The Alabama Department of Public Health is the main state health agency of the government of the US State of Alabama responsible for providing various public health services to Alabama residents (Alabama Department of Public Health, 2016). Hence, the agency strives for improved public health services and protection of the public by advancing disease prevention efforts and ensuring effective delivery of public health services to residents irrespective of prevailing difficulties, including payment and social conditions (Alabama Department of Public Health, 2016). The ADPH has designated the State Board of Health to advice on issues related to sanitation, and public health while working closely with the community to protect and preserve health through caring and delivering quality services. However, the state agency encounters some challenges in its efforts to provide, preserve, protect, and improve public health.
The Current Issue
The ADPH now faces a budget deficit. The agency has an annual operating budget of $481.3 of which $273.8 million came from the federal funding, $146.7 million originated from the state, $49.7 million came from state funds, and additional $11.1 was received from other sources. The agency’s state funding has declined by $1 million, but fee-based funding has risen by $13.2 million (Alabama Department of Public Health, 2015).
Additionally, the agency has noted that the trend of federal funding is characterized by declines. The ADPH strives to meet its wide and intricate issues of public health in an extremely competitive environment amidst dwindling resources. Notably, the agency heavily depends on federal funding to deliver its public health services. Over the past years, it has felt the consequences of appropriation and other budget declines initiated by the federal government. Still, funding issues do not end at the federal level because additional budget cuts also emanate from the state funding.
How the Current Issue Affects the Administrative and Managerial Processes
For any public agency, there are usually serious outcomes associated with inadequate funding, and the ADPH is no exception. For instance, in the fiscal year 2015-2016, the State of Alabama introduced a budget cut to handle the growing deficits occasioned by dwindling funding. The Department of Human Resources was affected by a budget cut of about 5%. This implies that the Department is most likely to dismiss some of the employees and increase job pressure on the few remaining ones. Moreover, the healthcare sector in the US now faces shortage of personnel while the current workforce is overstretched.
Inadequate funds leading to a budget cut will negatively affect service delivery to the public in Alabama (Rosenbaum, 2011). The Department of Public Health will close “Coosa County Health Department; reduce licensures and certifications; discard nicotine patch purchases; and reduce disease control staff and regionalization of county operations, staff for Restaurant Health Inspections, and area and state support staff” (Gardner, 2015, para. 3). These cases show how the cut would affect the Department of Human Resources, which offers public assistance programs. Additionally, more programs and policy implementation would be affected by the budget cut.
The Medicaid budget was reduced by 5% ($156 million) (Gardner, 2015). This cut will affect majorities in Alabama. The healthcare sector in the State employs hundreds of thousands, and any cuts affect such employees. Medicaid is the most important public healthcare model for Alabama’s majorities. The so-called harsh cut will affect “Alabama’s rural hospitals, pediatrician offices, and other healthcare professionals, who are already wavering on the edge of closure” (Melson, 2016, para. 4-5). Relative to the year 1980, about 85% of rural hospitals in counties delivered babies in which Medicaid covered over half. Today, however, only 17 rural counties can provide delivery services or gynecology and obstetrics services.
Moreover, about 1 million Alabamians depend on Medicaid, including over 500,000 children. This implies that harsh cuts on Medicaid would result in a collapse healthcare for the public. Additionally, the Mental health Department also got a cut of 5% ($5.2 million). Many critics have maintained that such a cut would lead to the collapse of the Department (Hinton, 2016). The cut would disproportionately affect individuals with mental conditions in various ways: over 24,000 would not receive mental healthcare completely, 589 would not get residential services, 4,800 shall forego intensive mental health services, about 16,000 will not get outpatient services from community health centers, and 2,600 would not get crisis mental health services (Hinton, 2016). Additionally, persons with intellectual disabilities will also be affected differently, including service reduction, closure, job loss, and support. The potential damages continue in other areas, such as outpatient dialysis and hospice among others (Lyman, 2015).
Fund deficit also influences budgeting and resource allocation in the agency (Bučková, 2015). Consequently, the ADPH has identified key focus areas in the strategic plan 2015-2016 to prioritize amidst budget cuts. The agency want to allocate more resources to enhance the use of technology and data by developing an Electronic Health Record and increasing data capture and analysis and analytics capabilities to enhance service provision for better outcomes. This approach would enhance regulatory roles and healthcare evaluation, assurance, strategic performance management processes and staff efficiency while improving overall service provision.
The agency has also prioritized improved access to care by developing productivity benchmarks related to clinical and non-clinical factors and assess case-by-case, region-by-region strategic evaluation to show specific areas in which it can demonstrate value versus cost to improve outcomes (Alabama Department of Public Health, 2015). The agency also wishes to prioritize marketing, communications, and branding strategies through programs that enhance overall public awareness about health and ongoing changes. Additionally, nutrition and enhanced physical activities are also a part of the strategic plan. They target obesity in adults and youth. Despite the budget cut for mental health, the agency has recognized its importance alongside substance abuse interventions.
While no report covers how the budget cut would affect policy creation, one may conclude that the agency is most likely to restrict the introduction of new policies that require additional funding for implementation. Moreover, for some programs, it is recognized that the agency has initiated some structural reforms to save costs, but these reforms depend on fund availability (Melson, 2016). Such reforms in healthcare service delivery require funds for implementation. Hence, any budget cuts are most likely to affect policy creation and implementation negatively (Rosenbaum, 2011).
The agency always conducts performance appraisal for all employees irrespective of funding. Performance evaluation is a part of employee contract contained in the employee handbook. It conducts an annual evaluation using similar processes and rating scales – just the same standards and rating used for employees on probation. Performance appraisal results are contained in the employee performance appraisal form.
Lawmakers play critical roles in passing bills that affect budget cuts. However, not all legislators are interested in bills that influence budgets. For instance, in the case of mental health budget cut, only 20 lawmakers chose to attend the budget hearing. However, some important figures, including Senate Health Committee Chair Gerald Dial, failed to attend the hearing, reflecting how sensitive budget cuts affect legislative processes negatively.
The agency relies on local and federal governments for funding. This relation is now defined by a declining trend of funding. Besides, capped funding, commitment, funding periods, purposes, reforms, emerging challenges, and cost savings among others define issues involving inter- and intra-governmental communication and negotiation about funding for the agency.
Given the budget constraints, the ADHP must embark on ethical decision-making to deliver public health services (Matei & Băieşiu, 2014). The agency, therefore, faces tough decisions. For instance, many have predicted the collapse of mental service provision by the State of Alabama because of the budget cut and dwindling quality of services because of Medicaid cuts over the year (Obama, 2016). Policymakers and decision-makers face critical ethical questions in a competitive environment before deciding to cut the budget and reallocate resources to other services.
Recommendations
Funding is now a major challenge facing the agency. This implies that the ADPH cannot implement most important public health services. Hence, it is imperative to find out alternative sources of funds. Notably, the ADPH has increased fee collection for alternative funding. This approach aims toward creating a self-supporting agency. The agency should also improve its efficiency management programs to ensure that costs are controlled while fees are derived from possible sources. Self-supporting programs would ensure that the agency is better prepared for future additional declines in state and federal funding. Without such initiatives, public health services could become poorer in Alabama.
References
Alabama Department of Public Health. (2015). 2015-2016 Alabama Department of Public Health strategic plan. Web.
Alabama Department of Public Health. (2016). Abous Us. Web.
Bučková, J. (2015). Knowledge management in public administration institutions. Procedia Economics and Finance, 34, 390-395. Web.
Gardner, M. (2015). Governor Bentley releases agency cuts in budget passed by the House. Web.
Hinton, A. (2016). ADMH commissioner predicts collapse of state mental health system.Alabama Political Reporter. Web.
Lyman, B. (2015). Cuts could mean layoffs, lawsuits, loss of services.Montgomery Advertiser. Web.
Matei, A., & Băieşiu, R. (2014). Good administration and performance of local public administration. Procedia – Social and Behavioral Sciences, 109, 684-687. Web.
Melson, T. (2016). Improving Alabama healthcare starts with funding Alabama Medicaid.Alabama Political Reporter. Web.
Obama, B. (2016). United States health care reform. Journal of the American Medical Association, 316(5), 525-532. Web.
Rosenbaum, S. (2011). The patient protection and Affordable Care Act: implications for public health policy and practice. Public Health Reports, 126(1), 130–135.