Ohio stands out as a national leader in accreditation. As of January 2025, 83% of the 111 local health departments (LDHs) in Ohio have achieved Public Health Accreditation Board (PHAB) accreditation and additional LHDs are seeking PHAB accreditation, vastly surpassing all other states. What has made Ohio so successful?

A qualitative study published in the Journal of Public Health Management and Practice, “Perspectives on Public Health Department Accreditation: Lessons Learned From Ohio’s Accreditation Mandate,” sheds light on the experiences of Ohio LHDs achieving accreditation. The study states, “Accreditation provides key benefits, including standardization of processes, enhancements in quality improvement and performance management, strengthened collaborations and partnerships, improved communication, and optimized resource use. However, barriers to accreditation—particularly financial expenses associated with the process and constraints on staffing resources—can be substantial, particularly for smaller health departments.”

Galvanized by legislation, backed by PHAB, and supported through funding, health departments in Ohio have the policy mandate, financial resources, robust workforce, and technical assistance they need to support their pursuit and achievement of PHAB accreditation.

In 2015, Ohio became the first and only state to require all its LDHs to achieve PHAB accreditation. Between 2013 and 2021, Ohio utilized several policy levers to advance accreditation, including increased state funding for accredited health departments, requiring reporting on accreditation efforts, and leveraging accreditation as a consolidation exemption for small city LHDs. However, policy was only one part of the equation.

In 2023, Ohio received a Public Health Infrastructure Grant from the Centers for Disease Control and Prevention, allocating funds to help health departments with initial accreditation or reaccreditation costs. Regardless of size, health departments were eligible to receive up to $50,000 for expenses such as staff payroll or required assessments related to accreditation.

As part of the PHIG, health departments also received training and technical assistance as they applied for accreditation. These sessions, offered both virtually and in person, provided health departments with the opportunity to receive hands-on assistance from PHAB staff. Last summer, LHDs across Ohio had the opportunity to bring their biggest accreditation challenges to in-person workshops for tailored assistance.

For the Ohio Department of Health’s Chief of the Center of Public Health Excellence, Bobbi Krabill, and Accreditation Coordinator Mackenzie Mays, this level of support was integral to achieving and maintaining their accreditation.

“With these additional supports, smaller and less-resourced health departments have been able to achieve accreditation,” said Mays.

Krabill also emphasized how accreditation reinforces credibility and trust.

“When you consider other sectors that have accreditation requirements such as hospitals and universities, community members view the institutions that are accredited to be most competent, and I think PHAB provides that for health departments,” said Krabill. “It is not a small task, but it holds us to a high standard.”

“When you consider other sectors that have accreditation requirements such as hospitals and universities, community members view the institutions that are accredited to be most competent, and I think PHAB provides that for health departments. It is not a small task, but it holds us to a high standard.” — Bobbi Krabill, Chief, Center of Public Health Excellence, Ohio Department of Health

Multifaceted support is especially crucial for smaller LHDs pursuing accreditation, like the City of Springdale Health Department (CSHD).

When first considering accreditation in 2015, CSHD had one nurse, one health inspector, and one administrative assistant. Eventually, CSHD received funding from the Hamilton County Health Department and the State of Ohio which allowed them to hire multiple staff members, some of whom assisted CSHD Accreditation Coordinator Becky Carrasco with tasks related to PHAB accreditation while also performing functions related to health promotion education, environmental health, and community health improvement.

This support helped CSHD achieve accreditation in 2022, leading to enhanced quality, performance, and services.

“Accreditation is about continuous quality improvement,” said CSHD Health Commissioner Matthew Clayton. “Accreditation makes it easier to ask for partnerships, which is crucial for smaller health departments like CSHD.”

Carrasco, who played a pivotal role in CSHD’s accreditation process, said accreditation improved multiple areas.

Among the improvements, CSHD collaborated with the City of Springdale’s IT department to create a searchable database of restaurant or pool/spa inspection reports, meeting PHAB’s standard for inspection report transparency. CSHD also implemented a monitoring plan for immunizations in its Vaccines for Children (VFC) clinics, improving scheduling efficiency and ensuring nurses allocated adequate time per student and documented their work effectively.
Additionally, CSHD transitioned to a 100% paperless operation with shared drives, improving remote work and staff connectivity.

As CSHD continues to reach for improvements, accreditation helps them stay on course.

“We are putting forth the effort and the improvement to provide the best services for the community that we serve,” said Clayton. “Accreditation is one tool in that process, and it’s a big tool.”

“We are putting forth the effort and the improvement to provide the best services for the community that we serve. Accreditation is one tool in that process, and it’s a big tool.” — Matthew Clayton, Health Commissioner, City of Springdale Health Department 

By embedding accreditation into legislation and linking accreditation to funding, Ohio established a clear framework that ensured every local health department had both the mandate and the necessary resources to meet national public health standards. Ohio’s success serves as a model for other states seeking to build stronger, more resilient public health systems, proving that with the right policies and support, accreditation is achievable and transformative.