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NCLHD Accreditation Program Frequently Asked Questions

Accreditation establishes a basic level of capacity and service that a local health department must provide to ensure the health of the public.
The North Carolina (N.C.) Division of Public Health and the N.C. Association of Local Health Directors established the NCLHD Accreditation Program in 2002 to ensure that all health departments in North Carolina meet the basic level of capacity and public health service.

The program continues to be a collaboration between the North Carolina Institute for Public Health (NCIPH), part of the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, the N.C. Association of Local Health Directors, and the N.C. Division of Public Health. NCIPH provides accreditation staff support including an Accreditation Administrator, Program Assistant and Training Coordinator.

There are three main steps for the NCLHD accreditation process: self-assessment, site visit and NCLHD Accreditation Board approval. First, a health department conducts a self-assessment and submits evidence that they meet established standards. Following the self-assessment, a four-person team of peer experts reviews the evidence, visits the health department and conducts interviews with staff and local partners. The site visit team produces a report and submits it to the NCLHD Accreditation Board. The NCLHD Accreditation Board makes the final determination whether the health department meets the standards for accreditation. Learn more about the process.
Once a health department has demonstrated that they met the minimum number of Activities for the Benchmarks, they are accredited for four years. Six months before their accreditation expires, they begin the process again.
If a health department does not meet the Standards for accreditation, they are conditionally accredited. A health department can be conditionally accredited for up to two years, during which time they are required to put a plan in place to meet accreditation Standards. If the conditions of the plan are met, the health department will receive accreditation. If the conditions are not met, the health department will be unaccredited.
Each health department is part of a cohort assessed on a four-year cycle. Two cohorts go through the assessment process per year.
North Carolina is the first state to mandate local health department accreditation. Since the pilot program involving six local health departments began in 2004, all 84 health departments in N.C. have been initially accredited and all have been reaccredited at least once. View the Accreditation Schedule to see past and future accreditation dates for each health department.
Accreditation ensures that local health departments provide a basic level of capacity and service. It does not limit a health department from adding services or activities to meet local needs. Many health departments strive to provide services beyond what is required for accreditation.
The NCLHD Accreditation Program provides an efficient way to ensure local health departments meet minimum requirements by linking basic standards to current state statutes, administrative code and the contractual and program monitoring requirements that are already in place through the N.C. Division of Public Health.

Accreditation is an ongoing process that allows health departments to assess their services compared to recognized standards and address any identified discrepancies. Through this process, health departments can regularly assess and improve the quality of their services. The process also supports staff and leadership development and community engagement.

Every health department in N.C. is different; they have different organizational structures and serve different populations. The NCLHD Accreditation Program uses a set of 147 Activities to objectively assess health departments on a wide range of capacities and services in a way that is applicable across the state. For example, to address customer service, one Activity requires local health departments (LHDs) to conduct customer satisfaction surveys, analyze them and consider improvements based on feedback. The Activity does NOT, however, “grade” a health department based on that feedback. Likewise, to assure that LHDs are conducting services in a compliant manner, one activity requires LHDs to show that they are in compliance with N.C. Division of Public Health (NCDPH) program reviews/audits through verification from NCDPH. This Activity does NOT conduct these program reviews/audits, but rather relies on subject-matter experts at NCDPH to conduct the reviews. As a last example, to address agency leadership, multiple Activities address having in place or being in the process of hiring a Health Director who is in compliance with N.C. General Statute requirements and having a system in place to assess performance. These Activities do NOT, however, directly assess that leader’s performance. Overall, these Activities require a health department to have a Quality Improvement/Quality Assessment system in place, but it is up to the agency to follow through and act accordingly to improve their practice.
The NCLHD Accreditation Program has a reliable accreditation process in place; however, we understand that there may be concerns about issues not apparent in our process. The NCLHD Accreditation Board will document and investigate complaints/allegations received against currently accredited local health departments that relate to accreditation Standards and Activities.

Complaints are submitted to the NCLHD Accreditation Program and reviewed by the NCLHD Accreditation Board. Complaints must be specific to accreditation Standards and Activities; we do not accept general complaints about a health department.

The NCLHD Accreditation Program has a policy and established procedures for accepting complaints. To learn more or to submit a complaint, please visit the “Report a Complaint” page.

You can learn more about the NCLHD Accreditation Program by exploring this website including the “About the NCLHDA Program” section, or by emailing us at