By Misti Crane

They spend taxpayer dollars for vital tasks such as uncovering contaminated foods and stemming the spread of deadly diseases.

But unlike hospitals, public health agencies have not been held to uniform standards.

Now, under state law, health departments in Ohio must earn national accreditation. If they don't receive the Public Health Accreditation Board's stamp of approval by 2020, they'll be cut off from the state and federal dollars that keep them afloat.

The Ohio Department of Health pushed for the law -- currently the only one like it in the nation -- because officials there wanted a common benchmark of quality, capability, policy and reporting, said department spokeswoman Melanie Amato.

The department distributes millions of dollars -- $86 million in 2014 -- in state and federal grants to Ohio's 123 local health districts.

Those that already can boast of accreditation (five departments so far) and those that have reported they're working on it (all the rest, save for 15) characterize the process as daunting and resource-intensive.

But they also say the board's criteria are reasonable and will make them better, if they haven't already. The state Health Department also is in the process of seeking accreditation.

The Public Health Accreditation Board began its work in 2011 as a voluntary system that allows departments to seek approval if they want to hold themselves up to nationally recognized, evidence-based standards.

The goal is to improve public health by pushing departments to do better work and regularly monitor their quality and progress.

Accreditation costs from about $12,700 for the smallest departments to $95,400 for the largest. Out of recognition that funding is tight and many departments are tiny, there are payment-plan options to help ease any financial burden.

Because the board is subsidized by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, it does not have to pass all of its costs to the health departments, said Kaye Bender, the board's president and CEO.

As of last week, 75 departments across the United States had received accreditation, and 259 were in the review process.

At the front end of the process, departments have to assess their community's needs, ideally by cooperating with others in the area, including hospitals, Bender said. They also must create community-improvement and strategic plans specific to the department.

Progressive health departments already do this kind of work, Bender said, and usually can get through initial accreditation in a year to 18 months. Accreditation must be renewed every five years.

Columbus Public Health was among the first in Ohio to seek and receive accreditation. Even though it is a larger department with many resources, the process was challenging, said Laurie Dietsch, the agency's accreditation coordinator.

She said she pulled more than 450 documents and had to pull aside employees who ordinarily would have been working on other tasks.

"It was labor-intensive, but it also was really fair," Dietsch said. "If we're really about protecting health and improving lives, why wouldn't we seek accreditation?"

The process helped Columbus standardize its approaches to everything from communicating with the public to responding to Ebola, she said. Once a month, staff members sit down and check in on how things are going.

The effort also called for interaction with the broader community to think deeply about how to better address problems, including the high rates of infant death and sexually transmitted disease, Dietsch said.

The other accredited health departments in central Ohio are the Delaware General Health District and the Licking County Health Department. All the others in the area have reported to the Ohio Department of Health that they are working toward accreditation.

"It's a very thorough and intense process," said Lois Hall, executive director of the Ohio Public Health Association, which represents health departments. The process helps departments strengthen the things they already do right and shines a light on things that need improvement, she said.

"It's always good to take a look at yourself and say, 'What am I doing, how could I do better?'" Hall said.

Some small health departments are struggling to figure out how to pull off accreditation given the state requirement.

"It'll cost them both in time and dollars, and there aren't a lot of extra funds set aside for that," Hall said.

The Pickaway County General Health District is sharing an accreditation coordinator with Fayette County to keep costs down and is receiving assistance from a local doctor who is working on a master's degree in public health, said Elaine Miller, director of clinical services in Pickaway County.

"It's a time-consuming process. We're just doing as much as we can," she said. "We don't have a lot of us -- 14 people -- and it's really difficult to do anything extra."

Mary Ann Webb, Madison County's health commissioner, said she has a levy-renewal request coming up, and the future financing for her department "kind of scares me."

Hiring someone to lead the accreditation work "is a drain on our budget, but we don't really have an option," she said.

And pulling staff away from grant writing and other aspects of their workloads is not ideal, she said. But the goal is worthwhile, Webb said. "It'll help us to improve. It already has."

Bender said the accreditation board has heard many concerns from smaller departments and is exploring an alternative pathway for them.

(c)2015 The Columbus Dispatch (Columbus, Ohio)