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What Is a Uniform Chart of Accounts?


How can public health leaders make sure they are using money as effectively as possible? Which programs are the most efficient? Which investments are the most worthwhile? Why do public health services vary in their costs across local health departments? How do public health investments affect these costs?

To answer these questions, public health leaders need to be able to compare the finances of different health departments. But that’s not currently possible because 2,800 local health departments across the country use almost 2,800 unique accounting systems. Without standard categories for programs and activities, it’s hard to make meaningful comparisons across departments.

The Uniform Chart of Accounts (UCOA) solves this problem by providing a standardized format for tracking local public health revenue and expenditures. It provides tools for financial professionals to crosswalk existing fiscal data with standard categories and enter them into a database that will allow a better understanding of public health finance.



Developing the Uniform Chart of Accounts


Many organizations have come together to make the UCOA a reality. 

In 2012, the National Academy of Medicine (NAM) identified the need for a public health uniform chart of accounts. Soon thereafter, the Public Health Informatics Institute (PHII) started work to standardize reporting on public health spending. The PHII developed a uniform chart of accounts aligned with the Foundational Public Health Services (FPHS) model developed by the Public Health Leadership Forum.

The team of researchers at PHAST (Public Health Activities and Services Tracking) built on this work through a grant by the Robert Wood Johnson Foundation. In 2015–2017, PHAST conducted a feasibility study, piloting a UCOA in local and state health departments. In this pilot study, 19 participating agencies were able to successfully crosswalk—or match—and report their financial data into the UCOA.

PHAST is now building on this work, using the UCOA to track public health expenditures and revenue in local health departments across the nation.



Why Join the Uniform Chart of Accounts?


The UCOA will help advance the field of public health as a whole. But it’s also valuable to individual agencies that choose to participate.

With the UCOA, you’ll be able to compare your data to other health departments both within and outside of your state. You’ll be able to use the data for your own planning and quality improvement. You’ll also be able to use it to inform policy makers and the public about how to make tough choices and allocate tight budgets.

According to the health departments that participated in PHAST’s pilot study, the UCOA was valuable to:

  • Understand the costs of individual programs and services
  • Analyze revenue sources
  • Improve the budgeting process
  • Communicate public health’s function to the public
  • Help legislators and boards of health understand the need for added investments in public health
  • Evaluate cross-jurisdictional sharing arrangements
  • Benchmark financial performance with peer agencies
  • Improve performance management
  • Help with other external reporting



Join Our Project


Help us set the standard for comparing expenditures and revenues in public health! Join the PHAST Uniform COA Project as a practice partner. Please contact the PHAST team via phast@uw.edu to find out how it works.

The PHAST UCOA Project has most recently collaborated with the de Beaumont Foundation, the Public Health National Center for Innovation, the Public Health Accreditation Board (PHAB), and the CDC in the Staffing Up initiative. Staffing Up developed a national estimate of governmental public health staffing levels needed to perform the Foundational Public Health Services. We collected representative data to develop a public health workforce calculator that will allow health departments to determine the number and type of staff to provide sufficient levels of public health services. Although this opportunity is no longer available, we plan to collaborate with PHAB going forward.

View interactive visualizations displaying UCOA data at phastdata.org/viz/coa-dashboard.

Together, we can create better ways to track how public health departments improve communities.