Summary

Congress asked us to examine issues regarding changes in obligations for administrative activities--generally conducted in CDC's leadership and management levels--and public health programs--generally conducted in CDC's division level--before and after the organizational restructuring and budget reorganization. GAO examined the following questions: 1. How were obligations distributed between CDC's division level and CDC's leadership and management levels from fiscal years 2003 through 2006? 2. How have obligations and activities at CDC's leadership and management levels--including shared business services in the CDC Office of the Director--changed from fiscal year 2003 through fiscal year 2006? 3. How have obligations and activities at CDC's division level changed from fiscal years 2003 through 2006?The Centers for Disease Control and Prevention's (CDC) mission is to promote health and quality of life by preventing and controlling disease, injury, and disability. In fiscal year 2005, CDC, an agency within the Department of Health and Human Services (HHS), completed its first major organizational restructuring in more than 25 years, known as the Futures Initiative, as part of its efforts to prioritize its strategies, programs, resources, and needs. In accordance with the conference report accompanying its 2005 appropriation, CDC also implemented a new internal budget reporting structure that specifically identifies funding obligated for leadership and management activities. However, questions have been raised concerning whether changing the budget reporting structure has made it difficult to compare obligations over time for leadership and management activities and for public health program activities. Prior to the fiscal year 2005 organizational restructuring, CDC consisted of an Office of the Director and national centers that housed CDC's public health programs, including programs to reduce or prevent infectious diseases, cancer, birth defects, injuries, and other health problems. CDC had two organizational levels that were primarily responsible for leadership and management: the CDC Office of the Director and the national center directors' offices. In fiscal year 2005, CDC added two national centers. CDC also added a new leadership and management organizational level, which consists of six coordinating centers designed to better integrate the work of the national centers. Four of the six coordinating centers each manage the work of two or more specific national centers, while the other two coordinating centers each manage agencywide issues related to global health and terrorism preparedness and emergency response. Adding coordinating centers to CDC's structure was consistent with our 2004 recommendation that CDC oversee the national centers' programmatic work at a level below that of the CDC Director. In addition to its leadership and management levels, CDC has one organizational level--consisting of the national center divisions, branches, and other units--that is primarily responsible for operating public health programs. In this report, we refer to this level as CDC's division level. You asked us to examine issues regarding changes in obligations for administrative activities--generally conducted in CDC's leadership and management levels--and public health programs--generally conducted in CDC's division level--before and after the organizational restructuring and budget reorganization.

The distribution of obligations between CDC's division level, which is primarily responsible for carrying out public health programs, and its leadership and management levels remained relatively stable from fiscal year 2003 through fiscal year 2006. Obligations at CDC's division level accounted for between 87 and 89 percent of CDC's obligations in each year, while obligations at CDC's leadership and management levels accounted for between 8 and 9 percent of CDC obligations. Obligations for buildings and facilities, which are not considered part of CDC's division level or CDC's leadership and management levels because they generally consist of onetime capital expenses, accounted for the remaining portion of CDC obligations. Overall, CDC's obligations increased from $6.05 billion in fiscal year 2003 to $6.14 billion in fiscal year 2006. Obligations at leadership and management levels fluctuated from about $483 million in fiscal year 2003 to a high of about $592 million in fiscal year 2004, before ending at $516 million in fiscal year 2006, as obligations and activities such as shared business services were consolidated in the CDC Office of the Director. Obligations at CDC's division level remained between about $5.4 billion and about $5.6 billion, despite the movement of some activities to the division level from leadership and management levels and the movement of some administrative activities from the division level to the leadership and management levels. However, after adjusting for inflation, from fiscal year 2003 to fiscal year 2006, obligations declined at the division level to a greater extent than at the leadership and management levels. We received written comments on a draft of this report from HHS. In its comments, HHS interpreted our findings to suggest that its 2005 organizational restructuring has had limited or no impact on funding available for public health program activities. However, because it is difficult to separate the effects of the organizational restructuring, inflation, or other factors on obligations for public health program activities, we did not draw this conclusion. We did note that, after adjusting for inflation, obligations at CDC's division level declined more than obligations at CDC's leadership and management levels from fiscal year 2003 to fiscal year 2006.