Background: The national accreditation of health agencies is anticipated to be a driving force for improving public health agencies’ administration, governance, and the capacity to provide essential public health services.

Purpose: This study examines local health departments’ (LHDs) and state health agencies’ (SHAs) engagement in accreditation, barriers to accreditation, and factors associated with level of engagement in accreditation. Method: Data from The National Association of County and City Health Officials’ 2013 Profile of LHDs and The Association State and Territorial Health Officials’ 2012 Profile of SHAs were used. Multinomial logistic regression was performed with levels of engagement as the outcome variable.

Results: Six percent of LHDs and 27% of SHAs had either submitted an application or statement of intent, whereas 15% of LHDs and 4% of SHAs had decided not to pursue accreditation. Significant predictors of variation in level of LHD engagement in accreditation included population size in the LHD jurisdiction, governance category, MD degree of top executive, LHD with one or more local boards of health, LHD’s collaboration with other organizations, per capita expenditures, and performance of two of the PHAB accreditation pre-requisites, namely community health improvement plan (CHIP), and agency-wide strategic plan (SP). Most frequently reported reasons for LHDs for not pursuing accreditation were time/effort required for accreditation exceeds benefits (72%), fee too high (54%), and standards exceed the capacity of their LHD (39%). SHA’s did not perceive the same barriers; only 2% indicated fees being too high, and 2% reported ‘other’ reasons.

Discussion/Conclusion: Accreditation is expected to provide the pathways to ensure accountability, consistency, better fit between community needs and public health services, and uniformity across health departments. National strategies targeting rapid diffusion of accreditation among public health agencies should include elements that address the needs of LHDs with varying degrees of intent to pursue accreditation.