During the first wave of H1N1, North Carolina identified and adapted contracting processes to facilitate more efficient and expedient response to the pandemic. Bureaucratic processes for contracting and response spending are often cited as a key barrier to using grant funding: many state Public Health fiscal systems and human resource systems cannot process funds and personnel changes with the adeptness needed for rapid response.
In responding to the emerging pandemic in April 2009, North Carolina identified the inherent processes in these systems that needed adaptation. These included the ability to rapidly process travel authorizations, purchase orders, and contracts, occasionally at non-traditional hours. In addition, the state also examined personnel policies such as flexible work schedules, time-keeping that fulfilled separate state and federal system requirements, and deploying personnel across agency and jurisdictional borders, which were affected during the early phases of H1N1 response. Additional issues that would arise were recognized as the second prolonged wave was anticipated.
To identify critical issues, a series of training sessions and a facilitated discussion exercise series were established specifically with the North Carolina Division of Public Health Human Resources and Budget Offices. The first step was a training program offered by the North Carolina Emergency Management Agency to review federal public assistance program opportunities and requirements.
Through these discussions and trainings, programmatic changes were established to capture expenditures using forms adapted from the FEMA Force Account Summaries. These correlate directly with North Carolina DHHS/DPH accounting and reporting forms so that data is easily transferable and input is made easy.
In addition, a discussion was conducted with DPH Budget Office staff including DPH Human Resource staff and procurement, contract, and compliance representatives. Using a standard scenario, the facilitated discussion focused on how these offices would interact with the Incident Management Team (IMT) and what demands would be placed on established systems. As a result, staff from both teams became more familiar with the reporting and documentation needs, process elements that needed revision, and what systems needed to have additions to accommodate non-traditional requests. An emergency meals policy was generated. Timekeeping system changes were instituted to document response hours centrally rather than using separate forms.
Most importantly, the administration staff, which typically does not serve on the IMT, gained an understanding of the IMT expectations; the IMT in turn left with an understanding of the requirements associated with the response spending processes. This was reflected in the Division's ability to distribute a majority of the PHER grants within 30 days, provide timely fiscal support to the H1N1 response at the state level, and to accumulate appropriate and adequate documentation with much less duplication and stress.