers to
their specific questions or shortcomings.
6. Will establish effective working relationships with the
Division of Preventive Health Services so that data from
registrations are of maximum value to program operations
and evaluation.
D. Evaluation
Evaluation of achievement of this objective will be found in the
degree to which specific methods or techniques are effective in
readily spotting deficiencies in records, in quickly identify-ing
constructive procedural improvements, and in clear identifica­tions
of desirable or necessary changes in the state law or in
rules and regulations.
183 Certifi~ion
Production of copies as a fee-paid public service demands a continuous,
painstaking attention to detail. Last year over 150,000 copies were
distributed -- about 1.2 copies every minute of every working day. A
highly organized teamwork effort coupled with sound records management is
indispensable. Experimentation has been under way for some time with
"service-while-you-wait" in certain cases and has proven practical.
A. Prohl.!!]
There is a recognizable need to effect improvements in service
and to increase efficiency in production without impairment of
accuracy and completeness of the individual certificate.
- 36 -
B. Objective
To achieve and maintain the highest possible level of public
service in the issuance of certificates commensurate with the
specified requirements for completeness and accuracy in those
certificates.
C. Methods
1. Continue the experimental project initiated last year to
test the efficacy and relative efficiency of issuing certifi­cates
on a llservice-while-you-wait" basis.
2. Survey for reevaluation the current records management system
for identifying possible areas of improvement and effect
necessary or desirable changes in procedures as indicated.
D. Evaluation
The ultimate evaluation of the degree to which this objective is
achieved will be based on measurable improvements in ser·rice,
increased production at the same or lower cost, and simplification
of issuing and record-keeping procedures.
184 Accounting
Statutes closely regulate the receiving and handling of public monies,
which in this context means fiscal accountability for fees paid for copies
of vital records. Also requires fiscal management responsive to the ac­counting
standards promulgated by the State Auditor, Treasurer, and Post
Auditor.
A. Proble~
1. There is need to improve accounting forms and procedures
and, at the same time, meet the accounting standards and
requirements issued by the State Auditor, Treasurer, Post
Auditor, and the State Department of Finance.
2. Some individual personal checks given in payment of fees are
subsequently found to be uncol1ectable, which poses the
question of continuing a policy which permits acceptance of
personal checks. Good public relations essentially dictates
the necessity of continuing the policy.
B. Objectives
1. Work will continue to realize an accounting scheme which
gives all the checks and balances required by the agencies
mentioned above but at the same time reduces clerical opera­tions
and other details to a minimum. Liaison will be main­tained
continuously with these agencies, and their consulta­tion
and guidance sought when innovations are tried out.
Recommendation for an annual audit of books is proposed.
- 37 -
2. A system of monitoring checks is already in existence to
weed out those likely to be returned for insufficient funds.
All checks over $5.00 must be initialed by director.
Counter checks are refused. Checks on foreign banks are
declined because of exchange problems. These procedures
will be refined and modified to meet any changing circum­stances.
C. Evaluation
Evaluation of the accounting sub-program will be measured by
comparing satisfactory accomplishment of the assigned task
against the standards cited, but with a minimum of personnel
and the least complex system of operations.
- 38 -
190 PUBLIC HEALTH NURSING
A. Problems (supplemental data attached)
There is 8 need to be constantly alert to every opportunity to
develop and improve public health nursing in all areas of the
State. This includes:
1. The need to alleviate the problems of nursing shortages,
particularly at the community level.
2. The need to elevate and maintain standards of performance
for nursing services at all levels, including the develop­ment
of methods for measuring performance in terms of stand­ards
and response to program requirements.
3. The provision of opportunities and methods for in-service and
on-the-job training.
4. The need to provide instructional guidance to nurses in areas
where local professional supervision is nonexistent.
5. The need to evaluate nursing in relation to quality, quantity
and disposition of patient care.
6. The need to continuously collaborate with program adminis­trators
of the Department on meeting the nursing requirements
of their ongoing and developing programs.
7. The need to implement an adequate statistical reporting
system of nursing activities.
B. Ob j ec!:..ives
1. Help alleviate nursing shortages at the community level on a
selected and scheduled basis.
2. Develop and improve public health nursing services in all
areas of the State through collaboration with local agency
directors, public health nursing directors, supervisors and
nurses responsible for nursing service at the local level.
3. Promote and conduct on-the-job orientation and in-service
education for nursing staff.
4. Provide instruction, counselling and guidance to nurses in
all areas of the State where local public health supervision
is not provided.
5. On a selected county basis, explore methods for evaluation of
quality, quantity and disposition of patient care.
6. Collaborate with program administrators and specialized nurs­ing
consultants to meet the nursing needs of various "special
service" programs.
- 39 -
7. Implement an adequate statistical reporting system of nurs­ing
activities.
C. Methods
1. a. To work with the Deputy Commissioner for Local Health
Services in:
1). Defining numbers and qualifications for nursing staff
in county health departments in order to have sup­port
of local boards of health and local boards of
supervisors to budget for these nursing positions.
Th~se counties already identified as having the great­est
need and top priority are:
a). Pinal County - Supervising nurse as there are
eight positions and no supervising nurse.
b). Yavapai County - Population 30,971 and only one
nurse and one home health aide.
c). Greenlee County - with no public health nursing
service.
b. Update data and assist in the construction of adequate
compensation plans for nurses in all counties of the State.
c. Assist in recruiting qualified nurses and other profes­sional
persons in all counties.
2. a. Begin to assist each county without nursing supervisors
in defining its health needs through analysis and evalua­tion
of vital statistics, county pertinent data, and as
may be indicated from health index surveys.
b. Assist in planning ways to best meet the nursing needs
of the community, for example: immunization programs,
cancer screening programs, home health services, etc.
c. Review existing programs in relation to stated needs.
d. Promote the development of a written plan for the nursing
activities in each county delineating what they expect
to accomplish for Fiscal Year 1968.
e. Assist in the development of standards of performance for
nursing services related to this plan.
f. Help in development of written methods to carry out the
plan for nursing services in counties without super­visors.
For example: Division of a county into districts
with a schedule for nursing visits to each district for
the best utilization of time and travel and personnel.
- 40 -
g. On a demonstration basis, assist in assessing patient and
family needs and making nursing care plans to meet these
needs.
h. Plan for the semi-annual meeting of the public health
supervisors, consultants and directors which provides
an opportunity for nurses to keep abreast of current
trends in public health nursing with specific application
to the needs of Arizona.
i. Provide technical and administrative consultation to
local health departments in planning new programs and ex­pansion
of existing programs.
j. Promote development and utilization of a reference file
on community resource material in each county.
k. Encourage nurses to identify opportunities for, and use
of, volunteers in carrying out selected activities.
1. Survey local agencies who wish to become certified home
health agencies and provide for periodic resurveys.
m. Participate actively with the professional organizations
and individuals for evaluation and improvement of nursing
resources in the State.
3. a. Continue quarterly in-service education programs for
nurses in the northern counties.
b. Participate in in-service educational programs when re­quested;
assist nurses in rural areas in planning, conduct­ing,
or arranging for in-service and on-the-job training
within their agencies.
c. Continue to make professional and pertinent reference
materials available, and assist nurses in selection of
such materials.
d. Acquaint nurses with training opportunities, and promote
attendance at selected programs, seminars or workshops.
e. Plan and conduct individual on-the-job training for newly
employed nurses at the Department.
f. Plan and conduct group and individual orientation for
newly employed nurses and other nurses who have not had
orientation. This will be done at least twice in 1968.
4. a. Periodic visits on a planned basis to the counties to
assist and guide the nurses in planning and selecting
methods for implementing her nursing program.
- 41 -
b. Complete revision of the Public Health Nursing Manual to
assist the new nurse or the nurse working without direct
public health nursing supervision.
c. Demonstrate and supervise a nursing visit, bag technique
and other procedures as needed.
d. Assist local nurses in the methods and techniques of super­vision
of employees, both professional and ancillary.
5. a. Encourage and assist at least two local nursing agencies
to plan and conduct patient progress studies and/or other
methods of assessing and evaluating nursing services.
b. Measure in at least three counties nursing services in
relation to stated standards.
6. a. Consult with program administrators in defining and inter­preting
the nursing component of proposed or developing
programs.
7. a. With Data Processing Unit, implement a new system of col­lecting
reports of nursing activities by county and total
for State.
b. To work toward inclusion of all community nursing activi­ties
in the State which will include Visiting Nurse Ser­vices
and the Division of Indian Health, Public Health
Nursing Services.
D. Evaluation
1. a. Enumerate the number of new positions budgeted during
Fiscal Year 1968.
b. Provide a chart comparison of compensation plans in the
counties for July 1, 1967 and July 1, 1968.
c. List positions unfilled July 1, 1967, resignations, and
number of vacancies filled during Fiscal Year 1968.
2. a. Tabulate what has been done in the counties to meet this
objective by summarizing the field trip reports made by
the director of nursing and the nursing consultants.
3. a. Report of in-service and orientation programs - content
and number attending. Submit an evaluation to demonstrate
how the participants used the knowledge gained to improve
services.
4. a. Study the number and spacing of visits by consultants and
list what was accomplished toward this objective.
- 42 -
5. a. Report on patient progress studies and/or other methods of
assessing and evaluating nursing services.
b. Using, in at least three counties, the nursing services
to measure the stated standards.
6. a. Tabulate the nursing activities and review nursing com­ponents
in their programs.
7. a. Evaluate, from a developed questionnaire, the value of
the new reporting system for all counties.
b. Report on the progress made toward including the Visiting
Nurse Services and the Division of Indian Health, Public
Health Nursing Services, in inclusion of all community
nursing activities in the State.
- 43 -
NUMBER OF NURSES NEEDED
IN PUBLIC HEALTH IN ARIZONA
·--··.. --------·T----··-·--·--··-·.····f NO~-OF· NURSES-' - NO. OF . ADDITIONAL j NON-INDIAN I EMPLOYED j NURSES NURSES
-CO-UN-TY--.f---T-O-T-A-L-.P....O..-P.-. '-"'-' ·--P-O-·P-.-*-----Ir-JU-·N·E--3·0· 1967+ NEEDED++ NEEDED L ..- ...,-..,-...._ ......." ......_ ...-- '-. . -_.
Apache 31,840 I 7,689 : 1 1\ \
Cochise 67,403 67,254 9 13\ 4\
Coconino 51,279 37,632 2 7\ 5\
Gila 26,577 22,634 2 5\ 3\
Graham 14,602 13,318 1 2\ 1\
Greenlee 12,000 12,000 0 2 2
Mohave 14,000 13,246 1 2\ 1% Il
Navajo 42,482 20,685 1 4 3 II
Pinal 72,901 66,718 8% 13~ 5 I
Santa Cruz 11,577 11,577 2 2 0
IYavapai 30,971 30,041 1 6 5 II
55,805 53,992 12 11 0 I I Yuma
Maricopa 837,674 827,741 69 166 97
IPima 330,993 323,131 64~ 31\
»-. """,
_. _.,
TOTAL 1,600,104 1,507,658 302 160\
~H""_~_"
*Indian Population served by Public Health Service, Division of Indian Health.
School Nurses total 316 and serve 90% of the school population.
+Inc1udes four counties with nursing supervision.
++Based on Ratio of one nurse per 5,000 populationo
7/12/67
200 LABORATORY SERVICES AND SUPPORT
201 Laboratory Direction
I. Legislation
A. Problem
There is need for legislation that recognizes the need for and
requires certification and licensure of clinical laboratories
and their personnel.
B. Objectives
Complete preparation of draft legislation authorizing the Board
of Health to establish rules and regulations to govern the
certification and licensure of clinical laboratories and certain
professional and technical personnel.
C. Methods
The Director and staff will collaborate with pathologists,
physicians, laboratory societies and other interested or con­cerned
groups in the development and drafting of acceptable
legislation~ and with the assistance of the Management Advisory
Section of the Division of Planning and Technical Support clear
final draft of the proposed legislation for submission to the
Legislative Council for action in the next Legislative session.
D. Evaluation
Evaluation of the steps taken will depend on the outcome of
Legislative action.
II. Laboratory Facilities
A. Problem
With the expansion and addition of new health programs in the
State which require support services of the Laboratory, space
and physical facilities of the Laboratory have become inadequate.
B. Objective
Complete detailed plans, specifications and costs and prepare
specific recommendations for future expansion and improvement of
the Laboratory's facilities.
C. Methods
Will obtain consultation from the National Communicable Disease
Center's Laboratory Development Section to assist in the
development of survey design and assessment techniques and will
visit a few selected State health laboratories which have been
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newly constructed or renovated in order to study their plans and
approaches and to assess their experiences. On the basis of these
actions and observations, the Laboratory will complete detailed
plans for a scheduled expansion which will take into account, on
a priority basis, the identification and costs of new or improved
facilities adequate to meet the laboratory support activities
required by such programs as radiological health, toxicology,
air pollution, water quality, adulterated foods, caustic alkali
and acids, meat products manufacture, etc.
D. Evaluation
Essentially, the planned expansion and improvement of the
laboratory·s facilities will be evaluated in terms of the
demonstrated feasibility of the plan as will be shown through
its implementation.
III. Staff Capability
A. Problem
There are deficiencies in the competence of State laboratory
personnel in new technology and instrumentation which can be
overcome by application of combinations of formal and in-service
training methods and techniques.
B. Ob1ective
Determine priorities of training and make selection of personnel
categories within those priorities to be given training opportu­nities
in new laboratory technology and instrumentation.
C. Methods
Develop and submit to the National Communicable Disease Center
an application for a regional training grant which will support
a specialist to assist in the development of a continuing educa­tion
program which initially, in FY 1968 provides for a course
in basic medical microbiology and for refresher courses (work­shops
and seminars) in laboratory methods for syphilis and
parasitology.
D. Evaluation
The continuing education program will be evaluated through
subjective assessment by trainees before and after participation
in each course and through follow-up assessment of laboratory
ability to implement new procedures and in identifiable improved
efficiency of personnel that have had benefit of the training
program.
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IV. Up-grading Clinical Laboratories
A. Problem
Clinical laboratories throughout the State generally are
deficient in capability, facility and technical competence
in terms of ability to adequately respond to new and expanding
demands for laboratory diagnosis.
B. Objective
Organize and establish a Laboratory Consultation and Evaluation
Section within the State Laboratory to initiate consultative
services leading to proficiency testing in parasitology and
improvement of diagnostic methodology in medical microbiology
in clinical laboratories.
C. Method
To send out unknown specimens at stated intervals to all labora­tories
requesting this service. Specimens included will be the
common parasites encountered in Arizona and those bacteria most
commonly found in medical practice. The methods will include
on-site visitations to at least 50% of the laboratories requesting
this service. Follow-up refresher courses are contemplated as
indicated by the evaluation.
D. Evaluation
The evaluation of the results returned on the unknown specimens
will indicate the directions in which the program should go with
follow-up refresher courses.
V. Program Costs
A. Prob1!!:!!!
The advent of formalized program planning and budgeting in the
Department coupled with expansion of laboratory support services
makes necessary the installation of systems which will provide
accurate information on costs of support services to each of the
several programs.
B. Objective
Install within the laboratory for all operations a fully effective
and efficient system for the identification of costs of support
services chargeable to each of the several programs.
C. Method
Will collaborate with the program divisions and the Division
of Administration and Planning to develop and install a cost
accounting system within the laboratory which will provide
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accurate cost information. A classification of definitive
support operations and procedures will be established; codes
will be assigned; time studies will be conducted; and standard
operating procedures for recording and reporting will be
installed.
D. Evaluation
Evaluation of the laboratory's cost accounting system will be
made primarily on the basis of its effectiveness in response to
the specific requirements of the Department's program planning
and budgeting system.
VI. Retrieval and Analysis of Laboratory Information
A. Problem
There is a need to develop a system for more rapid and accurate
retrieval and analysis of information obtainable from laboratory
procedures and operations.
B. Ob1ectives
To develop a system, to include possible use of automated data
processing equipment, which will permit obtaining timely
information in useful form to meet not only the internal needs
for evaluation of program efficiency but also to meet the
information requirements of programs using the laboratory services.
C. Methods
1. With the aid of a systems analyst, develop and implement a
pilot study to determine the efficiency of computerizing
data obtained from the Tuberculosis Unit within the Laboratory.
2. Obtain information on and evaluate experience on data
retrieval systems being used by similar operations in other
States.
3. Develop, pre-test and finalize a program to provide a
complete data retrieval system for inclusion in future plans
and budget submissions.
D. Evaluation
The program will be evaluated by assessment of progress towards
development of a data retrieval and analysis system which meets
the present and future demands for information.
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202 Chemistry
I. Air Pollution
A. Problem
With the establishment of an air pollution section in the
Health Department there is a need to supply analytical chemical
facilities to aid in the control of air pollution.
B. Objectives
Special equipment necessary for the laboratory support
air pollution program will be purchased and installed.
be necessary to train personnel since they will not be
with the methods to be used.
C. Methods
of the
It will
familiar
Working in close collaboration with the new chief of the air
pollution program, we will purchase equipment. Staff will be
trained at Public Health Service sponsored courses and instruments
will be checked out, standardized and calibrated.
D. Evaluation
Essentially, the planned expansion of the laboratory facilities
will be evaluated in the terms of its implementation. The
training phase will be evaluated through subjective assessment
of the courses and through follow-up assessment of the staff's
ability to implement new procedures in support of the air
pollution program.
II. Water Quality
A. Problem
With the adoption of the water quality standards for the
State of Arizona it will be necessary to expand the work which
has been done in support of this program.
B. Objectives
The establishment of a laboratory equipped and staffed to support
the water quality program.
C. Methods
Working closely with the new chief of the Water Quality Section,
we will supplement our presently owned equipment with special
instruments necessary to support the program. If it is found
necessary to train present staff and new personnel, we will send
trainees to the National center for Urban and Industrial Health.
- 49 -
We will continue to participate in programs for standardization
of laboratory methods originating with the National Center for
Urban and Industrial Health.
D. Evaluation
The program will be evaluated by assessment of the progress
toward the development of a water quality chemistry section as
measured by our ability to meet the present and future demands
for information. The training program will be evaluated by the
ability to implement the neW procedures and the identifiable
improvement of the efficiency of personnel.
III. Adulteration of Dairy Products
A. Problem
The intense competition in the marketing of dairy products has
tempted some of the manufacturers to substitute vegetable fats
for animal fats in order to gain a price edge. The problem will
be to detect the adulteration of dairy products with vegetable
fats.
B. Objectives
To reduce the contamination of animal fats with vegetable fats.
C. Method
The identification of the sterols present in ice cream using
chromatographic techniques.
D. Evaluation
The program will be evaluated by assessment of the progress made
in reducing the substitution of vegetable oils for animal fats
in manufactured dairy products, principally ice cream.
IV. Pesticide Residues
A. Problem
Arizona has a peculiar situation in which people, pesticides and
food are all mixed up. Analytical chemistry facilities must be
expanded in order to monitor water, various food products, and
soil as well as continuing the special dairy products study.
B. Objectives
Keep to a minimum the intake of pesticides into the human system.
Maintain surveillance on all products which have legal standards
for contamination with pesticides.
- 50 -
C. Methods
Remodel the laboratory to conform to safety standards and install
new equipment with multiple detector capabilities. Maintain
close collaboration with the University of Arizona Community
Pesticides Study.
D. Evaluation
The planned expansion and improvement of the laboratory
facilities will be evaluated in terms of the implementation of
the objectives. The effectiveness of the surveillance and
monitoring programs will be measured by the reduction in the
number of food products which are not in conformance with
standards.
V. Clinical Chemistry
A. Problem
Recognizing the poor quality of laboratory work in clinical
chemistry pointed out by nationwide studies, Arizona is
embarking on a program to develop a clinical section in the
State Laboratory. A proficiency testing program for clinical
laboratories throughout the State can then be implemented.
B. Objectives
To raise the level of laboratory performance in clinical
chemistry.
C. Methods
Since many states including Arizona do not have operating clinical
chemistry section within the State Department of Health program,
the National Communicable Disease Center has made available
their laboratories as a reference center and they have prepared
unknown specimens which can be used by the states in a proficiency
testing program. Arizona will take advantage of both of these
offers and use the facilities of the National Communicable Disease
Center.
D. Evaluation
The program will be evaluated through objective assessment of the
various clinical laboratories results to note identifiable
improved efficiency and accuracy.
- 51 -
203 Microbiology
I. Deficiencies
A. Problem
In the past few years many new techniques have been developed in
the analysis of food products for anaerobes and staphylococci.
Refresher course training is necessary to upgrade present staff
in these techniques.
B. Objectives
Train staff in the rapid handling of anaerobes and the
serological identification of the staphylococcus enterctoxins.
C. Methods
In-service training and Public Health Service sponsored courses
at the National Communicable Disease Center.
D. Evaluation
The in-service training program will be evaluated through
subjective assessment of trainees before and after participation
in each course and through follow-up assessment of their ability
to implement new procedures.
II. Laboratory Safety
One of the most hazardous and infectious agents with which we
work are the fungi. The control of the spores of these organisms
is essential to the health and safety of the personnel.
B. Objectives
Eliminate the safety hazard in our mycology laboratory.
c. Methods
Install a safety hood in which the mycological examinations can
be carried out.
D. Evalua~
The planned improvement of the mycology laboratory facilities
will be evaluated in terms of the demonstrated feasibility of
the plan as shown through its implementation.
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204 Virology
I. Use of Laboratory Facilities
A. Problem
How, what and when to collect specimens for virological examination.
B. Objectives
Developing an intelligent use of the virological services.
C. Methods
Orientation of physicians and local health departments to the
services available through presentation of seminars and
published articles in Arizona medical journals.
D. Evaluation
Effectiveness of the program will be determined by the increased
number of virus isolations and other confirming diagnostic aids
to the physician.
II. Laboratory Safety
A. Problem
Inadequate quarters for the safe handling of suspected virus
materials.
B. Objectives
Development of a long range plan for establishing a safe working
environment for the virus laboratory personnel and the "isolationlJ
of the virus unit from the rest of the laboratory.
C. Methods
Consult with National Communicable Disease Center Laboratory
Development Section in the planning of laboratory design. On
the basis of these recommendations the laboratory will complete
detailed plans which will take into account on a priority basis
the cost of new and improved facilities adequate to meet the
virology program.
D. Evaluation
Essentially, the planned expansion and improvement of the
laboratory's facilities will be evaluated in terms of the
demonstrated feasibility of the plan as will be shown through
its implementation.
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205 Serology
I. Use of Laboratory Facilities
A. Problem
With the development of newer testing procedures in the diagnosis
of syphilis there is a need to educate physicians, nurses and
Health Department personnel in the procedures used.
B. Objectives
Reduce the cost of serological testing by limiting the
unnecessary use of more expensive procedures.
C. Method
To use in-service training of Health Department personnel and
education of physicians through the venereal disease
investigators. Preparation and use of educational materials
for distribution.
D. Evaluation
The effectiveness of the program will be determined by noting
the reduction in the number of specimens requesting special
studies when they are not indicated by the clinical diagnosis.
II. Evaluation of Procedures and Reagents
A. Problem
With the development of commercial reagents for the diagnosis
of coccidioidomycosis, there is a need to evaluate the procedures
as performed in various laboratories. Conflicting results have
been brought to our attention and these in turn are lowering
the confidence of the physicians in all laboratory work.
B. Objective
Set up a proficiency testing program which will include sero­logical
tests for coccidioidomycosis.
C. Method
Send unknown specimens to participating laboratories. Selected
reference laboratories including National Communicable Disease
Center, the Veterans Administration Hospital in San Fernando and
the School of Public Health, University of California, Berkeley,
will be used in a comprehensive study to compare results with
those of the clinical laboratories and the State Department of
Health, Division of Laboratories.
- 54 -
D. Evaluation
The effectiveness of the program will be measured by the
agreement of the results obtained by the participating
laboratories and the reference laboratories.
206 Tucson Branch Section*
Will provide the same services performed in the central laboratory with
the exception of chemistry and virology. The area serviced will be the
southern tier of counties plus Graham and Greenlee on the east.
207 Flagstaff Branch Section*
Will provide sanitary bacteriology for water and milk programs, screening
tests for syphilis and limited bacteriological services of a screening
nature. The area serviced will be the northern tier of counties along
U.S. 66 and the Santa Fe Railroad.
* For administrative purposes only the Flagstaff and Tucson Branches are shown
as separate sections.
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210 ENVIRONMENTAL HEALTH
211 Sanitation
A. Problems
At the present time the Section is staffed with three sanitarians
and a clerk. Although the need for additional staff has been
presented many times, we have been unable to expand and staff
the Section adequately to meet the need.
1. Almost 50% of the personnel in the fourteen local health
departments are sanitarians. Their activities range to
some degree over a minimum of twenty-eight different categories
in Environmental Health. The Sanitation Section is responsible
for providing technical assistance and consultation in at
least twenty-five of these categories according to A.R.S.36-132~
B-2, 5 and 14, and Department assignments.
2. According to A.R.S. 36-132, B-l5, the Department (and the
Section by assignment) is also responsible for "conducting
a continuing evaluation of State, local and district public
health programs and must have the ability to study and
appraise State health problems and make recommendations for
their best solution".
3. One of the problems that exists is that a large percentage
of the sanitarians have a limited education. About 90% fail
to qualify for the minimum of a bachelor's degree. A number
of them do not have the two years of formal education in an
accredited school which was the minimum requirement for new
employees a year ago. Less than ten out of eighty have
received formal training in public health. Reliance on
military training has been the mainstay of most health
units in the State.
4. The Section has the responsibility for the enforcement of
the State Pure Food laws and for collaborating with the
Federal Food and Drug Administration in the enforcement of
the Federal Food and Drug Laws.
5. The Section is responsible for the enforcement of the health
and sanitation provisions appearing in the State dairy laws.
Traditionally one of the Section sanitarians has been assigned
to the milk program full time. However, this has not proved
adequate and the Department has had to rely on local health
units for routine inspection and control work.
- 56 -
6. The Section is responsible for licensing and inspecting
approximately fifty-five children's camps scattered through­out
the State. To date, the Section has not been able to
carry out its inspection responsibilities and has had to rely
on local approval. This has worked to a degree but there
has been little opportunity to coordinate inspections and
cause them to be made when camps are operating, or in some
cases, not even when the camp is occupied by a caretaker.
7. Food service program evaluations made the past year in seven
counties show that only two of the counties were able to
achieve an acceptable rating in both the level of sanitation
in their restaurants and conduct of their food sanitation
program.
None of the departments surveyed this year or in any
previous year since the latest P.H.S. rating survey method
was developed have achieved an excellent rating in either
category.
8. Several programs in other sections require the services of a
sanitarian either in a direct inspection or consultative
capacity. They are the Hospital, Nursing Home, Care for the
Aged, Epidemiology, Migrant Heal th and Child Day Care
(including certain types of schools), categories where a
part of the Health Department's concern is in the area of
sanitation. We should supply the technical services necessary
from this Section in order to strengthen the concern for
Environmental Health problems.
9. The authority for vector control activities is found in the
laws on nuisance and in the Department's general responsi­bility
for controlling communicable disease and the Depart­ment
has the responsibility for providing technical guidance,
consultation, etc. However, there is no specific authority
for the State Department of Health to conduct a routine
vector control program of a type which should be carried by
the Sanitation Section in support of the local health units.
Although the Department has epidemiologists to deal with out­breaks,
there is no provision for the services of a technical
expert who can focus on control methods, equipment and
identification of vectors in support of the local health
units and in cooperation with P.H.S. vector control teams.
10. Solid waste problems are a part of the Section's responsibil­ities.
Open burning dumps exist in the majority of the
counties in the State. A survey and planning program for the
purpose of designing activities for the control of these dumps
and other associated problems is needed.
11. The present Pure Food Law refers to a "standard of purity
of food prescribed by the Secretary of Agriculture". This
standard no longer exists because the pure food controls at
- 57 -
the Federal level were given to the Department of Health,
Education, and Welfare a number of years ago. The standard
referred to in the law should be the current standard used
by the Federal Food and Drug Administration. It would be
desirable to modernize the Pure Food Law by substituting a
modern "Uniform Pure Food Law" which has been adopted by a
number of states.
12. The past several years the Department and the State Board
of Health have maintained an interest in the promotion of
mattress and bedding legislation. Several proposals have
failed for various reasons, and to date there is little
control over the use of contaminated materials in such
articles. It is the desire of the State Board of Health to
continue to seek legislation which will permit the Department
to control this problem.
13. Housing problems have long been recognized as being related
to the "health of the community. The Department has the
general responsibility for maintaining an interest in all
health problems. However, provision has not yet been made for
the establishment of an activity which would clearly identify
the extent of the housing problems related to health in this
State and provide for the promotion of improvements.
14. The local departments are widely divided in capabilities and
resources. One county does not have the services of a
sanitarian at this time except for those services which this
Section is able to extend to them. Five counties are
staffed by a single sanitarian. Six counties have from two
to five sanitarians. One county has a staff of nineteen
sanitarians and the largest county is staffed with at least
thirty-two sanitarians plus a number of public health
engineers. The latter department has developed a Bureau
of Environmental Health. The Sanitation Section of the
State Department of Health must be sufficiently sophisticated
and competent to be of assistance to the largest unit and at
the same time be conversant with rural problems and direct
services.
B. f&.1ectives
The Sanitation Section will shift from a focus on milk and food
service sanitation activities to the development of a program
designed to evaluate all activities of the local health depart­ments
in environmental health, assess local and State sanitation
problems and provide technical assistance and consultation to
local health units.
We will also endeavor to maintain direct service programs and
provide consultative and technical services as required to other
Divisions within the Department. It should be emphasized that this
effort must De in accordance with Department policy and budgetary
limits for this fiscal year.
- 58 -
C. Methods
The Section will begin by making total program inventories in
local health departments. It is expected that we will concentrate
on the county health units which are not well equipped, without
neglecting to become knowledgeable about the problems in the
larger areas.
State sanitarians will work closely with environmental health
personnel in each local health department on the inventory of
activities and all that is required to proceed in each activity.
They will then proceed with an evaluation of sanitation problems
and suggestions for reorganization of effort, where necessary.
The State Sanitation Section will make an effort to provide
guidance in sanitation program management for local health
units for the purpose of strengthening those units. Guidance
will be provided by means of formal short courses presented by
experts of the P.R.S. when possible, the conduct of seminars
for supervising and head sanitarians, and person-to-person
sessions during routine activities. A routine training program
in technical subjects will be delayed as far as this Section is
concerned until a substantial need can be shown in a particular
activity. The Section will then describe this need to the
Department1s training officer and assist in the development of
appropriate training.
In summary this plan involves the State Department of Health
Sanitation Section and fourteen local health department sanitation
units. The effort will be carried to each local department a step
at a time with considerable concentration on those who are most
receptive and with considerable stu