TABLE 1—

Type and Frequency of Barriers to Allocating State Public Health Emergency Response Funding Identified in Grant Reports of State Health Departments: United States, October 2009–May 2010

Type of Barrier	Definition	Sample Quote	No. (%)
Regulatory issues	PHER funds allocation affected by state-specific rules or guidelines	“The state budget change process is lengthy due to the requirement of notification and approval of several control agencies.”	14 (28)
Contracting issues	Accounting or administrative process barriers or difficulties getting signatures or approvals in a timely manner	“Once the Notice of Grant Award is received Reimbursable Service Agreements must be created (accounting structures). This process can take as little as a week or up to 2 months if ledger accounts are not already created. Further, administrative signatures can be the most significant barrier in this process.”	14 (28)
Purchasing issues	Process barrier related to purchasing	“For any capital asset purchased (e.g., cold chain storage, improvements to vaccine tracking systems, computers, ventilators), capital authority must be granted by the Legislative Budget Board. Emergency requests can take weeks or months.”	6 (12)
Legislative issues	Related to a state law or requiring a legislative vote	“State law mandates critical or unanticipated budget changes, such as the award of PHER funds, be approved by the legislature, which requires at least a 30-day notice requirement.”	5 (10)
Staffing issues	Issues in hiring new staff or retaining specialized staff because of questions of continued funding	“Due to current financial situation, the governor and legislature have enacted/instituted extraordinary review processes for new hires.”	5 (10)
Funds transfer issues	Issues transferring funds from the state to the local level	“Getting the money out to the local health departments was a problem. Under the established rules/procedures the money was sent out as an advance, but this created problems as the local health departments were not familiar with doing it that way.”	4 (8)

Note. PHER = public health emergency response.