Objectives: The primary purpose of this study is to examine whether engagement in Public Health Accreditation Board (PHAB) accreditation process and its prerequisites are associated with financial resiliency of local health departments (LHDs).

Methods: For this study, we performed multinomial logistic regression using the 2016 National Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials.

Results: While budget did not change for a majority of LHDs in comparison with previous year (48.6%), there were 28.7% that reported budget increase, and almost a quarter of LHDs had reduced budget (23%). The multinomial logistic regression showed no significant association between LHDs that are accredited by PHAB or completed any of its prerequisites and their budget increase than previous year or even maintaining their budget the same as last year. However, government type, service delivery reduction, and proportion of revenue from local sources were significantly associated with budget increase.

Conclusion/Implications: Improved public health outcomes rely heavily on LHDs capacity to deliver quality essential public health services aligned with community health needs, which requires providing LHDs with adequate and consistent funding. LHDs have to find ways to overcome financial difficulties, maintain their existing funds, and try to find new revenue sources. Funding agencies and policymakers should support LHDs with the adequate funding and find strategies to help LHDs to be well-prepared for any future financial threats. LHDs may also want to diversify their funding through strategies to increase funding from local sources.