Project Public Health Ready (PPHR)

In collaboration with the Centers for Disease Control and Prevention, Project Public Health Ready (PPHR) is a criteria-based training and recognition program that assesses local health department capacity and capability to plan for, respond to, and recover from public health emergencies. PPHR aims to protect the public's health and strengthen the public health infrastructure by equipping local health departments with sustainable tools to plan, train, and exercise using a continuous quality improvement model.

Since 2004, more than 500 LHDs have been recognized as meeting all the PPHR requirements individually or working collaboratively as a region. For more information about pphr, email [email protected].

Program Description

Project Public Health Ready (PPHR) is a criteria-based training and recognition program created by the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC) to help local health departments (LHDs) develop core public health, emergency preparedness competencies. This intensive 18-month program provides LHDs the structure to build training and preparedness capacity using a continuous quality improvement model.

Program Objectives

The goal of the PPHR program is to help LHD become more fully integrated into the response community and to be prepared to respond to any emergency. The PPHR program offers LHDs an opportunity to (1) build partnerships with state and federal leads, community response partners and other stakeholders; and (2) facilitate collaboration and team-building across the entire health department. At the end of the program, LHDs will have a written all-hazards response plan that aligns with national and federal standards.


Local health departments will be fully integrated into the response community and prepared to respond to any emergency.


To protect the public's health and increase the public health infrastructure by building local health department preparedness capacity and capability with assistance from state health departments using sustainable tools to plan, train, and exercise a continuous improvement model.

PPHR Criteria

To meet the PPHR criteria, participants must create and implement an all-hazards preparedness plan, complete and maintain a training needs assessment and workforce development plan, and demonstrate readiness through an exercise or a real event. The PPHR criteria are updated regularly to align with federal guidelines and national initiatives, including:

  • CDC Public Health Preparedness Capabilities (PHEP)
  • Public Health Accreditation Board (PHAB) Standards and Measures
  • Operational Readiness Review (ORR) tool
  • Homeland Security Exercise and Evaluation Program (HSEEP)
  • ASPR Hospital Preparedness Program (HPP) metrics.

The Criteria are divided into three (3) goals:

Goal I: All-Hazards Response Plan

Local health departments or regions must provide their all-hazards response plan as evidence for this goal. The plan must meet a number of standards, including describing the specific roles and responsibilities department or regional staff will have in a response. Some examples of sub-measures for this goal include Communications, Epidemiology, Mass Prophylaxis and Immunization, and Environmental Health.

Goal II: Workforce Capacity Development

Local Health Departments or regions must provide evidence of a training needs assessment and training plan based on this assessment. This training plan shall reflect the workforce capacity building goals within the department.

Goal III: Exercise/Real-Event

Local health departments or regions must provide evidence of an exercise they have conducted or a response to a real event they have participated in. This evidence is provided through either an after-action report or an incident action plan.

NACCHO recognizes that not all local health department are structured in the same way or are at the same level of readiness. Prospective applications should download the three (3) types of resources below to help them better understand their readiness in applying to PPHR.

    For more information about starting the application process, please contact [email protected].

    Most information about the PPHR process such as program benefits, eligibility, cost, deadlines and application process can be found in the PPHR Process Guide. All interested applicant should review the information in this guide. In addition, to help visualize the PPHR application timeline, prospective applicants can also download the graphic below:

    The Pre-Application Checklist is only for applicants who are unsure about which version of the PPHR criteria (First-Time Application or Support Response Agency Application) will best assess their agency’s function and role in public health emergency response and recovery. Only those applicants unsure about which version to use should fill out the Pre-Application Checklist and submit it to [email protected] by Sept. 1 for a response.

    The gap analysis tool is available to help interested applicants and/or their State Lead determine the applicant's readiness by reviewing possible gaps within their plans prior to applying for PPHR. To do this, download the tool below that corresponds with the application the applicant will use in applying for PPHR recognition. This is an optional but highly encouraged tool.

    Recruitment for 2024 National Reviewers is now open!

    In collaboration with CDC, PPHR is a criteria-based training and recognition program that assesses local health department (LHD) capacity and capability to plan for, respond to, and recover from public health emergencies. As part of the PPHR application process, applicants develop their application over the course of nine months and submit their application for national review. NACCHO recruits and trains national reviewers from across the country to assess each application’s level of compliance with PPHR criteria. NACCHO values the expertise and unique experiences of LHD personnel which is why we aim to recruit reviewers from diverse professional backgrounds and geographic locations.

    Interested applicants should complete an application by Friday, June 28 for consideration. Click here to complete an application.

    Applicants will be notified of the results no later than Monday, July 15.

    National Review Timeline

    August: reviewers will attend one reviewer orientation and training webinar and complete an online training assessment.

    September 3: 6-week review process will begin. Reviewers will be assigned applications and begin working with their review team.

    Week of October 14: 2-day in-person national application review meeting. Location: TBD

    November 4: 4-week review of additional evidence will begin.

    December: the 2024 review cycle will conclude with final review calls conducted virtually.

    For the 2025 cycle, applicants will be able to submit their Intent to Apply Forms and Part 1 Payments beginning on Monday September 9, 2024, and will have until Thursday, October 31, 2024, to finalize their submissions. To review the Project Public Health Ready application criteria for the 2025 review cycle, see below:

    First-time Applicant Criteria (version 10.0)

    Re-recognition Criteria (version 5.0)

    Support Response Agency (SRA) Criteria (version 2.0)

    Note: Please use the following guidance document for instructions on how to complete and submit the Intent to Apply and generate the Part 1 Invoice.

    Note: For those applying for Re-Recognition, it's highly recommended to use a First-Time application if your LHD has been through significant changes.

    Note: Instructions for payment including how to generate an invoice or to pay by credit card can be found by clicking here.

    Applicants and their State Lead should submit an Intent to Apply form to NACCHO by October 31, 2023. To review the Project Public Health Ready application criteria for the 2024 review cycle, see below:

    First-time Applicant Criteria (version 10.0)

    Re-recognition Criteria (version 5.0)

    Support Response Agency (SRA) Criteria (version 2.0)

    Note: Click here to view the PDF Guide for filling out the Application Signature Form.

    Everything applicants need to successfully apply for PPHR recognition can be found in NACCHO's Virtual Communities. This includes downloadable resources such as recommended resources, submission guidelines, calendars, reviewer training, criteria FAQs and more.

    To join Virtual Communities, users must have a account. Once a user account is established, members can visit NACCHO's Virtual Communities and search for the "Project Public Health Ready (PPHR) Applicant" group to join.

    Click the links below to access NACCHO's Virtual Communities site, create a NACCHO account and download the guide on how to use the Virtual Community platform. For assistance with joining the Virtual Community group, please email [email protected].

    NACCHO’s Toolbox is a free, online collection of public health tools and resources that have been created and shared by members of the public health community. These tools and resources can further be refined by categorized ‘toolkits'. Tools related to the PPHR application can be searched by simply choosing ‘PPHR toolkits’ in the drop-down box.

    Accessing tools in NACCHO’s Toolbox will require the same account from above.

    Since 2004, more than 500 LHDs have been recognized as meeting all the PPHR requirements individually or working collaboratively as a region, all of which are identified in the map below. To view which agencies have been recognized in each state, click the respective state.

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    Is PPHR an accreditation?

    PPHR is a recognition program administered by NACCHO and is a collaborative activity between NACCHO and the CDC. NACCHO is the only entity that can provide recognition for Project Public Health Ready.

    When did PPHR begin?​

    PPHR began in 2003.

    How is PPHR funded?

    What agencies have been recognized by PPHR?

    Please click on our MAP tap to see an expansive list of current and past PPHR recognized agencies on the PPHR webpage.

    How long does recognition last for?

    PPHR recognition lasts five (5) years. Prior to recognition expiration an agency is eligible to apply using the re-recognition criteria.

    Why should I apply for PPHR? What are the benefits of being PPHR recognized?

    The benefits of being PPHR recognized include:

    • PPHR-recognized LHDs will be exempt from certain planning elements of the CDC’s Operational Readiness Review (ORR) expansion process (see page 23).
    • Demonstrate your agency’s commitment to preparedness and a return on investment of federal and state funding.
    • Provides a framework to ensure that public health preparedness is meeting national standards.
    • Create distinction among other health departments and agencies.
    • Drive internal continuous quality improvement and build a culture of collaboration among LHD staff.
    • Strengthen community and other stakeholder partnerships and increase confidence in your agency’s preparedness capability.
    • Demonstrate your agency’s alignment with federal initiatives including CDC’s public health preparedness capabilities, National Incident Management System (NIMS), the Homeland Security Exercise and Evaluation Program (HSEEP), and the National Health Security Strategy’s Biennial Implementation Plan.
    • Strengthen working relationships and improve integration within the preparedness community by working with response partners to develop and enhance plans and processes
    • Drive plan updates and allow department staff to become more familiar with emergency preparedness plans.
    • Grants LHDs credibility and visibility through national recognition endorsed by the CDC and NACCHO.
    • Grants access to knowledgeable peers for review and comment on performance.
    • Showcase your organization competitiveness for recruitment of high-level staff.
    • Prepares LHDs for other recognition programs (i.e. PHAB, CDC’s ORR).

    Is there a cost to applying? What does that fee pay for?

    The fee for applicants (without current PPHR recognition status) is $5,000. The fee for applicants pursuing re-recognition using the re-recognition criteria is $2,500. Currently, CDC allows the use of PHEP funding to pay for PPHR application fees.

    The fee supports a designated point of contact to provide technical assistance on the application process, beginning when the Intent to Apply Form is submitted and ending with the submission of an application, and the following services:

    • Orientation and training for all national reviewers at the start of each review cycle;
    • Travel and expenses for an in-person meeting for national reviewers to conduct application reviews;
    • Associated IT costs, such as conference calls with national reviewers and software and server space used for application submission, review, and storage;
    • A public recognition reception for PPHR-recognized agencies at the annual Preparedness Summit;
    • Recognition materials, including plaques presented to recently PPHR-recognized agencies at the annual recognition reception;
    • Annual updates that highlight unique funding opportunities, success stories, and information on the newest federal guidance and national initiatives that support PPHR re-recognition.

    Is my health agency eligible to apply for PPHR recognition?

    The governmental entity that has the primary statutory or legal responsibility for public health in a Tribe or at the local level is eligible to apply for PPHR recognition. To be eligible, such entities must operate in a manner consistent with applicable federal, Tribal, state, territorial, and local statutes. A health department must meet one of the following definitions to apply for PPHR recognition.

    Local Health Department

    An LHD is defined, for the purposes of PPHR recognition, as the governmental body serving a jurisdiction or group of jurisdictions geographically smaller than a state and recognized as having the primary statutory authority to promote and protect the public’s health and prevent disease in humans. This authority is defined by the state’s constitution, statute, or regulations or established by local ordinance or through formal local cooperative agreement or mutual aid. The entity may be a locally governed health department, a local entity of a centralized state health department, or a city, city-county, county, district, or regional health department.

    Tribal Health Department

    A Tribal health department is defined, for the purposes of PPHR recognition, as a federally recognized Tribal government, Tribal organization, or inter-Tribal consortium, as defined in the Indian Self Determination and Education Assistance Act, as amended. Such departments have jurisdictional authority to provide public health services, as evidenced by constitution, resolution, ordinance, executive order, or other legal means, intended to promote and protect the Tribe’s overall health, wellness and safety; prevent disease; and respond to issues and events. Federally recognized Tribal governments may carry out the above public health functions in a cooperative manner through formal agreement, formal partnership, or formal collaboration.

    Regional Health Department

    Any eligible local or Tribal health departments, as defined above, may apply jointly for PPHR recognition if certain essential services are provided by formally sharing resources, and the manner in which this occurs is clearly demonstrated. The formal resource-sharing must be centralized in a regional agency, and that agency must hold primary responsibility for public health response activities at the local level. Interested entities should refer to the Regional Guidance Document.

    Support Response Agency

    The support response agency criteria is intended for those agencies whose lead role during a response is to support those serving as primary operational response agencies. If you believe your agency may qualify as a support response agency please fill out the pre-application checklist and send to [email protected] to facilitate a discussion of the most appropriate criteria version.

    How do I apply for PPHR?

    To start the PPHR application process, contact your state lead, or if you are unsure who your state lead is, contact [email protected].

    What is the application timeline? Can I apply anytime?

    The PPHR application development process occurs on a fixed yearly cycle. Eligible potential applicants should express their interest early to provide maximum flexibility regarding the application cycle in which they apply. The deadline to notify NACCHO of an ‘Intent to Apply’ for each cycle occurs in late October. Please review the Process Guide for more information regarding the PPHR timeline.

    What assistance will I receive with my application?

    NACCHO supports applicants and state leads through the process by providing technical assistance throughout the application preparation period, including providing an initial orientation, participating in periodic conference calls, and maintaining regular communication with the state lead.

    Why do I need a State Lead?

    The state lead plays a critical role as the primary contact point for both agencies applying for recognition and for NACCHO. NACCHO heavily relies on the role of the state to maintain the capacity of the program. A state lead is often, but not always an individual at the state level that aids applicants in coordinating necessary parts of the PPHR application.

    Where can I download the PPHR application criteria?

    Please click on the ‘Current Applicants’ tab of the PPHR webpage.

    Who reviews the PPHR applications? How do I become an application reviewer?

    PPHR reviewers are selected by the PPHR staff for their strong understanding of local public health preparedness and response. Most are local health department personnel and include preparedness planners, first responders, exercise and training coordinators, and epidemiologists. Qualified candidates from state health departments and other organizations may also be reviewers. All reviewers must attend an orientation and training webinar and complete a training assessment to demonstrate their understanding of the PPHR review process, criteria, and scoring and commenting procedures.

    Reviewers for each review cycle will be selected from the list of interested individuals based on the following criteria:

    • No affiliation with any application that is under review in the current cycle (this includes both applicants and state leads);
    • Agreement to all reviewer responsibilities;
    • Previous PPHR experience as a national reviewer (for lead and primary reviewers);
    • Public health preparedness experience, particularly on the local level;
    • Current position and its relationship to public health preparedness;
    • Whether the reviewer’s state or local health department is pursuing or interested in pursuing PPHR recognition;
    • Involvement in developing or contributing to a past PPHR application; and
    • Diversity of geography and professional background.

    Reviewer selection occurs around June/July each year. If you would like to be notified when reviewer applications are open, please fill out this survey. Note: Reviewers receive no compensation from NACCHO for their participation.

    Do you have any informational materials to share?

    The PPHR flyer can be viewed here.

    Are there any applicant success stories?

    To hear about the experiences from past applicants, download the audio file below:

    Will NACCHO come to my agency/city/state and present on PPHR?

    Please contact [email protected] for possible coordination.

    My agency was previously recognized, which application do I fill out to be re-recognized?

    If your agency currently holds recognition, you are eligible to use the re-recognition criteria before your current recognition expires. For example, if your agency is PPHR recognized for the five year period 2018-2023, you will have to start the re-recognition application process in 2022 to be recognized in 2023. Note, regardless of your recognition status, applicants are eligible to use the first-time application at any point of their recognition status.

    Who do I contact if I have more information?

    For questions or concerns, contact the PPHR team by emailing [email protected].

    For more information on PPHR, or to contact the PPHR team, email [email protected].

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