PER-0189

We are pleased to submit this performance audit of the Martin-Tyrrell-Washington District Health Department (MTW). This audit was requested by Secretary David Bruton of the Department of Health and Human Services (DHHS). This report consists of an executive summary, operational findings and recommendations, and program overview. The objectives of the audit were to: 1) determine and assess governance and oversight responsibilities for MTW, 2) determine the appropriateness of MTW's budget and audit processes, and 3) review and assess operational and fiscal management practices. Some of the recommendations include: The General Assembly should consider modifying existing statutes to clearly define the level of oversight responsibility DHHS and local boards of health should exercise over local health departments. DHHS should develop specific monitoring procedures and establish a notification process for troubled health departments to ensure Board chairpersons and county managers are kept adequately informed of concerns. We concur with DHHS decision to continue to offer support until MTW is running efficiently with well-trained staff. However, the current level of support for MTW severely limits staff available to assist other health departments. DHHS should determine the appropriate level of staff needed to adequately provide effective assistance to the State's local health departments. DHHS should then request additional resources from the General Assembly. The County Commissioners from each of the participating counties should actively seek persons from the required professions for appointment to the MTW Board of Health. We encourage the Commissioners to continue to appoint representatives to the Board who have substantial knowledge of governmental accounting and budgeting. Additionally, the General Assembly should consider revising GS Sec. 130A-37 to require local boards of health to include members with governmental accounting and budgeting experience. The General Assembly should consider revising the statutes to charge DHHS with requiring that members of local boards of health undergo training in fiscal management, budget development, fiscal accountability, and orientation on operational issues. The Association of Boards of Health offers this type training at little cost to local boards. MTW management should identify needed repairs to all health department facilities and bring these to the attention of the Board of Health. The Board should request assistance from each of the three counties in addressing the physical plant needs of the health department as funds become available. The MTW Board and Health Department Director should immediately put controls in place to ensure compliance with the Local Government Finance Act in its entirety. The Director should designate a qualified individual to prepare a balanced, realistic budget and present it to the Board for approval prior to statute deadline. Changes to the budget should be made only after the Board has approved budget revisions.