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The development of the NCLHD Accreditation Program was initiated in 2002 by local health directors across the state with support from the Division of Public Health within the North Carolina Department of Health and Human Services. The program became a legislatively mandated process in 2006. North Carolina was an early national leader in health department accreditation and was the first state in the nation to mandate accreditation for local health departments. Since the North Carolina program started, a national effort through the Public Health Accreditation Board has been established for accrediting local, state and tribal health departments based on the framework and standards of the NCLHD Accreditation Program.


Senate Bill 804, signed in fall 2005, created and funded North Carolina Local Health Department Accreditation, an act to improve the public health infrastructure by establishing an accreditation system for local health departments. The legislation outlines the membership of a governing board to be established within the North Carolina Institute for Public Health.

View the legislation on the NCGA website

§ 130A-34.4. Strengthening local public health infrastructure: effective July 1, 2014, local public health agencies must be accredited by the North Carolina board in order to continue to receive state and federal funding

View the legislation on the NCGA website

Accreditation Rules

The Rules Commission adopted permanent Accreditation Rules, effective October 1, 2006. These Rules were incorporated the Health Department Self-Assessment Instrument (HDSAI), which outlines the standards that local health departments must meet to become accredited. The HDSAI went into effect January 1, 2007.

The Rules Review Commission adopted amendments to the Accreditation rules on April 1, 2015 to respond to passage of HB 438 in June 2012 allowing all counties in N.C. to consolidate human service agencies. Corresponding changes to the HDSAI were approved by the NCLHD Accreditation Board on May 15, 2015 with changes made to Benchmarks 34, 37, 38, 39, 40 and 41.

View the Accreditation Rules (pdf)

Accreditation Program Overview

The NCLHD Accreditation Program seeks to assure and enhance the quality of local public health in North Carolina by promoting the implementation of activities for local public health departments and evaluating and accrediting local health departments on their ability to meet these activities. The program is based on the three core functions of assessment, assurance and policy development and the ten essential services as detailed in the National Public Health Performance Standards Program.

The NCLHD Accreditation Program links basic standards to current state statutes, administrative code and contractual and program monitoring requirements that are already in place through the Division of Public Health. This process allows local health departments to assess how they are meeting national and state-specific standards for public health practice and provides the opportunity to address any identified gaps.

The NCLHD Accreditation Process comprises three steps:

  • 1. Health Department Self-Assessment:

    Each local health department conducts a self-assessment using the Health Department Self-Assessment Instrument (HDSAI). The HDSAI, which includes 41 Benchmarks and 147 Activities, allows health department to assess if they are meeting the established Standards.

  • 2. Site Visit:

    A site visit is conducted by a multidisciplinary team of peer volunteers to review the evidence submitted through the self-assessment, visit the health department and interview staff and community partners to determine if the activities have been met. The Site Visit Team will assign a recommendation for accreditation status based on the results of the site visit.

  • 3. Adjudication:

    The determination of accreditation status is made by the NCLHD Accreditation Board based on the recommendation of the Site Visit Team.

Accreditation is achieved by meeting requirements evidenced by documented completion of prescribed Activities through the completion of the HDSAI and Site Visit. Requirements may be met by either direct provision or assurance (through contracts, memoranda of understanding or other arrangements with community providers) of important services and activities.

While the NCLHD Accreditation Standards and framework of  Benchmarks being applied are similar to the NACCHO Operational Definition of a Functional Local Public Health Agency (2004) and drawn from work done in other states, the Activities are specific to practices in North Carolina local public health agencies.