.- -A - United States General Accounting Office Report to the Chairman, Committee on Energy and Commerce, House of Representatives 1 April - 1989 ruBLICHEALTH nT Tn- Centers for Disease Control Staffing for GAO United States General Accounting Office Washington, D.C. 20648 Human Resources Division B-230539 April 2’7, 1989 The Honorable John D. Dingell Chairman, Committee on Energy and Commerce House of Representatives Dear Mr. Chairman: In April 1988, you requested information on the extent to which the Centers for Disease Control (CDC)has reallocated staff from ongoing pro- grams to support acquired immunodeficiency syndrome (AIDS) activities, as well as the potential effects of these reallocations on CD& other pub- lic health missions. We briefed your staff on our preliminary results on November 8, 1988, and agreed to present our findings in this report. CDC,an agency in the Department of Health and Human Services (HHS), Background is one of the federal Public Health Service agencies responsible for com- bating AIDS, which is caused by the human immunodeficiency virus (HIV). CDCleads AIDSeducation and surveillance programs to track and reduce the spread of HIV and also conducts epidemiological research on how HIV is transmitted. CDCbegan its AIDS effort in 1981 by reallocating four staff-years from other programs to work on the emerging health problem. By fiscal year 1988, CDChad allocated over 400 staff-years to its AIDSactivities. CDC’S total AIDSbudget also increased significantly, from about $200,000 in fiscal year 1981 to about $306 million in fiscal year 1988. Since 1983, the Congress has increased funding and, concurrently, perti- Results in Brief nent oversight committees have directed CDC to allocate an increasing number of staff-years specifically for AIDSprograms. By 1988, about 40 percent of AIDSstaff-years were allocated pursuant to specific congres- sional directives and the remaining 60 percent were reallocated from other programs. Although it is customary for CDC to shift staff tempo- rarily to priority areas, the AIDSprogram will probably take a large share of resources in the foreseeable future because the epidemic does not appear to be abating. CDCofficials report that allocating staff to AIDSprograms has had less effect on meeting existing programs’ missions than on the agency’s abil- ity to start and expand programs. Moreover, during the same time that staff were shifted to AIDS activities, CDCalso reallocated staff from Page 1 GAO/‘HIUN3985 CDC StafTlng for AIDS Programs 5230639 -- existing programs to other new and ongoing programs. Therefore, any effects on programs losing staff-years could not be attributed solely to expansion of AIDs activities. Finally, CDC does not account for actual staff time spent by program or activity. As a result, the agency cannot easily determine and document staffing needs for its diverse activities. These activities include the high priority AIDSprograms, which have been the subject of congressional oversight hearings on adequacy of resources, including dollars, staff, and space. We recommend that CDCstaff develop better management information so that the agency and the Congress can make more fully informed staff allocation decisions. (See p. 7.) In March 1988, the Director of CL%testified before the Congress that CDC Principal Findings budgeted 416 staff-years for AIDSactivities during fiscal year 1988. Of these staff-years, 251 were diverted from other programs and 165 were allocated for AIDSactivities pursuant to specific congressional directives. In November 1988, CDCestimated that 489 staff-years had actually been used for AIDSactivities,in fiscal year 1988-a difference of 73 staff- years. CM: estimated this staff usage by surveying its employees and asking them to recall how much time they spent on AIDSactivities. This survey method was necessary because CDC’S time and attendance system is a sign-in/sign-out system that accounts for total hours worked but does not track actual staff time expended by program or activity. Conse- quently, CDCestimates of staff-years devoted to AIDSactivities cannot be independently verified. Between 1981 and 1988, CDC’S staff-years allocated to existing programs decreased by about 1,250, while staff working on AIDSactivities and other new programs increased. Most of these cuts were for services that CDCcontracted out. About 430 staff-years, however, were cut from other public health programs. As agreed with your staff, we conducted preliminary work to determine Objectives, Scope,and the availability of information pertaining to (1) staff-year reallocations Methodology from other CDCprograms to AIDSactivities and (2) the effects of such reallocations on the other CDCprograms. Page 2 GAO/- CDC Staffing for AIDS Programs B-230639 To do this, we interviewed CDC officials in the Office of the Deputy Director for AIDS,’ Office of Program Support, Financial Management Office, Center for Health Promotion and Education,2 Center for Infec- tious Diseases, and Center for Prevention Services. We also asked CDCto survey its employees to estimate staff-year reallocations from other pro- grams to AIDS activities, and we analyzed documentation on CDC’Sper- sonnel ceilings and AIDSbudgets. At your request we did not obtain written agency comments. The views of agency officials were sought during the course of our work, however, and are incorporated where appropriate. We did our work in accordance with generally accepted government auditing standards from August 1988 to December 1988. In its annual budget, CDC is provided an overall staff-year ceiling by the CDC Reallocated Staff- Office of Management and Budget in the Executive Office of the Presi- Years From Other dent, HHS,and the Public Health Service; however, staff-years are not Programs to Support generally authorized by individual program. To fulfill its overall mission of preventing unnecessary illness and premature death, CDCallocates its AIDS Activities staff-years to problems or programs deemed to have the highest priori- ties, including rapid response to public health threats such as the HJY epidemic. Since the emergence of AIDSin 1981, CDC has allocated an increasing number of its staff-years to AIDSactivities. Through its internal budget process, the agency has reallocated staff-years from other programs to support AIDSactivities, starting with 4 in fiscal year 1981, and totaling 251 in fiscal year 1988. During this period, CDC, as part of the annual appropriations process, has agreed, based on congressional recommen- dations, to allocate staff-years specifically for AIDSactivities, starting with 20 in fiscal year 1983, and increasing each year to 165 in fiscal year 1988. Thus, 416 staff-years were budgeted for AIDSactivities in fis- cal year 1988. Table 1 shows CDC’Sstaff-year ceilings, reallocated staff- years for AIDSactivities and new programs, and staff-years for other programs for fiscal years 1981 through 1988, as provided by the Office of the Director. - ‘In November 1988, the Office of the Director (AIDS) was changed to the Office of the Dn-ector ciIIV). ‘In October 1988, the Center for Health Promotion and Education was reorganized as the (‘mwr for Chronic Disease Prevention and Health Promotion. Page 3 GAO/HRD-8966 CDC Staffing for AIDS Programs B-230639 Table 1: CDC Staff-Year Allocations (Fiscal Years 1981-88) Fiscal year 1981 1982 1983 1984 i 985 1986 1987 1988 Staff-year ceiling 4,249 4,268 4,045 4,151 4,194 4,153 4,142e 4,405e - AIDS staff-year@ 0 0 20 72 89 114 152 ___- 165 AIDS reallocated staff-yearsb 4 25 25 8 8 66 138 251 - New programs - reallocated staff-yearsc 0 17 53 96 144 190 447" 836' - Other programs staff -year+’ 4,245 4,226 3,947 3,975 3,953 3,783 3,405 3.153 %umulatrve staff-years allocated specifically for AIDS activities during the appropriahons process bCumulative staff-years reallocated by CDC from other ongoing programs to support AIDS actrvrtres ‘Cumulatrve staff-years reallocated by CDC from other ongoing programs to start or Increase support for new, non-AIDS programs, such as Superfund. Agent Orange, and injury control. dPrograms In exrstence rn 1981 when AIDS emerged, such as rmmunrzation, tuberculosrs, and sexually transmitted drsease actrvities. eWithout the transfer of the National Center for Health Statistics to CDC (see table 3) the authorized cerlrngs would have been 3,972 in 1987 and 3,904 in 1988. Accordingly, reallocated staff-years for new programs would have been 277 in 1987 and 335 in 1988. CDCofficials reported that as of fiscal year 1988, about 1,250 cumulative staff-years were cut from other programs existing in 1981. They identi- fied over 430 staff-years cut from the budgets of 33 programs. For example, CDCreduced the budget for laboratory activities by almost 62 staff-years; bacterial; parasitic and viral diseases by about 37 staff- years; hospital infection control by about 18 staff-years; sexually trans- mitted diseases by 17 staff-years; and tuberculosis by 10 staff-years. Of the remaining 820 staff-years, about 60 represented the transfer of a Phoenix laboratory to Atlanta, and about 760 reflected services that CDC contracted out. Of these, about 100 staff-years were for overhead ser- vices not associated with specific programs and the rest were in specific programs, including over 175 staff-years for research, health assess- ments, and pilot studies in the Superfund program and about 110 staff- years for vital statistics and census data collection activities in the National Center for Health Statistics. accounts for staff-year use by organizational subunit (e.g., Center Actual Staff-Years CDC for Prevention Services or Center for Infectious Diseases), not by pro- Cannot Be Verified by gram or activity. Although many CDCemployees work on more than one Program or Activity program, the agency’s time and attendance system is a sign-in/sign+ut system that accounts only for total hours worked. Thus, actual time charges cannot be accurately allocated to specific programs cr actlvltles. Page 4 GAO/‘HMMMa CDC Sbffing for AIDs F’mumms Because CDC does not track staff-year usage by program or activity, agency officials must use either budgeted amounts or estimates when requested to provide data on actual staff-years expended and for other management functions. For example, the Director of CDCtestified before the Congress in March 1988 that CDChad allocated 416 staff-years for AIDSactivities during fiscal year 1988. In November 1988, we asked CDC to estimate the staff-years actually used on AIDSactivities during fiscal year 1988. Based on employee surveys at various centers (see table 2), the Office of the Director told us that 489 staff-years were used. Since CDC’Ssystem does not track staff- year usage by program or activity, however, we could not determine the accuracy of the estimate. Table 2: Allocated and Estimated Staff- Years Used by CDC for AIDS ActlvlUer Staff-years for AIDS activities (Fiscal Year 1988) Allocated Used (estimated) Office of the Director, CDC 18.00 79.20 Office of the Director, AIDSa 17.00 15.00 Center for Health Promotion and Educationb 16.00 39.00 Center for Infectious Diseases 239.50 237.20 Center for Prevention ServicesC 88.00 51.7.V Center for Environmental Health and injury Control 1.00 -2.00 - National Center for Health Statistics 5.00 12.10 National Institute for Occupational Safety and Health 1.50 3.00 National AIDS Information/ Education Program 21 .oo 19.00 Epidemiology Program Office 0.00 6.25 Training and Laboratory Program Office 9.00 24.50 Total 416.00 469.00 % November 1988, the Office of the Director (AIDS) was changed to the Office of the Dlrector (HIV) bin October 1988 the Center for Health Promotion and Education was reorganized as the Center for Chronic Disease brevention and Health Promotion. ‘According to the Director, Office of Financlai Management, CDC staff assigned to the states do not count toward the agency’s staff-year ceiling levels in accordance with Public Law 100-202 Conse- quently, estimated staff-years actually used do not include 35 state assignees. According to the Center’s Assistant Director for Management, essentially all staff-years available for AIDS actlvltles were used by year end. The Director of the Financial Management Office said that CDCuses the time and attendance system prescribed by HHSfor all of its components. The Director of CDCstated that he is not concerned about the lack of documentation showing actual time used by CDCstaff on a program-by- program basis as long as staff are working hard on priorities established Page S GAO7 CDC Staffing for ADS Programs Is230639 by the agency. The Deputy Director of CDCsaid that CDCemployees can- not be expected to account for their time in such a manner because they are too busy to identify and record time charges against numerous projects and added that the cost of doing so would not be worth the benefits derived. The Standards for Internal Controls in the Federal Government pub- lished by our office in 1983, however, calls upon agencies to account for staff-years used in a manner that allows actual usage to be reported by program or activity. Lack of data on how resources are used constitutes a weakness in management information that predisposes the agency to potential misallocations of staff resources. For example, management cannot compare budgeted to actual staff resources to determine where and why variances exist. Furthermore, agency officials have no histori- cal data to rely on when deciding future resource needs or justifying requests for additional staff in the annual appropriations process. Development of more reliable management information on actual staff usage should strengthen CDC’S budget requests, which have been closely scrutinized by the Congress in the last few years. A method for routine recording of time charges by staff working on numerous projects would be more accurate as well as less burdensome than reconstructing these time charges later by employee surveys. In addition, there is precedent for such a method; CDCemployees assigned to Superfund activities are already required by the Environmental Pro- tection Agency to account for their time charges for reimbursement purposes. According to agency officials, staffing limitations had more of an Effects of Staff-Year adverse effect on CDC’Sability to start or expand new programs than to Decreaseson Other carry out the missions of existing programs. CDCofficials were con- Programs Cannot Be cerned that between fiscal years 1982 and 1988, they could not start or expand about 50 activities. These activities included prevention and Determined control of infectious and chronic diseases, such as hepatitis B, influenza, Lyme disease, and infectious diseases in neonatal intensive care units and day care centers; vaccine programs; and occupational health activities. On the other hand, because other new programs as well as AIDS activities were staffed from existing programs during the same time period, any effects on these programs identified by CDCcould not be attributed solely to AIDS.In addition, we could not substantiate reported actual Page 6 GAO/HRD-8!M6CDCStaffing forAIDSPrograms B230539 staff-year reductions for each existing program because CDCdoes not maintain supporting records. Table 3: Allocated Staff -Years for New CDC Programs (Fiscal Years 1982-88) Proaram 1982 1983 1984 1985 1986 1967 1968 ATDSR (Superfund)” 17 39 47 89 101 138 175 Agent Orange 14 49 55 55 55 55 lniurv Control 20 20 20 Prevention Centers 2 2 2 Chronic Disease Initiative 12 24 29 Pediatnc Nutrition 4 4 Infant Mortality 16 3 Smokina and Health 18 18 Center for Health Statistics 170b 501b Worker Notification 4 Chronic Fatigue Syndrome 2 Disability Prevention 3 Diabetes Translation -7 Totals 17 53 96 144 1% 447b 636b aAgency for Toxic Substances and Disease Regrstry. bThe Nahonal Center for Health Statistics was transferred to CDC in June 1967, and CDC’s staff-year celling was increased accordingly. Although this was a new program for CDC, it did not requrre staff- years to be reallocated from other programs. Consequently, the total reallocated staff-years for new programs for fiscal years 1987 and 1986 should be 277 and 335, respectively. Table 3 shows that of the 836 staff-years allocated to new CDCpro- grams, only 335 were allocated to programs not previously imple- mented. The rest represent staff-years for the National Center for Health Statistics, which was transferred to CDC.Table 3 also lists the new programs other than AIDSthat were started during this period and the staff-years allocated to each. CDCshould implement a method to supplement its current time and Conclusions attendance system to account for staff-years used by program or activ- ity. This will allow proper classification and reporting of such informa- tion for internal management or when needed by the Congress and others for oversight, evaluation, or other purposes. Recommendation employees’ actual time spent on each program or activity. Page 7 GAO/‘HWM985 CDC Staffing for AID6 Programs Unless you publicly announce its contents earlier, we plan no further distribution of this report until 30 days after its issue date. At that time, we will send copies to the Secretary of Health and Human Services; the Director, Office of Management and Budget; and the Director, Centers for Disease Control. Copies also will be made available to others on request. This report was prepared under the direction of Janet L. Shikles, Direc- tor of Public and National Health Issues. Other major contributors are listed in appendix I. Sincerely yours, Lawrence H. Thompson Assistant Comptroller General Page 8 GAO/HRD-fWX CDC Staffing for AIDS Programs Page 9 GAO/lIlWW85 CDC Staffing for AIDS Progmms Appendix I Major Contributors to This Report Janet L. Shikles, Director of Public and National Health Issues, Human Resources (202) 275-545 1 Division, Cynthia A. Bascetta, Assignment Manager Washington, D.C. Carl S. Mays, Evaluator-in-Charge Atlanta Regional Leo B. Sullivan, Site Senior Office Lisa M. Warde, Staff Member (109892) Page 10 GAO/HRD-8946 CDC Staffing for ADS Programs &%quests for copies of GAO reports shouki be sent to: U.S. General Accounting Office post office Box 6015 Gaithersburg, Maryland 20877 Telephone 202-275-6241 The fast five copies of each report are free. AdditionaI copies are $2.00 each. There is a 25% discount on orders for 100 or more copies mailed to a single address. Orders must be prepaid by cash or by check or money order made out to the Superintendent of Documents.
Public Health: Centers for Disease Control Staffing for AIDS and Other Programs
Published by the Government Accountability Office on 1989-04-27.
Below is a raw (and likely hideous) rendition of the original report. (PDF)