Centers for Disease Control and Prevention: Human Capital Planning Has Improved, but Strategic View of Contractor Workforce Is Needed
Published: 2008-05-28T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The Centers for Disease Control and Prevention (CDC)--an agency in the Department of Health and Human Services (HHS)--has experienced an expanding workload due to emerging health threats, such as bioterrorism. Strategic planning helps agencies like CDC sustain a workforce with the necessary education, skills, and competencies--human capital--to fulfill their missions. In September 2007, CDC released its Strategic Human Capital Management Plan (CDC Plan). GAO was asked to review CDC's human capital planning. GAO determined (1) whether the CDC Plan was designed to address the human capital challenges CDC faces; (2) the extent to which the CDC Plan is strategically aligned with agency goals, plans, and budget; and (3) the extent to which CDC incorporated GAO's principles for strategic human capital planning. To do so, GAO interviewed officials and analyzed data and documents.
section_title: What GAO Found
paragraphs: GAO identified six key challenges CDC faces in its efforts to sustain a skilled workforce to fulfill its mission and goals, and the CDC Plan includes strategies that could help the agency address five of them. These challenges are (1) changing workforce demographics, highlighted by the potential loss of essential personnel due to retirement; (2) the limited supply of skilled public health professionals; (3) CDC's acknowledged need to increase the diversity of its workforce; (4) changing workforce needs resulting from the agency's expanding scope of work and responsibilities; (5) logistical difficulties involved in acquiring and retaining a skilled workforce; and (6) difficulties presented by managing a workforce with a large and growing number of contractors. While the CDC Plan includes strategies designed to address the first five challenges, it does not address the challenge involving contractors, which represent more than one-third of its workforce. Thus, the CDC Plan may not be as useful as it could be to provide a strategic view of its contractor workforce and to assist the agency with managing all of its human capital. The CDC Plan only partially meets the criteria for strategic alignment: the strategies in it are linked with the agency's mission and goals, but they are not integrated with the documents that serve as the strategic plan, performance plan, or budget. According to CDC officials, the agency will update the CDC Plan annually and will integrate it with these documents as it is updated. CDC incorporated aspects of all of GAO's principles of strategic human capital planning into the CDC Plan and has outlined intended actions that could further incorporate the principles in subsequent updates. CDC partially incorporated the first principle--to involve managers, other employees, and stakeholders in developing, communicating, and implementing the human capital plan--by formally involving management and stakeholders in plan development. CDC intends to involve other employees in implementation and future updates. CDC partially incorporated the second principle--to determine the skills and competencies needed to achieve agency mission and goals, including identifying skill and competency gaps--by conducting a preliminary workforce analysis. The agency had not completed its analyses of skill and competency gaps for the occupations it deemed most critical when the plan was developed, but has now completed an analysis for one critical occupation and is conducting others. The plan partially follows the third principle--to develop strategies to acquire, retain, and develop a skilled workforce and to address gaps. CDC developed strategies for its plan and intends to target gaps once they are identified. CDC has incorporated the fourth principle--to build capabilities to support the strategies--through such activities as ongoing efforts to streamline hiring. The fifth principle is to monitor and evaluate the contribution that strategies have made toward achieving mission and goals. The agency indicated in the CDC Plan that it intends to monitor and evaluate its strategies as part of its implementation activities. Further incorporation of GAO's principles into plan updates could help the agency strengthen its human capital efforts.

section_title: Letter
paragraphs: With an annual budget of about $8.6 billion, the Centers for Disease  Control and Prevention (CDC) has a mission to promote health and quality  of life by preventing and controlling disease, injury, and disability. The  agency’s scope of work and responsibilities—as one of the major  operational divisions of the Department of Health and Human Services  (HHS)—have expanded over the years in concert with new and emerging  infectious diseases such as avian influenza, and health threats, including  bioterrorism. CDC’s ability to fulfill its mission and address its expanded  scope of work and responsibilities depends on whether it can sustain its  human capital—a workforce with the necessary education, knowledge,  skills, and competencies. However, concerns have begun to surface about  CDC’s management of its workforce. For example, the Office of Personnel  Management’s (OPM) 2006 Federal Human Capital Survey noted a CDC- wide decrease in staff satisfaction with the agency between 2004 and  2006. Reports issued by CDC’s Ombudsman Office in 2007 delineated staff  concerns about personnel problems and the workplace environment.
Additionally, media reports have highlighted several issues related to  CDC’s workforce, such as stories in 2005 and 2006 on the loss of senior  leadership and key scientists and a 2007 journal article discussing  problems with morale at the agency.
CDC’s workforce consists of employees in about 168 occupations,  including physicians, statisticians, epidemiologists, and laboratory  experts. This workforce consists of full- and part-time federal staff—Civil  Service or U.S. Public Health Service Commissioned Corps—and  contractors. In fiscal year 2007, CDC’s workforce included 9,000 federal  staff and an estimated 5,000 contracted staff. Of the federal staff, about  two-thirds worked in CDC’s headquarters in Atlanta, Georgia. In addition,  about 2,500 employees worked at other locations in the United States, and  about 200 federal staff worked in 50 foreign countries. The estimated 5,000  contractors worked in various locations and occupations throughout the  agency.
Managing a complex federal agency such as CDC requires strategic human  capital planning—the systematic assessment of current and future human  capital needs and the development of long-term strategies to address any  identified gaps—in order to optimize workforce performance to achieve  the agency’s mission and goals. In past work, we noted that effective  strategic human capital planning requires strategic alignment. Strategic  alignment exists when an agency’s human capital strategies are linked  with its mission and goals and integrated with its strategic plan,  performance plan, and budget. It is important because it allows agencies  to assess and understand the extent to which their workforce contributes  to achieving their overarching mission and goals. We also noted in our  prior work that strategic human capital planning should incorporate five  principles, which are (1) involving top management, managers, other  employees, and stakeholders in developing, communicating, and  implementing the human capital plan; (2) determining the skills and  competencies needed to achieve an agency’s mission and goals, including  identifying gaps in these skills and competencies; (3) developing strategies  to acquire, retain, and develop a skilled workforce and to address gaps in  skills and competencies; (4) building capabilities needed to support the  strategies; and (5) monitoring and evaluating the contribution that  strategies have made toward achieving the agency’s mission and goals.
We have previously identified strategic human capital management as a  governmentwide high-risk area. We found that a lack of attention to  strategic human capital planning is a pervasive problem in the federal  government and creates a risk to its ability to effectively serve the  American people and to address the challenges of the 21st century. In a  January 2004 report on CDC’s management, we noted that while CDC was  facing several human capital challenges, including the loss through  retirement of a key portion of its workforce that possessed both  managerial and technical expertise, CDC had suspended development of  its human capital plan. At that time, we recommended that CDC ensure  that its human capital planning efforts receive appropriate leadership  attention, including resuming human capital planning and linking these  efforts to the agency’s strategic plan. CDC resumed its strategic human  capital planning, and in September 2007 released its Strategic Human  Capital Management Plan (CDC Plan).
Given your interest in strategic human capital planning in federal agencies  that heavily rely on a scientific, technical, and engineering-based  workforce, you asked us to review human capital planning at CDC. We  determined (1) whether the CDC Plan was designed to address the human  capital challenges CDC faces in sustaining a skilled workforce; (2) the  extent to which the strategies in the CDC Plan are linked with the agency’s  mission and goals and integrated with its strategic plan, performance plan,  and budget, that is, the extent to which the plan is strategically aligned;  and (3) the extent to which CDC incorporated our five principles for  strategic human capital planning into its plan.
To determine whether the CDC Plan was designed to address the human  capital challenges CDC faces in sustaining a skilled workforce, we  analyzed information collected from interviews we conducted with  officials from CDC, HHS, OPM, and CDC’s external partners, which  include policy research and professional associations that work with the  agency. We corroborated testimonial evidence from our interviews with  analysis of relevant documents, such as reports on the public health  workforce, and workforce statistics and retirement eligibility data  computed by CDC. On the basis of our review and analysis of these  workforce data and our interviews with CDC officials, we determined that  the data were sufficiently reliable for the purposes of this report. We used  this information to identify the challenges faced by CDC and then analyzed  the CDC Plan to determine whether it was designed to address the  challenges. To determine the extent to which the CDC Plan meets criteria  for strategic alignment, we interviewed CDC and HHS officials and  analyzed the CDC Plan and OPM’s Human Capital Assessment and  Accountability Framework (HCAAF), which provides guidance on human  capital planning and management. We also analyzed other relevant CDC  and HHS documents. To determine the extent to which CDC incorporated  our five principles for strategic human capital planning, we examined the  CDC Plan and interviewed officials from CDC and HHS’s Atlanta Human  Resources Center (AHRC), a stakeholder in CDC’s human capital planning.  We also analyzed related documents about CDC’s workforce and training  efforts and past and planned strategies to acquire, retain, and develop  CDC’s workforce; new systems, programs, and processes that support  human capital planning; and efforts to monitor and evaluate the agency’s  human capital efforts. We conducted our work from March 2007 to May  2008 in accordance with generally accepted government auditing  standards. (See app. I for more detailed information on our scope and  methodology.)
subsections: section_title: Background
paragraphs: CDC currently serves as the national focal point for developing and  applying disease prevention and control, environmental health, and health  promotion and education activities designed to improve the health of  Americans. CDC is also responsible for leading national efforts to detect,  respond to, and prevent illnesses and injuries that result from natural  causes or the release of biological, chemical, or radiological agents. To  achieve its mission and goals, CDC relies on an array of partners, including  public health associations and state and local public health agencies. CDC  collaborates with these partners on initiatives such as monitoring the  public’s health, investigating disease outbreaks, and implementing  prevention strategies. CDC also uses its staff located in foreign countries  to aid in international efforts, such as guarding against global diseases.
subsections: section_title: CDC Organizational Structure
paragraphs: In April 2005, CDC completed a reorganization known as the Futures  Initiative, which was designed to realign its resources to better meet the  challenges of 21st century health threats. Before the reorganization, CDC  consisted of an Office of the Director, 10 national centers, and the  National Institute for Occupational Safety and Health. The reorganization  created 4 coordinating centers and 2 coordinating offices that report to the  Office of the Director. (See fig. 1.) The 4 coordinating centers facilitate and  integrate the work of the 11 discipline-specific national centers and   1 national office. (See app. II for a description of the work of the   4 coordinating centers and 2 coordinating offices.) The national centers  are primarily responsible for operating CDC’s public health programs and  generally include, among other things, a director’s office, programmatic  divisions, and branches.
section_title: CDC Goals and Goal Action Plans
paragraphs: As part of the Futures Initiative, CDC also created new agency goals—its  Health Protection Goals, which are (1) Healthy People in Every Stage of  Life, (2) Healthy People in Healthy Places, (3) People Prepared for  Emerging Health Threats, and (4) Healthy People in a Healthy World. CDC  uses the Health Protection Goals to develop Goal Action Plans, which aid  in the agency’s strategic planning of the direction of its work. Goal Action  Plans are associated with specific objectives, strategies, and actions, as  well as performance goals, which are measured quarterly by the  Organizational Excellence Assessment process. Coordinating centers and  coordinating offices are charged with implementing these goals and the  related Goal Action Plan in its areas of expertise, while also providing  intraagency support and resources for cross-cutting issues and specific  health threats. For example, the Coordinating Center for Infectious  Diseases leads the Goal Action Plan associated with addressing emerging  infections under the third Health Protection Goal—People Prepared for  Emerging Health Threats. At the same time, this coordinating center  supports the Coordinating Center for Environmental Health and Injury  Prevention in its lead role for the Goal Action Plan on adolescent health,  which links to the first Health Protection Goal—Healthy People in Every  Stage of Life.
section_title: CDC Human Capital Entities
paragraphs: Although each coordinating center and coordinating office conducts some  of its own human capital activities, such as recruiting staff and conducting  succession planning, two entities are responsible for CDC’s human capital  activities agencywide—HHS’s AHRC and CDC’s Office of Workforce and  Career Development (OWCD). AHRC is responsible for CDC’s  administrative personnel activities, and OWCD is responsible for human- capital-related planning for the agency. Before 2004, CDC’s Human  Resources Management Office was responsible for the administrative and  the planning activities at CDC. The office, which was one of 40 human  resource offices in HHS, reported directly to CDC management. In 2004,  CDC’s Human Resources Management Office was consolidated into  AHRC. At that time, CDC began reimbursing HHS for the services provided  by AHRC. AHRC reports directly to HHS management and manages all of  CDC’s administrative services relating to personnel, including processing  pay and benefits, posting vacancy announcements, conducting initial  screenings of candidates, and hiring new employees. OWCD is part of  CDC’s Office of the Director. OWCD assists coordinating centers and  coordinating offices with human-capital-related efforts, such as workforce  analysis or succession planning. In addition to human-capital-related  planning, specific activities of this office include developing and  implementing a human resources leadership and career management  program for all occupations within CDC and the CDC Plan. Additionally,  OWCD manages the agency’s fellowship programs and is responsible for  CDC University, which provides training and development opportunities to  CDC staff.
section_title: Federal Strategic Human Capital Management
paragraphs: OPM is responsible for providing guidance to agencies on federal human  capital policies and procedures and for an initiative associated with  strategic human capital management within the President’s Management  Agenda. As part of this responsibility, OPM developed HCAAF in  conjunction with GAO and the Office of Management and Budget.  HCAAF is intended to assist federal agencies with their human capital  planning process, including developing strategies that support each  agency’s mission and goals. HCAAF outlines an ongoing process of human  capital planning for five elements: (1) strategic alignment, (2) leadership  and knowledge management, (3) results-oriented performance culture,   (4) talent management, and (5) accountability. The first element involves  planning and goal-setting activities that are essential to promoting  strategic alignment, which includes linking strategies with an agency’s  mission and goals and integrating these strategies into an agency’s  strategic plan, performance plan, and budget. The next three HCAAF  elements are used in implementing an agency’s strategies. Specifically,  leadership and knowledge management ensures continuity in leadership  and maintaining organizational knowledge; results-oriented performance  culture promotes a diverse, high-performing workforce; and talent  management addresses gaps in needed skills. The fifth element— accountability—focuses on the importance of evaluating the results of  strategies to assess their effectiveness and to determine whether  adjustments are needed.
section_title: GAO’s Five Principles for Strategic Human Capital Planning
paragraphs: In our past work on human capital issues, we identified five principles for  strategic human capital planning that agencies should incorporate as they  develop plans and strategies for how they will meet their current and  future human capital needs. Associated with each principle are some key  points for agency officials to consider when applying these principles to  their planning efforts. (See table 1.)
section_title: The CDC Plan Includes Strategies to Address Key Human Capital Challenges, Except for Managing a Workforce with a Large and Growing Number of Contractors
paragraphs: The CDC Plan includes strategies that could help the agency address five  of the six key human capital challenges we identified that it faces in its  efforts to sustain a skilled workforce. These six key challenges are   (1) changing workforce demographics, highlighted by the potential loss of  essential personnel due to retirement; (2) the limited supply of skilled  public health professionals; (3) CDC’s acknowledged need to increase the  diversity of its workforce; (4) changing workforce needs resulting from the  agency’s expanding scope of work and responsibilities; (5) logistical  difficulties involved in acquiring and retaining a skilled workforce; and   (6) difficulties presented by managing a workforce with a large and  growing number of contractors. While the CDC Plan includes strategies  designed to address the first five challenges, it does not include strategies  that address the challenge of managing a workforce with a large and  growing number of contractors.
subsections: section_title: CDC Faces Six Key Challenges in Sustaining a Skilled Workforce
paragraphs: The first challenge, changing workforce demographics, is highlighted by  the potential loss of essential personnel due to retirement. As of the end of  fiscal year 2007, about 27 percent of CDC’s overall workforce was eligible  for retirement within the next 5 years. For CDC’s three most-populated  occupations—general health scientist, public health analyst, and medical  officer—the percentages of employees eligible for retirement in the next   5 years were 20 percent, 22 percent, and 34 percent, respectively.  Collectively, these three occupations account for 34 percent of CDC’s  workforce eligible to retire within the next 5 years. The potential loss of so  many essential personnel creates a challenge for CDC because it could  result in a shortfall of staff with the experience and skills needed to fulfill  CDC’s mission and goals. For example, one of the most-populated  occupations is medical officer, which is a difficult position to fill due to a  shortage of physicians with specific training in public health.
The limited supply of skilled public health professionals is the second  challenge we identified. According to reports issued by CDC, the Institute  of Medicine, and the American Public Health Association, federal, state,  and local agencies are experiencing workforce shortages, some of which  are severe, in many of the public health professions vital to CDC. For  example, epidemiologists play an important role in responding to  emerging infectious diseases. However, states have reported needing more  epidemiologists than are currently available in the workforce. In addition  to shortages of public health physicians and epidemiologists noted in  these reports, other shortages occur in the positions of public health  informatics specialists, laboratory scientists, and environmental health  specialists.
The third challenge that CDC faces is its acknowledged need to increase  the diversity of its workforce. Results from OPM’s Federal Human Capital  Surveys showed a decrease from 2004 to 2006 in the percentage of staff  who agreed that CDC management worked well with employees of  different backgrounds and was committed to creating a diverse  workforce. CDC officials acknowledged that the agency’s workforce was  not as diverse as it could be and told us the agency needs to improve its  recruitment of Hispanics and persons with disabilities. However, in its  plan, CDC noted that establishing a diverse workforce is a challenge for  several reasons. For example, technical skills and education levels vary  across racial, ethnic, and socioeconomic groups, which in turn can have  an impact on the pool of qualified job applicants from which to hire.
CDC’s fourth challenge is the changing workforce needs resulting from the  agency’s expanding scope of work and responsibilities. For example, the  globalization of health threats has increased CDC’s responsibility to  prepare for and respond to infectious disease outbreaks. In 2003 the rapid  spread of severe acute respiratory syndrome (SARS) in Asia showed that  disease outbreaks pose an immediate threat beyond the borders of the  country where they originate. For this reason, CDC needs a workforce that  is capable of working with global partners, such as other countries’  ministries of health, to expand surveillance systems used to detect and  respond quickly to outbreaks. In addition, throughout the SARS outbreak,  CDC was the foremost participant in the multinational response effort,  with CDC officials constituting about two-thirds of the public health  experts deployed to affected areas. CDC’s significant role in the SARS  response highlights the agency’s expanding need for a workforce that is  capable of rapidly responding to international public health emergencies.
A fifth challenge that CDC faces is logistical difficulties involved in  acquiring and retaining a skilled workforce, including problems with the  hiring process and difficulties associated with retaining employees for  international positions. For example, from fiscal year 2003 to fiscal year  2007, CDC did not meet its 2007 goal of hiring new employees in an  average of 58 days or fewer; instead, during this time, it has averaged  between 73 and 92 days to hire each new employee. HHS and CDC  officials told us that logistical difficulties were exacerbated when hiring  responsibilities were centralized from CDC to HHS and the human  resources staff was reduced from 178 to 105 people. Logistical difficulties  have also hindered CDC’s efforts to sustain international positions. For  example, HHS officials told us the process to approve and hire staff for  overseas positions can take 9 months to 1 year. Officials added that part of  this process—the amount of time it takes to get an individual approved,  including obtaining clearance through the Department of State—can be  particularly problematic because an individual may lose interest and  accept another employment offer. In addition, retaining staff can be  difficult because international programs have few opportunities for  promotion.
The sixth challenge we identified is the difficulties presented by managing  a workforce with a large and growing number of contractors. From fiscal  year 2000 through fiscal year 2006, the estimated number of contractors  working at CDC increased 139 percent, while CDC’s federal staff increased  by 3.5 percent. CDC officials told us that using contractors is beneficial,  particularly because they can be brought on board quickly to fill an  immediate need for specific skills. For example, as of August 2007 over   75 percent of employees in the National Center for Public Health  Informatics were contractors because the area is a relatively new field and  the skills needed are constantly changing. (See app. III for more  information on CDC’s workforce and the number of contractors within  each organizational unit.) While there are benefits to using contractors,  there are also concerns. For example, CDC officials told us that because  contractors are not CDC employees, the agency does not control certain  aspects of their employment, such as diversity or training, and does not  technically supervise their work. For instance, if a CDC manager  determines that the work provided by a contractor is unsatisfactory, the  manager has to communicate his or her concerns to the contractor’s firm  instead of directly addressing the contractor. Moreover, CDC does not  fund training to assist contractors in improving their work. CDC officials  also told us that data collection on how contractors are used within the  agency is primarily decentralized and not systematically monitored at an  agencywide level. CDC has begun collecting more data on contractors  across the agency because of increased security needs. Understanding  how contractors are used across the agency is important to ensure their  appropriate use and oversight. For example, federal regulations call for  enhanced oversight of contracts for services that could potentially  influence the authority, accountability, and responsibilities of government  officials. Issues may arise when contractors have been involved in  activities relating to policy development, reorganization and planning,  technical advice or assistance, developing or providing information  regarding regulations, or preparing budgets. Because CDC lacks  information on how its contractors are used across the agency, it may not  be able to ensure adequate oversight of contractors.
section_title: The CDC Plan Includes Strategies to Address Five Human Capital Challenges, but Not the Challenge of Managing a Workforce with a Large and Growing Number of Contractors
paragraphs: CDC developed strategies to address the human capital challenges  described by the agency in the CDC Plan, which correspond to five of the  six challenges we identified. (See table 2. For a full list of strategies in the  CDC Plan, see app. IV.) CDC officials told us they used the human capital  challenges identified in the plan to develop related strategies that directly  addressed specific areas of concern. On the basis of our analysis of the  CDC Plan and additional documentation, we found that the CDC Plan  contains strategies that could help address the first five challenges we  identified. According to CDC officials, the CDC Plan does not include  strategies to address the challenge of managing a workforce with a large  and growing number of contractors—our sixth challenge—because CDC  wanted to follow HHS guidance, under which contractors are not  considered part of the HHS workforce, and to maintain consistency with  the department in the treatment of contractors.
However, without considering the challenge of managing a workforce with  a large and growing number of contractors and without developing related  strategies, the CDC Plan excludes any efforts to address more than one- third of the total workforce. As a result, it may not be as useful as it could  be in assisting the agency with improvements in human capital  management. For example, CDC cannot fully assess the human capital  available across the agency and how it is assisting the agency in meeting  its expanding scope of work and responsibilities without understanding  how contractors are used across the agency and what gaps in skills and  competencies they are filling. Because CDC does not monitor the use of  contractors agencywide, the agency’s ability to determine the appropriate  balance of government-performed and contractor-performed services is  hindered. CDC’s lack of information to oversee contractors agencywide is  also a problem because, as our reviews of other agencies have shown,  adequate oversight of contractors is critical to ensure that they are  producing outcomes to achieve the agencies’ respective missions and  goals and the agencies are not risking having mission-related decisions  influenced by contractor judgment.
section_title: Strategies in the CDC Plan Are Linked with CDC’s Mission and Goals but Are Not Integrated with Its Strategic Plan, Performance Plan, or Budget
paragraphs: The CDC Plan partially meets criteria for strategic alignment. CDC relied  on HCAAF guidance, which includes strategic alignment as an element, to  develop its framework for the CDC Plan. The CDC Plan partially meets the  criteria for strategic alignment by explicitly linking the plan’s strategies to  the agency’s mission and goals. However, the CDC Plan does not integrate  these strategies with the agency’s Goal Action Plans—the documents that  serve as CDC’s strategic plan—or with its performance plan or budget.  CDC officials told us they intended to update the CDC Plan annually and  to integrate the plan with these documents as the plan is updated.
subsections: section_title: CDC Plan Was Based on HCAAF Framework, but Only Partially Meets Its Criteria for Strategic Alignment
paragraphs: CDC officials relied on HCAAF as guidance when developing the  framework for the CDC Plan. According to CDC, HCAAF was the best  model framework to follow because of its simplicity, transparency, and  alignment with the President’s Management Agenda. The CDC Human  Capital Management framework, which serves as the foundation for the  CDC Plan, uses the HCAAF model. Specifically, CDC’s framework includes  the same elements—strategic alignment, leadership and knowledge  management, performance management for results, talent management,  and accountability. (See fig. 2.) The HCAAF criteria for strategic alignment  are consistent with the definition we have used in our past work.
In examining the CDC Plan, we determined that the plan partially meets  the criteria for strategic alignment. In developing its plan, CDC linked the  strategies in the plan to its mission and goals as well as to those of HHS.  The plan states that its purpose is to ensure that CDC’s human capital  efforts are aligned to most effectively support the agency’s  accomplishment of its mission and goals. Further, the plan integrates  CDC’s Health Protection Goals and the Organizational Excellence  Assessment, which CDC uses to measure its progress toward meeting the  Health Protection Goals. Specifically, CDC linked the strategies in its plan  to the Organizational Excellence Assessment. To ensure linkage with  HHS’s mission and goals, the CDC Plan refers to HHS’s strategic plan for  fiscal years 2007 through 2012, which delineates how the department will  achieve its mission “to enhance the health and well-being of Americans by  providing for effective health and human services and by fostering sound,  sustained advances in the sciences underlying medicine, public health, and  social services” and outlines HHS’s four strategic goals. CDC also linked  the CDC Plan to HHS’s strategic plan. For example, the CDC Plan  describes how CDC has adopted a program described in HHS’s strategic  plan—the Performance Management Appraisal Program—to connect  employee expectations to the agency’s mission and to link employee  performance ratings with measurable outcomes.
The CDC Plan only partially meets the criteria for strategic alignment as  defined by GAO and OPM because the strategies in the CDC Plan are not  integrated with the documents that serve as the agency’s strategic plan, its  performance plan, or its budget. CDC officials told us that while the  agency did not have a strategic plan, the agency’s Goal Action Plans served  in this capacity. Goal Action Plans are organized according to the four  Health Protection Goals and are designed to link, leverage, and coordinate  CDC’s activities across the agency to increase effectiveness and impact.  (See app. V for a summary of CDC’s Health Protection Goals.) While the  strategies in the CDC Plan are not currently integrated with the Goal  Action Plans, officials told us they intended to integrate the strategies with  the Goal Action Plans and have taken initial steps to do this in their  January 2008 revision of the CDC Plan. Additionally, the strategies have  not been integrated with the agency’s performance plan or budget, which  limits the plan’s usefulness in supporting day-to-day activities aimed at  long-term human capital goals. However, officials told us they also  intended to integrate the strategies in the CDC Plan with the agency  performance plan and the budget as the plan is updated.
section_title: CDC Incorporated Aspects of Our Principles for Strategic Human Capital Planning into the CDC Plan and Has Outlined Further Actions
paragraphs: CDC incorporated aspects of our five principles for strategic human  capital planning into the CDC Plan and has outlined further actions it  intends to take. (See table 1 for the principles.) The agency incorporated  part of the first principle by having top management and a stakeholder  comment on a draft of the plan, and it intends to involve nonsupervisory  employees in future implementation. For the second principle, CDC  conducted a preliminary workforce analysis, but it has not completed the  analysis of gaps in skills and competencies. However, CDC intends to  conduct additional analyses and plans to use them in subsequent plan  updates. CDC incorporated an aspect of the third principle by developing  strategies to acquire, retain, and develop a skilled workforce, but it is  unclear to what degree these strategies will address the agency’s gaps in  skills and competencies because they were developed before the gap  analyses were completed. CDC has also taken steps to incorporate the  fourth principle, which stresses building the capabilities needed to support  the strategies. With regard to the fifth principle, while CDC previously  collected limited information with which to monitor and assess its human  capital efforts, the CDC Plan outlines steps to monitor and evaluate its  strategies.
subsections: section_title: CDC Involved Top Management and a Stakeholder in Developing Its Plan and Intends to Include Nonsupervisory Employees in Future Implementation and Updates
paragraphs: In development of the CDC Plan, the agency incorporated aspects of our  first principle, which is to involve top management, managers, other  employees, and stakeholders in developing, communicating, and  implementing the human capital plan, but it did not formally involve  nonsupervisory employees. CDC involved top management, managers, and  AHRC as a stakeholder in the development of the CDC Plan through the  agency’s leadership groups, specifically the Executive Leadership Board,  the Management Council, and the Center Leadership Council. AHRC  participated as part of the Management Council. A CDC official involved  in creating the plan briefed members of the board and councils on the  outline of the plan while it was being developed, and members  subsequently reviewed and provided recommendations on drafts of the  plan. Additionally, OWCD officials worked with selected members of the  board and the Management Council in developing some of the strategies.  CDC officials told us they did not formally involve nonsupervisory  employees in the development of the plan. For example, managers in the  diversity office informally shared the CDC Plan with nonsupervisory  employees during its development. In our prior work on the principles, we  found that involving such employees on strategic workforce planning  teams can identify new ways to streamline processes and improve human  capital strategies. Nonsupervisory employee involvement in the  development of the human capital plan can also garner support for  proposed changes and help an agency develop clear and transparent  procedures to implement strategies.
CDC officials told us that they intended to communicate the CDC Plan  within the agency and to involve nonsupervisory employees in  implementing and updating it. The CDC Plan has been approved by the  Director of CDC and after final clearance will be communicated via CDC’s  intranet site and an intranet article, or through an e-mail message to all  agency employees. CDC officials said that, in addition to top management,  other agency managers, and stakeholders, they intended to involve  nonsupervisory employees in implementing the plan and updating it in the  future. For example, OWCD has conducted several focus groups with  employees regarding the results of the 2006 Federal Human Capital  Survey, and CDC officials indicated that the findings from these focus  groups would be considered in updating strategies in future updates of the  CDC Plan.
section_title: CDC Conducted a Preliminary Workforce Analysis and Is Completing Efforts to Identify Gaps in Skills and Competencies
paragraphs: CDC has begun to incorporate the second principle—determining the  skills and competencies needed to achieve the mission and goals,  including identifying gaps in these skills and competencies—by  conducting a preliminary workforce analysis and is working to complete  analyses to identify gaps in skills and competencies. In this preliminary  analysis, CDC determined useful information regarding its workforce,  including the number of individuals in each occupation, the size and  diversity of its workforce, agencywide retirement eligibility, and the  number of mission-critical occupations in each coordinating center and  coordinating office. However, CDC has not completed competency gap  analyses for its employees to determine whether employees have the skills  needed to perform effectively, and to identify any gaps between their  current skill levels and skills needed in the future. In 2006, CDC conducted  a competency gap analysis for one of its mission-critical occupations, and  it has begun competency gap analyses for its other mission-critical  occupations.
In addition, CDC plans to conduct additional workforce analyses, which it  anticipates completing in fiscal year 2008, as part of the workforce  planning process outlined in the CDC Plan. Prior to the CDC Plan, each  coordinating center and coordinating office conducted its own workforce  planning activities, resulting in wide variability across the agency. CDC  has implemented standardized procedures for its workforce planning  process, by developing a consistent methodology and approach for  workforce analyses to be used throughout the agency. As part of the  agencywide methodology, the coordinating centers and coordinating  offices have been asked to provide information about how federal  employees and contractors are used to meet their needs. Additionally,  OWCD has developed a standardized template for the coordinating centers  and coordinating offices to use to collect data on employees’ skills and  competencies. As of January 2008, OWCD was in the process of using the  template to collect information, which could then be aggregated to an  agencywide level and used in the annual update of the CDC Plan.
section_title: The CDC Plan Has Strategies to Acquire, Retain, and Develop Skilled Staff, but It Is Unclear How Well They Will Address Current Gaps in Skills and Competencies
paragraphs: The CDC Plan includes strategies to improve its current efforts to acquire,  retain, and develop its skilled staff, and their implementation could  address some past weaknesses in CDC’s efforts. The CDC Plan thus  incorporates an aspect of our third principle, which is to develop  strategies to acquire, retain, and develop a skilled workforce and to  address skill and competency gaps. However, the plan’s strategies may  have limitations in how well they address skill and competency gaps,  because they were developed before the agency finished its gap analyses.
Developing new strategies to acquire and retain staff is important because  CDC’s efforts conducted prior to the publication of the CDC Plan had  several weaknesses with regard to recruitment and retention. For  example, because recruitment efforts were decentralized throughout the  agency, CDC and AHRC officials conducted recruitment efforts on an ad  hoc basis, and coordinating centers and offices offered recruitment and  relocation incentives as part of their recruitment efforts with little  coordination. Regarding retention, we found that CDC had programs and  incentives designed to promote retention, but lacked information on their  effectiveness. For example, CDC offers retention incentives to key  individuals to induce them to remain with the agency. However, CDC does  not collect and analyze data on how successful these programs and  incentives have been in retaining skilled employees.
As part of CDC’s efforts to improve recruiting and retention efforts, one of  the strategies in the CDC Plan calls for developing, implementing, and  evaluating a collaborative strategic recruitment effort, for the purpose of  establishing initiatives, resources, operational strategies, and practices to  ensure agency access to quality candidates and to aid in meeting CDC’s  recruitment objectives. In January 2008, CDC established a strategic  recruitment team comprised of representatives from various entities,  including each coordinating center and coordinating office, AHRC, and  OWCD. As part of its work, this team intends to develop a database for  targeted recruitment, which is scheduled for completion in February 2009.  This strategy could help address weaknesses in CDC’s current ad hoc  approach. Another strategy involves expanding the use of “career  ladders” within the agency, including identifying target positions to be  used on a career ladder and assessing the career ladder program for  potential areas of improvement. CDC anticipates completing this strategy  by the end of 2008.
Our review of CDC’s current efforts to develop skilled staff found that the  agency based its current employee development efforts on a training needs  assessment and had additional strategies that could improve employee  development in the CDC Plan. According to CDC officials, CDC University,  the unit responsible for training at CDC, worked with partners throughout  the agency to develop and implement agencywide strategies for training  and to identify the skills needed by CDC’s workforce in the future. CDC  University also conducted annual competency-based needs assessments  that allow employees and supervisors to review the competencies for each  occupation and determine whether sufficient training exists or additional  training is needed. Several strategies in the CDC Plan could build on  these current efforts. For example, CDC plans to implement a transition  from its current training system to HHS’s Learning Management System.  According to CDC, this transition will improve the career development of  its employees, in part by allowing CDC to target its learning plans to  specific groups of employees and to track competency gaps by employee,  CDC entity, occupational group, and specific competency. CDC has begun  this transition and expects it to be completed by September 2008.
Although CDC has developed strategies that may improve some of its  current efforts, it is unclear how well these strategies will address current  gaps in skills and competencies. In our prior work on the principles, we  found that it is important for agencies to consider how their strategies can  be aligned to eliminate gaps and improve the contribution of critical skills  and competencies. However, developing strategies to eliminate gaps  assumes that an agency has identified the gaps in skills and competencies  before its strategies are developed, and while CDC has begun gap  analyses, these analyses were not completed when the CDC Plan was  developed. As a result, the strategies in the plan could not be tailored to  address specific gaps in skills and competencies. However, CDC  recognized this need, is completing the gap analyses, and has outlined, as  part of one strategy, the development of additional steps to close identified  gaps in skills and competencies. It is also working to improve its ability to  identify training needs to address skill and competency gaps.
section_title: CDC Has Been Building Capabilities to Support Its Strategies
paragraphs: Consistent with the fourth principle, CDC has taken steps to build the  capabilities needed to support its strategies. Developing and effectively  utilizing agencies’ resources, human capital flexibilities, and personnel  are essential to the successful implementation of strategies. CDC is  making efforts to establish these capabilities. For example, OWCD has  hired a strategic recruiter to oversee the development and implementation  of its recruitment function strategy, as described in the CDC Plan.
CDC officials are also planning to streamline the agency’s administrative  processes, with a focus on hiring. In response to AHRC’s current efforts to  achieve its goal of hiring new employees within an average of 58  workdays, CDC and AHRC have developed a system to track the hiring  process and have created a committee to evaluate the current hiring  process. The system has generated reports that would allow managers to  see how long the hiring process takes. In addition, CDC officials are  implementing some of the recommendations made by the hiring  committee. One problem the committee identified was the use of  individualized position descriptions for vacancies. Historically, managers  requested individualized descriptions for most positions. New position  descriptions needed to be formally reviewed, adding time and complexity  to the hiring process. As of February 2008, AHRC and CDC have  standardized position descriptions for 20 occupations, which could help  the agency reduce the time it spends filling positions.
In addition, CDC is working to create transparency and accountability and  to improve the utilization of its human capital flexibilities. For example, a  responsible individual has been identified for each of the strategies  described in the plan. According to CDC officials, the agency intends to  incorporate this responsibility into these individuals’ performance  reviews. Also, agency supervisors and managers are to receive training on  their roles and responsibilities in employee development, which includes  using human capital flexibilities. Detailed information on these flexibilities  is available via the Web to all employees. However, CDC officials told us  they were limited in how they implemented some of these flexibilities  because policies and practices of this type are developed at the  department level by the HHS Office of Human Resources. As these policies  are delegated to the agency, CDC management may in turn develop  implementing policies and practices for the agency that support the  department’s policies.
section_title: CDC Has Incorporated Efforts to Monitor and Evaluate the Contribution of Its Strategies
paragraphs: Prior to the CDC Plan, CDC had limited information with which to assess  its human capital efforts. However, consistent with the fifth principle, the  agency has incorporated efforts to monitor and evaluate its human capital  strategies into its plan. In our prior work on the principles, we found that  high-performing agencies understood the fundamental importance of  measuring both the outcomes of their human capital strategies and how  these outcomes have helped them accomplish their mission and goals.  CDC officials told us that prior to completing the CDC Plan they relied on  multiple mechanisms to evaluate the effectiveness of the agency’s  strategies to acquire, retain, and develop staff. However, these strategies  were not always effective. For example, while retention was measured in  part by evaluating exit survey data, only 20 percent of departing  employees completed the exit survey.
The CDC Plan includes strategies to address the issues of limited data for  monitoring and evaluation. For example, one strategy related to retention  evaluates the factors affecting turnover and is designed to develop plans  for improvement. This strategy outlines specific milestones and time  frames for addressing this issue, such as conducting a literature review of  factors affecting employee turnover, which was completed in November  2007. In addition, CDC officials planned to develop strategies in January  2008 to increase the exit survey response rate. Improving the response rate  could make the data collected more valuable. The CDC Plan also has a  milestone to develop recommendations for improving the collection and  analysis of employee data associated with turnover by September 2009.  Further, the plan includes a strategy to develop an outreach plan with  materials and activities targeted to specific groups of potential employees.  As part of this strategy, CDC has a milestone to evaluate outcomes of  these outreach materials, including attainment of goals and objectives and  return on investment for its efforts by September 2008. CDC officials told  us the CDC Plan principally focuses on using data from existing measures  to develop strategies for improvement. They noted that while some  monitoring and evaluation approaches might be refined, the emphasis in  the plan is on how to use the data currently being collected more  effectively.
section_title: Conclusions
paragraphs: CDC identified challenges it faced in achieving its human capital needs in  the CDC Plan and considered the challenges in developing its human  capital strategies. However, the strategies in the CDC Plan do not address  the sixth challenge we identified—the difficulties presented by managing a  workforce with an increasing number of contractors, which make up more  than one-third of the agency’s workers. Without addressing this challenge  as part of its strategies, the CDC Plan may not be as useful as it could be in  providing the agency with a strategic view of its governmental and  contractor workforce. Thus, the plan will be less helpful to guide the  agency in improving the management of its entire human capital so it can  effectively and efficiently meet its expanding scope of work and  responsibilities and thereby achieve its mission and goals.
The strategies in the CDC Plan are linked with the agency’s mission and  goals; however, they are not integrated into a strategic plan, performance  plan, or budget. CDC officials told us they intended to integrate the  strategies in the CDC Plan with the documents that serve as the agency’s  strategic plan, the performance plan, and the budget as the plan is  updated. Completing this effort is important because without it the CDC  Plan may not be as effective as it could be in helping the agency meet its  human capital needs or in assessing and understanding the extent to  which CDC’s workforce contributes to achieving its mission and goals.  Additionally, the plan may be limited in its usefulness in supporting day-to- day activities aimed at long-term human capital goals.
The CDC Plan represents progress in the agency’s human capital planning  efforts because the CDC Plan includes strategies, due dates, and the  individuals responsible for implementing them. However, because the plan  is new and has not been fully implemented, it is too soon to determine the  degree to which it will improve CDC’s human capital management. As the  agency moves forward with the CDC Plan, it is important that the planned  strategies are fully implemented and the agency continues to incorporate  HCAAF and our principles for strategic human capital planning into  subsequent plan updates, in order to strengthen its human capital efforts.
section_title: Recommendation for Executive Action
paragraphs: To improve CDC’s ability to use its human capital planning efforts to meet  its current and future needs for a skilled workforce, we recommend that  the Director of CDC incorporate strategies that address the challenge of  managing a workforce with a large and growing number of contractors  into future updates of the CDC Plan.
section_title: Agency Comments and Our Evaluation
paragraphs: HHS provided written comments on a draft of this report, which are  included in appendix VI, and a technical comment, which we partially  incorporated. In its comments, HHS concurred with our conclusion that  the strategic alignment component of the September 2007 edition of the  CDC Plan could be improved by better connecting the plan with the  agency’s Goal Action Plans. HHS stated that it addressed the issue of  aligning the plan with the Goal Action Plans in its January 2008 revision of  the CDC Plan, but the documentation it provided to us did not show how  strategies from the CDC Plan would be integrated with the Goal Action  Plans. Further, strategic alignment includes integrating the CDC Plan with  the agency’s performance plan and budget, a step that CDC has yet to  complete.
HHS also stated that our recommendation—to incorporate strategies in  the CDC Plan that address the challenge of managing a workforce with a  large and growing number of contractors—was somewhat unexpected.  HHS noted that CDC officials reviewed human capital plans of other  agencies and several GAO and OPM human capital reports and did not  address the use of contractors in detail when developing the CDC Plan in  order to be consistent with these sources. Further, it stated that the  agency does not control contractors’ hiring, diversity, compensation,  training, and other key human capital factors and noted that our draft  report did not recognize the legal, regulatory, and policy prohibitions in  treating contractors as if they were federal employees.
We believe that HHS misinterpreted our findings and recommendation  related to the challenge of managing a workforce with a large and growing  number of contractors. At CDC, contractors represent more than one-third  of the agency’s workforce and thus are clearly a critical part of the  agency’s human capital. Our December 2003 report on key principles for  effective strategic human capital planning noted that it involves  developing long-term strategies for acquiring, developing, and retaining an  organization’s total workforce, which includes full- and part-time federal  staff and contractors. In our current report, we clearly state that CDC does  not control certain aspects of contractor employment such as diversity or  training and technically does not supervise the work of contractors.
Nevertheless, as we have explained in this report, strategic human capital  planning includes identifying the skills and competencies needed and  developing strategies to address those needs. CDC could not provide us  with specific information on how contractors were being used agencywide  to complement federal staff. Without this information, the CDC Plan  cannot present the nature of the current balance of government-performed  and contractor-performed work at the agency, a complete picture of the  skills and competencies needed agencywide, or strategies to address those  needs. It is unclear to us how the entire workforce of both federal and  contractor staff could be managed strategically without such information.  Such information would facilitate making informed decisions, such as  whether CDC needs to increase training for federal staff or contract for  those skills. Similarly, without information on how contractors are used  throughout the agency, it remains unclear to us how top-level management  can be assured that contractors are being used appropriately and that  sufficient oversight is provided for contractor staff engaged in activities  that could potentially influence the authority, accountability, and  responsibilities of government officials. Consequently, we concluded that  CDC should incorporate strategies related to the use of contractors into  the CDC Plan.
HHS also commented that our report indicated that CDC does not have a  comprehensive repository of human capital information on its contracting  staff and thus does not ensure adequate contractor oversight. HHS said  that it disagreed with our assessment. However, we did not make such an  assessment. We did not suggest or recommend that CDC develop a  comprehensive repository of human capital information on contractor  staff. In addition, we did not review whether such a repository would be  needed for effective contractor oversight, because such work was outside  the scope of this engagement. Our concern is that CDC does not have a  strategic human capital plan that encompasses strategies for the use of its  contractors as complements to its federal employees so that the agency  can most effectively manage these blended resources to achieve its  mission and goals.
As agreed with your offices, unless you publicly announce the contents of  this report earlier, we plan no further distribution until 30 days from its  date. At that time we will send copies to the Secretary of HHS, the Director  of CDC, and other interested parties. We will also make copies available to  others on request. In addition, the report will be available at no charge on  GAO’s Web site at http://www.gao.gov.
If you or your staffs have any questions about this report, please contact  me at (202) 512-7114 or BascettaC@gao.gov. Contact points for our Offices  of Congressional Relations and Public Affairs may be found on the last  page of this report. GAO staff who made major contributions to this report  are listed in appendix VII.
section_title: Appendix I: Scope and Methodology
paragraphs: To determine whether the Centers for Disease Control and Prevention  (CDC) 2007 Strategic Human Capital Management Plan (CDC Plan) was  designed to address the challenges CDC faces in sustaining a skilled  workforce, we analyzed interviews we conducted with multiple entities  from CDC, the Department of Health and Human Services (HHS), the  Office of Personnel Management (OPM), and three policy research and  professional associations. Specifically, the interviews included officials  from CDC’s four coordinating centers and two coordinating offices, Office  of Workforce and Career Development (OWCD), Executive Leadership  Board, Management Council, Center Leadership Council, Division  Directors Council, and Office of Diversity. We also interviewed officials  from the U.S. Public Health Service Commissioned Corps who work at  CDC and officials from HHS’s Office of Global Health Affairs and Atlanta  Human Resources Center (AHRC). Further, we interviewed policy  research and professional association officials who work with CDC,  including officials from the National Academy of Public Administration,  the Association of State and Territorial Health Officials, and the National  Association of County and City Health Officials. We corroborated  testimonial evidence from our interviews with analysis of relevant  documents, workforce statistics, and retirement eligibility data computed  by CDC. We assessed the reliability of CDC’s data by confirming that the  data included the elements we requested and were consistent with CDC- provided documentation and information collected from interviews,  including interviews with officials responsible for maintaining these  databases. As a result, we determined that the data generated from CDC’s  system were sufficiently reliable for the purposes of this report. In  addition, we reviewed reports on the public health workforce written by  the Institute of Medicine, the American Public Health Association, and  CDC, as well as our prior work on the use and management of contractors  in the federal government. Some interviewees noted the difficulties of  managing CDC’s responsibilities given its funding; however, we did not  assess the adequacy of CDC’s budget. Based on our analysis of these  interviews, reports, and data, we identified the challenges that CDC faces  in sustaining a skilled workforce. In order to determine whether the CDC  Plan was designed to address the challenges we identified, we reviewed  CDC’s plan. We also interviewed OWCD officials about how they used the  challenges CDC identified in the plan to develop related strategies. We  then compared the CDC challenges to the challenges we identified and  determined how the strategies in the CDC Plan corresponded to the  challenges we identified.
To determine the extent to which the CDC Plan is strategically aligned, we  interviewed CDC officials from OWCD and the Office of Strategy and  Innovation. We also reviewed and analyzed the CDC Plan, OPM’s Human  Capital Assessment and Accountability Framework (HCAAF), and our  prior work on human capital planning to understand the guidance used to  develop the plan. Additionally, to determine how the strategies in the plan  were linked to the agency’s mission and goals, we analyzed the CDC Plan,  the CDC Health Protection Goals, and HHS’s 2007-2012 Strategic Plan. To  determine how the plan was integrated into other agency documents, we  reviewed CDC’s budget documents for fiscal years 2006 through 2008,  annual performance plans and reports for fiscal years 2005 and 2006, and  CDC Goal Action Plans and related documents, which serve as the  agency’s strategic plan. We also interviewed officials from HHS’s Office of  the Assistant Secretary for Administration and Management about the  criteria and guidance that office provides to CDC on human capital  planning efforts.
To determine the extent to which the CDC Plan incorporated the five  principles for effective strategic human capital planning, we reviewed our  previous work on the five principles and examined the CDC Plan.
Specifically, for the first principle—involving top management, managers,  other employees, and stakeholders in developing, communicating, and  implementing the plan—we interviewed officials from CDC’s Executive  Leadership Board, Management Council, Center Leadership Council, and  the Division Directors Council to determine management and employee  involvement in the development of the plan. We interviewed officials from  AHRC, a stakeholder in CDC’s human capital planning, to determine its  involvement in the development of the plan. We also interviewed officials  with OWCD, the entity responsible for the plan, to determine how  management, stakeholders, and employees would be involved in  communicating and implementing the plan.
For the second principle—determining the skills and competencies  needed to achieve the agency’s mission and goals—we analyzed  documents on CDC’s (1) workforce analysis, (2) training needs  assessments, and (3) competency gap assessments. We also interviewed  officials in OWCD and discussed plans for additional workforce analyses.
For the third principle—developing strategies to acquire, retain, and  develop a skilled workforce and to address gaps in skills and  competencies—we examined the CDC Plan and how the strategies in the  plan related to CDC’s workforce analysis. We also interviewed CDC  officials and reviewed pertinent documents. To determine how the  strategies in the plan compared to CDC’s efforts prior to the plan, we  interviewed officials and analyzed prior human capital documents. We  interviewed officials from HHS’s AHRC and CDC’s four coordinating  centers and two coordinating offices, the National Institute for  Occupational Safety and Health, CDC University, and OWCD to discuss  human capital efforts prior to the CDC Plan and how they related to the  efforts in the CDC Plan. We also analyzed documents from these entities,  including AHRC’s July 2006 Workforce Plan, CDC’s Talent Management  Plan, CDC’s 2006 Strategic Human Capital Plan, and human capital  documents from the coordinating centers and coordinating offices.
For the fourth principle—building capabilities needed to support the  strategies—we examined CDC’s new programs and processes that support  human capital planning. Additionally, we interviewed officials from both  OWCD and AHRC.
For the fifth principle—monitoring and evaluating the contribution that  strategies have made toward achieving the agency’s mission and goals— we reviewed the CDC Plan and related documents and interviewed OWCD  officials in order to determine CDC’s current monitoring efforts and how  CDC planned to monitor and evaluate the agency’s progress toward its  human capital goals.
We conducted our work from March 2007 to May 2008 in accordance with  generally accepted government auditing standards.
section_title: Appendix II: CDC Coordinating Centers and Coordinating Offices and Their Missions
subsections: section_title: Coordinating Center for Environmental Health and Injury Prevention
paragraphs: To plan, direct, and coordinate national and global public health research, programs,  and laboratory sciences that improve health and eliminate illness, disability, and/or  death caused by injuries or environmental exposures.
To assure that CDC provides high-quality information and programs in the most  effective ways to help people, families, and communities protect their health and  safety.
To plan, direct, and coordinate a national program for the prevention of prematurity,  mortality, morbidity, and disability due to chronic diseases, genomics, disabilities,  birth defects, reproductive outcomes, and adverse consequences of hereditary  conditions.
To protect health and enhance the potential for full, satisfying, and productive living  across the lifespan of all people in all communities related to infectious diseases.
To provide leadership, coordination, and support for CDC’s global health activities in  collaboration with CDC’s global health partners. The office’s mission is to increase  life expectancy and years of quality life, especially among those at highest risk for  premature death, particularly vulnerable children and women, and increase global  preparedness to prevent and control naturally occurring and man-made threats to  health.
To protect health and enhance the potential for full, satisfying, and productive living  across the lifespan of all people in all communities related to community  preparedness and response.
section_title: Appendix III: CDC Workforce and Breakdown by Each Organizational Unit as of August 2007
paragraphs: National Center for Preparedness, Detection, and  Control of Infectious Diseases  National Institute for Occupational Safety and Health  uirements than employees under the Civil  Service system.
section_title: Appendix IV: CDC’s Objectives and Strategies from Its Strategic Human Capital Management Plan
section_title: Appendix V: Summary of CDC’s Health Protection Goals
subsections: section_title: 1. Start Strong—increase the number of infants and
paragraphs: (a) Promote healthy pregnancy and birth outcomes  toddlers that have a strong start for healthy and safe  lives (Infants and Toddlers, ages 0-3 years) (b) Promote social and physical environments that support the health,         safety, and development of infants and toddlers  (c) Promote optimal development among infants and toddlers  (d) Increase early identification, tracking, and follow up of infants and         toddlers with special health care and developmental needs  (e) Prevent infectious diseases and their consequences among infants        and toddlers  (f)  Prevent injury and violence and their consequences among infants        and toddlers  (g) Promote access to and receipt of quality, comprehensive pediatric         health services, including dental services, by infants and toddlers  2.  Grow Safe and Strong—increase the number of children  who grow up healthy, safe, and ready to learn   (Children, ages 4-11 years)
Achieve Health Independence—increase the number of  adolescents who are prepared to be healthy, safe,  independent, and productive members of society  (Adolescents, ages 12-19 years) (a) Promote social and physical environments that are accessible; that       support health, safety, and development; and that promote healthy       behaviors among adolescents  (b) Promote access to and receipt of recommended quality, effective,        evidence-based preventive and health care services, including        dental and mental health care, among adolescents  (c) Promote social, emotional, and mental well-being for adolescents  (d) Prevent injury, violence, and suicide and their consequences among       adolescents  (e) Prevent Human Immunodeficiency Virus, sexually transmitted        diseases, and unintended pregnancies and their consequences        among adolescents  (f)  Promote healthy activity and nutrition behaviors and prevent        overweight and its consequences among adolescents  (g) Prevent substance use and its consequences, including tobacco,        alcohol, and other substance use, among adolescents  4.  Live a Healthy, Productive, and Satisfying Life— increase the number of adults who are healthy and able  to participate fully in life activities and enter their later  years with optimum health (Adults, ages 20-49 years) (a) Promote social and physical environments that are accessible; that       support health, safety, and quality of life; and that promote healthy        behaviors among adults  (b) Promote access to and receipt of recommended quality, effective,        evidence-based preventive and health care services, including        dental and mental health care, among adults  (c) Promote, social, emotional, and mental well-being for adults  (d) Promote reproductive and sexual health among adults  (e) Prevent chronic diseases and their consequences among adults  (f)  Prevent infectious diseases and their consequences among adults  (g) Prevent injury, violence, suicide, and their consequences among        adults  (h) Improve behaviors among adults that promote health and well-being 5.  Live Better Longer—increase the number of older adults  who live longer, high-quality, productive, and  independent lives (Older Adults and Seniors, ages 50  and over) (a) Promote social and physical environments that are accessible; that       support health, safety, and quality of life; and that promote healthy        behaviors among older adults  (b) Promote access to and receipt of recommended quality, effective,        evidence-based preventive and health care services, including        dental and mental health care, among older adults  (c) Promote independence, optimal physical, emotional, mental, sexual       health, and social functioning among older adults  (d) Prevent chronic diseases and their consequences among older        adults  (e) Prevent infectious diseases and their consequences among older        adults  (f)  Prevent injury, violence, and suicide and their consequences among       older adults  (g) Improve behaviors among older adults that promote health and well-      being  Healthy People in Healthy Places—The places where people live, work, learn, and play will protect and promote their health and  safety, especially those at greater risk of health disparities  1.  Healthy Communities—increase the number of  communities that protect and promote health and safety  and prevent illness and injury  (a) Promote safe and high-quality air, water, food, and waste disposal,       and safety from toxic, infectious, and other hazards, in communities  (b) Support the design and development of built environments that        promote physical and mental health by encouraging healthy        behaviors, quality of life, and social connectedness  (c) Support a robust, sustainable capacity to provide access to and        ensure receipt of essential public health, health promotion, health        education, and medical services  (d) Understand and reduce the negative health consequences of         climate change  (e) Prevent injuries and violence and their consequences in         communities  (f)  Improve the social determinants of health among communities with       excess burden and risk  2.  Healthy Homes—protect and promote health through  (a) Promote homes that are healthy, safe, and accessible  safe and healthy home environments  (b) Promote adoption of behaviors that keep people healthy and safe in        their homes  (c) Promote the availability of healthy, safe, and accessible homes  3.  Healthy Schools—increase the number of schools that  protect and promote the health, safety, and  development of all students, and protect and promote  the health and safety of all staff (e.g., healthy food  vending, physical activity programs)
Improve the timeliness and accuracy of communications  regarding threats to the public’s health    Decrease the time to identify causes, risk factors, and  appropriate interventions for those affected by threats to  the public’s health    Decrease the time needed to provide countermeasures  and health guidance to those affected by threats to the  public’s health    Decrease the time needed to restore health services and  environmental safety to pre-event levels.
section_title: Appendix VI: Comments from the Centers for Disease Control and Prevention
section_title: Appendix VII: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Acknowledgments
paragraphs: In addition to the contact named above, Sheila K. Avruch, Assistant  Director; Danielle Bernstein; George Bogart; La Sherri Bush; Gay Hee Lee;  and Roseanne Price made key contributions to this report.