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)

                 -A   -

                          United   States   General   Accounting   Office
                          Report to the Chairman, Committee on
                          Energy and Commerce, House of

1 April
   -      1989
                          nT       Tn-

                          Centers for Disease
                          Control Staffing for
GAO                United States
                   General Accounting Office
                   Washington, D.C. 20648

                   Human Resources Division


                   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

                        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

                         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

                         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

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

                        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

                        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

                        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

                                          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

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
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