Project Public Health Ready’s New Support Response Agency Criteria Now Includes Regional Agency Models

The National Association of County and City Health Officials (NACCHO) kicked off the Project Public Health Ready (PPHR) program in 2003. PPHR criteria aligns to three goals: 1) All-hazards Preparedness Planning; 2) Workforce Capacity Development; and 3) Demonstration of Readiness through Exercise or Real Event. The original criteria was designed to assess a primary response agency, or health departments who lead operational responses to a public health emergency; while this includes the majority of local health departments who apply for the PPHR program, there are other applicants who operate in a support response agency model, such as regions. To be more inclusive of regional agency models, NACCHO recently rolled out an addendum to the criteria called the Support Response Agency framework.

In 2004, NACCHO widened the application pool to include regional agencies to better understand the challenges faced by local health departments (LHDs) with complex boundary or jurisdictional issues. During the 2004 review cycle, PPHR reviewers found that regional approaches to preparedness varied widely and demonstrated capacity building obstacles including communication, logistics, and management. Competing political and legal structures across jurisdictions compounded these issues. Over time, the regional applications were phased out and all applicants were required to use a single application. Reverting to using a standard application again presented many challenges. Globally assessing LHDs and Regions on the same criteria is inherently difficult as regions may operate differently across the nation. Some LHDs have operational authority to lead response and recovery efforts, whereas others take on a supporting role, assisting their LHDs as the leading entities in local response efforts.

Last year, in an effort to address these challenges, the Preparedness Planning, Outcomes and Measurement (PPOM) Workgroup examined the possibility of creating PPHR criteria geared specifically toward support response agencies—those agencies whose response role is support of local ‘boots on the ground’ agencies. A kick-off meeting was held immediately following the 2016 in-person national review meeting for PPHR, where selected reviewers were asked to participate in focus group meetings. There were three separate focus group meetings held throughout the country focusing on specific topics and involving different stakeholders. Participants included previous PPHR reviewers (including reviewers of regional applications), previous PPHR applicants (including regional applications), subject matter experts (SMEs) from state and local health departments, and a contingent of New England States to provide unique perspectives on operational responses with and without authority. The last focus group meeting took place at the 2017 Preparedness Summit where the draft Support Response Agency (SRA) criteria and framework was presented during a learning session. Active participation from audience attendees was captured via live feedback devices and question-and-answer sessions. The development of the SRA criteria was overseen by an ad-hoc workgroup consisting of approximately 10 PPHR SMEs with Melissa Marquis of the West Hartford-Bloomfield Health District and Robert Goff of the Tennessee Department of Health, Southeast Region, acting as workgroup chairs. Upon completion, the criteria were presented to the PPOM committee for review and approval.

At first glance, the standard criteria and SRA criteria might appear to be similar, and for the most part, they are. The standard criteria requires that a primary response agency (PRA) provide evidence regarding how the agency will directly respond to emergencies and how that response will be staffed and managed. The SRA criteria, requires that an SRA provide evidence regarding how the agency will support a PRA. For example, a PRA might be required to show the assignments of employees during a response. The SRA might be required to explain the process for activation and deployment of employees at the request of the PRA, but not the roles SRA personnel will fill, because the SRA might not know the assignments in advance. Another significant change is the addition of pre-application checklist. This checklist will assist NACCHO, in consultation with the respective state lead, if the agency should complete the PRA or SRA criteria.

The SRA criteria offers a new set of standards which are intended to recognize the hard work and planning of agencies that are designed to offer logistical, material, and operational support to primary response agencies. The SRA criteria will give agencies a platform to define and describe their valuable and necessary role in public health emergency preparedness and response. To learn more please or contact

Project Public Health Ready (PPHR) is a criteria-based training and recognition program that assesses local health department capacity and capability to plan for, respond to, and recover from public health emergencies. The program recognizes excellence in emergency preparedness planning, training and exercises for local health departments across the country. PPHR provides health departments with a national standard which they can use to measure their capabilities and ensure they are effectively responding to an emergency or disaster. Health agencies (including regional and supportive response agencies) can apply for this prestigious recognition. NACCHO is the only institution that provides this national recognition.

Since 2004, more than 475 LHDs have been recognized as meeting all the PPHR requirements individually or working collaboratively as a region.

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