Department of Health’s nine public health districts

The Department of Health plans to shutter six of its public health district offices by June 30 as part of a massive agency-wide reorganization that it hopes will help the department reconcile a $12 million budget cut.

Currently, much of the administration for the Department of Health is divided between nine public health districts, with each district overseeing the county health offices they serve. The new plan consolidates these nine district offices into three regional offices, composed of a northern, central, and southern region.

The Department of Health has not yet decided where the three new offices will be located, nor has it determined which ones will close.

The goal, according to Liz Sharlot, communications director for the Department of Health, is to cut agency expenses without cutting what she called “core public health services.” As a result, she said, the department is looking at making most of its cuts in administrative areas, although certain services will be cut as well.

“We know that we have got to make changes, reorganize the store so to speak,” Sharlot said. “Really what we’re doing, we’ve been trying to operate more like a business model. We want to be more efficient and effective and align our funding streams and decrease our administrative costs.”

Administrative reorganizations are not new to the Department of Health. Last year, the department cut is 81 county health offices down to 72. Sharlot said closing more county offices this year, however, “is not on the table.”

In fiscal year 2017, the state appropriation for the Department of Health was $36 million, although a series of state-wide mid-year budget cuts eventually whittled that down to $31 million.

Next year’s appropriation of $24.6 million represents a 32 percent cut to the budget from last year’s original $36 million appropriation. Sharlot said the agency plans to absorb some of the costs by not filling currently open positions and positions that will open when employees leave the department or retire.

But, she said, job cuts are inevitable.

Liz Sharlot

“We’re still going to have to look at reduction in workforce,” Sharlot said.

Currently, the department employs approximately 1,800 people. Sharlot said the department had not decided how many positions it would need to eliminate.

The department also plans to eliminate some services, although Sharlot emphasized that what she called “core public health services” won’t be among them. These include food and daycare inspection, water safety and public disease control.

Possible cuts include some of the best-known programs at the county health offices, such as childhood immunizations, the Early and Periodic Screening, Diagnosis and Treatment program and maternal health services.

Sharlot said the decision is also driven by the department’s new “business-oriented” approach — those three programs were declining in popularity and costing the department money.

In fiscal year 2009, the Early and Periodic Screening program saw 44,000 patients. In fiscal year 2016, that number had fallen by almost half to 23,000. The same pattern appeared in maternal health, where during that same time period the number of patients dropped from 7,741 to 4000. Childhood immunizations between fiscal years 2009 and 2015 fell from 207,000 patients to approximately 96,000.

Sharlot said the changes are largely due to the Affordable Care Act, which allowed Medicaid to reimburse doctors for these services.

“You have to look at changing numbers if you’re a business,” Sharlot said. “If people are not buying this shirt that you’re selling, you’re going to buy a different shirt, and if people aren’t using our services we’re going to provide different ones. We’re going to move to a more preventative health model.”


Larrison Campbell is a Greenville native who reports on politics with an emphasis on public health. She received a bachelor’s from Wesleyan University and a master’s from Columbia University's Graduate School of Journalism.Larrison is a 2018 National Press Foundation fellow in public health, a 2019 Blue Cross Blue Shield Foundation of Massachusetts fellow in health care reporting and a 2019 Center for Health Journalism National Fellow.