MPH 508 Week 4 Organizational Assessment Example

Organizational Assessment: The Merritt County Health Department's Readiness to Dispense Medication to 214,000 People in 48 Hours, Judged Against the National Capability Standard

Student Name

Chamberlain University

MPH 508: Leadership and Administration in Public Health Systems

Instructor Name

Month Day, Year

Organizational Assessment: The Merritt County Health Department's Readiness to Dispense Medication to 214,000 People in 48 Hours, Judged Against the National Capability Standard

Scope and Standard

This assessment judges one function of the Merritt County department, the composite agency of 64 staff used throughout this course: its capacity to dispense preventive medication to the whole population within 48 hours of a large biological event. The standard is the national preparedness capability for medical countermeasure dispensing and administration, which sets out what a health department must be able to do, from deciding on a dispensing strategy to receiving supplies, activating operations and dispensing to targeted populations (Centers for Disease Control and Prevention, 2018). The assessment also places this function within the essential public health services framework, which treats preparedness as part of the department's core work rather than a separate grant program (Castrucci, 2021).

Structure as It Operates

On the organization chart, preparedness sits in the Office of the Health Officer, with one full-time coordinator and a half-time planner, both funded by the federal preparedness cooperative agreement passed through the state. In practice, the structure works differently. During an activation, dispensing depends on nurses from the community health division, environmental health staff as site managers and county facilities staff for logistics, none of whom report to the coordinator. Their time is promised in the plan but not in their job descriptions or division budgets. The structure therefore operates as a small planning office that borrows its operational capacity from other divisions.

Where Capability Actually Sits

Capability is unevenly placed. Planning skill sits with the coordinator and planner. Clinical authority, including standing orders, sits with the health officer. Operational experience sits with about a dozen nurses who staffed mass vaccination clinics in 2021 and 2022; four of them have since left. Relationships with closed dispensing partners sit almost entirely with the coordinator, so that each change of coordinator, or each partner contact who leaves, risks the network. Rebmann et al. (2022) found that turnover at partner sites and keeping them engaged were the most common challenges reported by planners managing closed dispensing networks.

Funding and Its Restrictions

The function is funded almost entirely by the federal preparedness cooperative agreement, about $310,000 a year after the state's share. The funds can pay for planning staff, training, exercises and supplies, but they are restricted to preparedness activities, cannot replace county general funds and arrive with deliverables set by the state. No county general fund money supports dispensing readiness. The restriction matters because the operational staff the plan depends on are paid from other programs, whose managers have no budgetary reason to release them for drills.

Culture, Through Evidence

The department's culture can be judged from behavior rather than adjectives. Attendance at the 2025 full-scale dispensing exercise was 31 of 48 assigned staff, and 9 of the 17 absences were from divisions whose managers cited caseload. After-action reports from 2023, 2024 and 2025 each listed slow setup of the dispensing site as a finding, and the same corrective action, a pre-staged supply cache, was assigned each year and not completed. These patterns suggest that preparedness is respected but treated as secondary to daily programs, and that corrective actions lack an owner with authority to complete them.

Judgments Against the Standard

Table 1

Dispensing Capability Judged Against the National Standard

Note. Note. Status from the department's composite exercise records, 2023 to 2025.

The department meets the standard for receiving supplies, partly meets it for strategy and activation, and does not meet it for reaching residents who cannot come to a dispensing site. National data suggest these gaps are common: in a survey of disaster planners, about half of jurisdictions had written closed dispensing plans and almost half had trained no dispensing staff in the previous two years (Rebmann et al., 2014).

One Gap and Its Cost

The gap that matters most is the shrinking closed dispensing network. Each closed site removes people from the public lines. The current network covers about 11,000 people, roughly 5% of the county; the plan assumes 45,000. If an event occurred today, the public sites would need to serve about 34,000 more people than planned within the same 48 hours, which the department's own throughput data suggest is not possible without adding at least two more public sites and staffing them, staff the department does not have. Closing that gap requires relationship work with partners, which the current structure leaves to one person, and an owner for the supply cache that each year's after-action report has asked for.

Strengths Worth Keeping

The assessment found real strengths that a plan to close gaps should not disturb. The receiving function works: the county warehouse agreement has been tested and the warehouse staff know the procedure. The health officer has signed standing orders for the main medications and reviews them each year, which many health departments lack. The nine remaining closed sites include two long-term care facilities whose residents could not reach a public site, so the network, though small, covers some of the people most in need. And the department has a recent record of mass vaccination clinics from 2021 and 2022, so a core of staff has dispensed at scale under pressure. These strengths suggest the department does not need a new structure; it needs to fix where relationship work and corrective actions sit.

What the Department Should Do First

Two actions follow directly from the findings. First, give the supply cache corrective action an owner with budget authority, the community health division manager, and a date, so that the finding repeated for three years is closed. Second, spread partner relationships beyond one person, by assigning senior staff as second contacts for each closed site, so that turnover on either side does not end an agreement. Both actions cost little money; they cost decisions about who owns what.

References

Castrucci, B. C. (2021). The "10 Essential Public Health Services" is the common framework needed to communicate about public health. American Journal of Public Health, 111(4), 598-599. https://doi.org/10.2105/AJPH.2021.306189

Centers for Disease Control and Prevention. (2018). Public health emergency preparedness and response capabilities: National standards for state, local, tribal, and territorial public health. https://www.cdc.gov/readiness/media/pdfs/CDC_PreparednesResponseCapabilities_October2018_Final_508.pdf

Rebmann, T., Foerst, K., Charney, R. L., Mazzara, R. L., & Sandcork, J. (2022). Challenges in managing, sustaining, and assessing closed point of dispensing sites: Findings from a qualitative study. PLOS ONE, 17(7), e0271037. https://doi.org/10.1371/journal.pone.0271037

Rebmann, T., Loux, T. M., Swick, Z., Reddick, D., Dolgin, H., Anthony, J., & Prasad, R. (2014). A national study examining closed points of dispensing (PODs): Existence, preparedness, exercise participation, and training provided. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 12(4), 208-216. https://doi.org/10.1089/bsp.2014.0014