Detailed Information on the
Bioterrorism: Centers for Disease Control and Prevention Intramural Activities Assessment

Establish outcome oriented measures with baselines and targets which reflect CDC's enhanced preparedness

Explicitly tie budget requests to the accomplishment of annual and long-term goals, and present resource needs in a complete and transparent manner.

Demonstrate adequate progress in achieving the program's long-term and annual performance goals.

Conduct independent evaluations of sufficient scope and quality to indicate the program is effective and achieving results.

Measure: Increase the percentage of the TPER allocation for which budget execution matches strategic funding priorities.

Explanation:

Measure: Improve the on-time achievement of individual project milestones for Epidemiology, Laboratories and Emergency Response.

Explanation:

Measure: Achieve progressive improvements in the quality of projects submitted for TPER Upgrding CDC Capacity funding consideration.

Explanation:

Measure: By 2010, CDC's epidemiology system will reduce the time to initiate, coordinate and resolve investigations to identify causes, risk factors and recommended interventions.

Explanation:

Measure: By 2010, CDC's laboratory system will decrease the time from receipt of tissue, food and environmental samples to confirm and report chemical, biological and radiological agents to stakeholders.

Explanation:

Measure: By 2010, CDC's response operations system will decrease the time from event to actions that will minimize morbidity and mortality.

Explanation:

Measure: Decrease annual costs for personnel and materials development with the development and continuous improvement of the budget and performance integration information system tools.

Explanation:As information technology improves, the need for staff time and resources will accordingly decrease. Benefits of improved systems technology are expected to be realized over the next three years.

Is the program purpose clear?

Explanation: : The purpose of the projects funded by the Terrorism Preparedness and Emergency Response (TPER) budget activity, "Upgrading CDC Capacity," is to improve CDC's epidemiology, laboratory and response operations directed to achieve CDC's nine preparedness goals. (Note: surveillance, the fourth of CDC's preparedness capabilities, is funded in the Biosurveillance budget line.) Projects funded from this budget activity must address one of these three capabilities and must demonstrably align to one or more of these nine goals: 1. Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents, and naturally occurring health issues 2. Decrease the time needed to classify health events as terrorism or naturally occurring in partnership with other agencies 3. Decrease the time needed to detect and report chemical, biological, radiological agents in tissue, food, or environmental samples that cause threats to the public's health 4. Improve the timeliness and accuracy of information regarding threats to the public's health 5. Decrease the time to identify causes, risk factors, and appropriate interventions for those affected by threats to the public's health 6. Decrease the time needed to provide countermeasures and health guidance to those affected by threats to the public's health 7. Decrease the time needed to restore health services and environmental safety to pre-event levels 8. Increase the long-term follow-up provided to those affected by threats to the public's health 9. Decrease the time needed to implement recommendations from after-action reports following threats to the public's health As the nation's primary Federal public health asset, CDC has developed expertise in surveillance, epidemiology, laboratory, and response during its 60 year history. In the aftermath of terrorism and naturally occurring public health events in the late 1990s and early 2000s, CDC began a reorganization to put greater focus on these capabilities and to align its terrorism preparedness and emergency response activities with the larger national goals for preparedness. As part of that reorganization, the Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER) was established to coordinate all of CDC's TPER allocation. The allocation has been provided by Congress in five budget lines: 1) Anthrax; 2) BioSurveillance; 3) Strategic National Stockpile; 4) Upgrading CDC Capacity; and 5) Upgrading State and Local Capacity. While all five budget lines support activities that should be considered to "upgrade" CDC capacity, the activities specifically funded from the "Upgrading CDC Capacity" budget line are the subject of this review.

Evidence: ?? CDC Preparedness Goals ?? FY2006 TPER Budget Table ?? COTPER Vision/Mission statements ?? Appropriation legislation

Does the program address a specific and existing problem, interest, or need?

Explanation: The 9/11 terrorist and October 2001 anthrax events revealed that intentional public health threats agents are a viable national concern. Naturally occurring public health emergencies like SARS, natural disasters, or pandemic influenza also continue to concern Americans. Preparation of the public health system for terrorist or naturally occurring public health threats requires the same considerations for improvements in epidemiology, laboratory and response operations to eliminate or mitigate casualties. Epidemiology, laboratory, and response are three core CDC functions that apply equally to terrorism, naturally occurring urgent threats, and daily public health practice. CDC has developed superior technical capabilities in these three areas in its 60 year history, but additional work in all three areas to improve preparation for urgent threats is needed. Epidemiology is essential for the detection, control, and prevention of public health threats. The response to SARS highlighted progress in preparedness but also gaps in surveillance systems, laboratory facilities and workforce shortages. Increasing numbers of specially trained epidemiologists to address emerging infectious diseases and to provide technical assistance requested by local, state, and national governments are required. As the hub of the nation's public health laboratory infrastructure, CDC develops and evaluates new laboratory methods and reagents; provides training and evaluation of state and local public health laboratories; develops, manufactures, and supplies reagents, and provides testing services for unknown agents or confirmation of results. Prior to 1999, most state and local public health laboratories were not capable of rapid molecular testing for biological threat agents. Labs that could test for threat agents were using slower traditional culture testing methods. In addition, the risk of a terrorist chemical attack underscores the need for a reliable way to determine the identity of chemical agents and find out who has been exposed and to what extent. Getting test results within hours, not days, is critical in the event of a biological or chemical attack and requires improved public health laboratory capacity. The improvements needed to support more rapid turnaround of results include renovation of many state and local public health laboratories to comply with strict safety and containment standards; purchase of state-of-the-art testing equipment; a trained cadre of laboratory workers; and supplies to support testing. A seamless national laboratory network will also speed the response to urgent health threats by improving accuracy and timely reporting. Such a network can be achieved by defining the role of public health laboratories in public and private laboratory service delivery and establishing defined core functions and capabilities for state public health laboratories. Core functions in turn provide the foundation for the development of laboratory performance standards, against which state and local public health laboratories and clinical laboratories will establish and implement best laboratory practices. Traditionally, CDC's response operation capacity for outbreak investigation and control or response to natural disasters has been diffused across the agency. The 9/11 attacks and anthrax events in October 2001, underscored the need for a coordinated, efficient response operation capacity. Such a capacity must provide a solid foundation on which CDC subject matter experts could respond given the nature of the event. In addition, CDC response capacity must fit into the larger national system of response by following the National Incident Management System. Finally, CDC's response capacity improvement must include development of risk communication expertise, emergency management workforce development, and provision of technical assistance to state and local health departments for preparedness and response.

Evidence: ?? GAO Report GAO-03-769. May 2003. http://www.gao.gov/new.items/d03769t.pdf ?? The state of the U.S. laboratory infrastructure prior to 1999: http://www.bt.cdc.gov/lrn/infrastructure.asp ?? GAO Report GAO-06-467. February2006. http://www.gao.gov/new.items/d06467t.pdf ?? CDC. Core Functions and Capabilities of State Public Health Laboratories. MMWR, September 20, 2002: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5114a1.htm ?? CDC. Assessment of the Epidemiologic Capacity in State and Territorial Health Departments. MMWR October 31, 2003: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5243a6.htm ?? GAO Report GAO-03-373. April 2003. Preparedness varied across state and local jurisdictions. http://www.gao.gov/new.items/d03373.pdf

Is the program designed so that it is not redundant or duplicative of any other Federal, state, local or private effort?

Explanation: CDC's epidemiology, laboratory and response operations capacity has two unique dimensions: it seeks to provide services and technical assistance for public health practice in epidemiology, laboratory and response and it does so at the national level. For example, while all states, and many localities perform these standard public health preparedness activities, a national system is required to prevent and control multi-state outbreaks and public health issues of national scope or of importance to homeland security. CDC's portfolio of epidemiology, laboratory, and response activities brings this public health service and technical assistance to a national level. Additionally, while other federal agencies also perform some elements of all of these capabilities (e.g., Department of Homeland Security provides response capabilities), CDC is the only Federal agency to perform all of these capabilities as its core capabilities. Within CDC, COTPER was specifically designed to prioritize and coordinate terrorism preparedness and emergency response activities across the agency to avoid duplication of activities and achieve efficiencies. Because multiple Centers, Institutes and Offices (CIOs) at CDC have developed expertise in different aspects of preparedness and response, COTPER achieves a terrorism preparedness and response system that integrates sound management principles and superior technical expertise.

Evidence: Program Authorizing language 42 USC Sections 247d-2 and 247d-4

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: Upgrading CDC's epidemiology, laboratory, and response operations capacity for preparedness requires that the agency identify and fund activities in a strategic and efficient manner. The major potential limit to effectiveness or efficiency of CDC efforts in this area is haphazard, duplicative or non-strategic funding. To prevent this limitation, COTPER has establish a system for establishing funding priorities and selecting projects for funding that will achieve the objective of upgrading CDC capacity for epidemiology, laboratory and response preparation. First, the forthcoming preparedness goal action plans (part of CDC's major strategic planning effort) will establish specific objectives and action plans for each of CDC's core capabilities for preparedness to achieve the promise of the nine preparedness goals. These objectives and action plans will allow COTPER to be as strategic as possible in determining the priorities for distribution and balance of funds across the various goal areas, types of hazards (e.g., all-hazards versus specific agents), and capabilities. Agency timelines call for goal action plans to be complete by April 2007, and thus used to set priorities for executing the FY2008 Terrorism Preparedness and Emergency Response allocation. Second, COTPER's budget execution leads the agency in designing a system to maximize efficiency by centralizing the project submission and review process, thereby allowing for the early identification of duplicative efforts. Following a call for submissions, all terrorism preparedness and emergency response project proposals for upgrading CDC's epidemiology, laboratory, or response operations capacity are entered into HealthImpact.net. Project submissions include detailed workplans and timelines, and must include responses to standardized evaluation questions that are used to rate and select projects for funding. This process allows for the selection of projects that 1) are most likely to achieve the objectives of upgrading some part of CDC's preparedness capacity; 2) are not duplicative of each other; and 3) are well-specified and, therefore, likely to succeed.

Evidence: ?? FY2007 Spend Plan Documentation ?? HealthImpact.net documentation

Is the program design effectively targeted so that resources will address the program's purpose directly and will reach intended beneficiaries?

Explanation: The "Upgrading CDC Capacity" budget activity is executed in a manner that ensures resources are being used directly and effectively to meet the program's purpose of upgrading CDC's epidemiology, laboratory, and response capacity. As described in response 1.4, projects are selected for funding based on 1) the ability to achieve the objectives of upgrading some part of CDC's preparedness capacity; 2) not duplicating other CDC projects; and 3) the likelihood of success. Thus, projects funded as part of the "Upgrading CDC Capacity" budget activity are directly tied to the purpose of the program. In addition, part of the specifications required for all projects submitted are specific workplans with associated short and long-term (annual) performance measures. Thus, the effectiveness of each program that is funded is monitored via tri-annual reporting periods. Each project is evaluated for its achievement of milestones. Technical assistance is provided to each program as necessary. In addition, continuation funding in the next fiscal year is tied to performance. The program is structured so that resources and outcomes will adequately reach the intended beneficiaries. The first beneficiaries are the CDC programs receiving funding to implement projects that will contribute to upgrading CDC capacity. COTPER uses all communication channels at its disposal to inform CDC program staff about the availability of funds, consulting opportunities, and documentation. In addition, COTPER takes advantage of "matrixed" positions in the new CDC organizational structure to reach across organizational units. Thus, through the Chief Management Officials, Strategy and Innovation Officers, Enterprise Communication Officers, Science and Public Health Practice Officers and others, information is provided directly and efficiently to all of the management chains throughout the Agency. Ultimately, the beneficiary of each of the program activities is the American public. While some projects are limited in scope, many projects funded in this program have direct national reach with epidemiology personnel and laboratories funded and supported across the country, thereby reducing response time and improving direct local relationships. All internal capacity is directly translated to the American public through response operations.

Evidence: ?? FY2007 TPER Spend Plan Documentation ?? "New CDC" organizational structure ?? Example workplans from HealthImpact.net ?? EIS and CEFO program descriptions ?? LRN program description

Does the program have a limited number of specific long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: Upgrading CDC Capacity aligns with CDC's overarching preparedness goal: People in all communities will be protected from infectious, occupational, environmental and terrorist threats. Nine subordinate goals relate to CDC's core capabilities of epidemiology, laboratory, or response. Long-term performance measures for these 3 capabilities help define "upgrading CDC capacity" for preparedness. 1. By 2010, CDC's epidemiology system will reduce the time to initiate, coordinate and resolve investigations to identify causes, risk factors and recommended interventions. Related preparedness goals: ?? Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents, and naturally occurring health issues ?? Decrease the time needed to classify health events as terrorism or naturally occurring in partnership with other agencies ?? Decrease the time to identify causes, risk factors, and appropriate interventions for those affected by threats to the public's health. The time reductions stipulated by this performance measure will directly affect the ability of public health and law enforcement personnel to implement prevention interventions, decrease the time to classify health issues as terrorism or naturally occurring, and decrease the time to identify risk factors and causes of urgent public health events. These time savings will decrease the time needed to communicate with the public about important health issues, and to identify and provide countermeasures. 2. By 2010, CDC's laboratory system will decrease the time from receipt of tissue, food and environmental samples to confirm and report chemical, biological and radiological agents to stakeholders. Related preparedness goal: ?? Decrease the time needed to detect and report chemical, biological, radiological agents in tissue, food, or environmental samples that cause threats to the public's health. The time reductions stipulated by this performance measure will directly affect the ability of public health and law enforcement personnel to identify events of national public health importance and indirectly will decrease the time needed to communicate with the public about important health issues, initiate investigations, and to identify and provide countermeasures. 3. By 2010, CDC's response operations system will decrease the time from event to actions that will minimize morbidity and mortality. Related preparedness goals: ?? Improve the timeliness and accuracy of information regarding 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 ?? Increase the long-term follow-up provided to those affected by threats to the public's health ?? Decrease the time needed to implement recommendations from after-action reports following threats to the public's health. The time reductions stipulated by this performance measure will directly affect the ability of public health and law enforcement personnel to identify events of national public health importance, initiate investigations, determine causes and risk factors, identify and implement effective countermeasures and provide timely and accurate communications with the public. Ultimately, a public health response system that is prepared, efficient, and effective will reduce morbidity and mortality associated with terrorism or naturally occurring public health threats.

Evidence: See measures

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: : All of the individual projects funded through this budget activity line must be able to provide data to one or more of the performance measures that define "upgraded CDC capacity." Given the diverse nature of the individual contributing projects, finalizing the performance measures in terms of data requirements and realistic but ambitious targets thus requires the development of a method for incorporating individual project-level data. This work , though not yet complete, will be carried out through the CDC goal action planning process which is on a very rapid timeline. While goal team leaders have only recently been identified and selected for details into these important strategic positions, the Agency plans to have strategic action plans in place by April 2007. Far earlier than that time, the long-term performance measures associated with "upgrading CDC capacity for preparedness" will be vetted, finalized and documented. These overarching performance measures must be "SMART" - specific, measurable, achievable, relevant and time-bound. The development of SMART performance measures will allow for targets and timeframes to be developed. This will be followed by a well-crafted analysis of current activities (i.e., how are current activities moving the Agency toward this objective as indicated by the performance measures?), gaps (i.e., what else should the Agency be doing?), and priorities (i.e., what are the first things the Agency should fund?).

Evidence:

Does the program have a limited number of specific annual performance measures that can demonstrate progress toward achieving the program's long-term goals?

Explanation: Individual projects aimed at upgrading CDC capacity will contribute to one or more of the long-term goals and demonstrate progress toward the long-term goals by showing progressive improvements on the same measure each year. Because decreasing the time required to accomplish these tasks directly impacts all of CDC's other major preparedness goals, measuring performance on these objectives should begin immediately and be monitored over time. Annually, CDC's epidemiology system will reduce the time to initiate, coordinate and resolve investigations to identify causes, risk factors and recommended interventions. Annually, CDC's laboratory system will decrease the time from receipt of tissue, food and environmental samples to confirm and report chemical, biological and radiological agents to stakeholders. Annually, CDC's response operations system will decrease the time from event to actions that will minimize morbidity and mortality.

Evidence: See measures

Does the program have baselines and ambitious targets for its annual measures?

Explanation: As described for response 2.2, all of the individual projects funded through this budget activity line must be able to provide data to one or more of the performance measures that define "upgraded CDC capacity." Finalizing the performance measures so that baselines and realistic but ambitious targets can be developed thus requires the development of a method for incorporating individual project-level data. This work will also be carried out through the CDC goal action planning process and is anticipated to be completed by December 31, 2006.

Evidence:

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) commit to and work toward the annual and/or long-term goals of the program?

Explanation: While the "Upgrading CDC Capacity" budget line grant program per se, it functions like one by establishing funding priorities, review criteria, and performance criteria; conducting peer reviews; making funding recommendations to CDC leadership; and monitoring performance over time. All funded projects are required to establish outcomes, performance measures and milestones that reflect their relationship to the overall goals and objectives of upgrading CDC capacity in one or more of the three CDC core capabilities supported by this budget line. All funded partners see the contribution of their individual programs as reflecting an upgraded CDC capacity for preparedness. As long-term performance measures are developed that better define this objective in collaboration with these and other partners, all partners will similarly commit to contributing to the achievement of the measurable objective.

Evidence: ?? PMET end-of-year 2005 report

Are independent evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: Formal independent evaluations of the UCCP have not been conducted. With the establishment of the new "matrixed" Strategy and Innovation Officer position, COTPER leadership selected a senior staff member from CDC but from outside of COTPER to assume this position in April 2006 with immediate responsibility for review and revision of the FY2007 budget spend plan process. In addition, because many of COTPER's tactical functions are funded through this line, reviewers from outside COTPER have always been included in the review process.

Evidence: No formal independent evaluations have been conducted.

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: : Internally, COTPER is leading CDC in the development and use of a performance budget. Since 2004, COTPER has tied funding of program activities in all of its budget lines, including the Biosurveillance Program, to performance. To do this, it led the creation of HealthImpact.net and the IRIS Budget and Performance Integration (B&PI) module that transparently link program data and budget information. Today, COTPER continues to lead the agency by using these tools to conduct annual project submission and subject matter expert review panels to identify strategic projects, evaluate past performance, and conduct standards-based scientific reviews to determine budget execution. Past performance is based on triannual reporting of project performance against established milestones and performance measures. Currently, though, the agency is in the process of identifying long term and annual targets to assign to its performance measures. Once these targets are identified, the agency will be able to link its budget requests to the performance of the programs. The FY 2007 Congressional Justifications do not identify the rationale for the budget request for this line item.

Evidence: ?? HealthImpact.net documentation ?? IRIS Budget and Performance Integration module documentation

Has the program taken meaningful steps to correct its strategic planning deficiencies?

Explanation: CDC has developed four goal areas and twenty-four strategic goals, which will drive the formation of measurable agency strategic and core objectives. These objectives will drive budget requests for agency programs that will accomplish them. Twenty-one goal team leaders have been selected to develop the goal action plans that will identify the agency's strategic priorities for accelerating health impact. Goal action plans will be the foundation of the agency's strategic plan and will drive the strategic plans for its national centers. The goal action plans will include 1) an assessment of current agency activities, funding and performance measures, 2) a review of the burden of disease and the known effective interventions, 3) analytic work on the most effective areas for research and intervention, 4) a gap analysis, and 5) the strategic objectives and actions that have the greatest potential for accelerating health impact. The goal action plans are being developed in collaboration with CDC's centers and divisions and with CDC's partners and stakeholders. Upon completion, these plans will be reviewed by CDC's Executive Leadership Board, Center Director Council, and Division Director Council and the Annual National Partners Meeting. Once they have been approved, these strategic plans will guide the annual implementation plans and budgets of all CDC organizational units. COTPER has embraced the goal action planning process. An overarching preparedness goal action plan is under development, as are six scenario-specific action plans representing health issues of particular interest to the agency. COTPER will use these action plans to drive budget formulation, spend plan priorities, its overall evaluation plan (incorporating existing and planned PART and GPRA measures), and its overall communications plan. Included in these preparedness goal action plans will be specific "PART-ready" long-term performance measures to which every program funded through the CDC's Terrorism Preparedness and Emergency Response allocation will be required to contribute.

Evidence: ?? CDC Health Protection goals and Preparedness Goals. http://www.cdc.gov/about/goals/default.htm ?? Roles of Strategy and Innovation Officers and Goal Team Leaders http://www.cdc.gov/about/goals/goals.pdf ?? COTPER Goals Management Project Plan from HealthImpact.net

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation: Performance of all projects supported by the "Upgrading CDC Capacity" budget line is monitored by the COTPER Performance Measurement and Evaluation Team using the performance budget tools, HealthImpact.net and IRIS Budget and Performance Integration module. Funding of projects is predicated on the establishment and ability to monitor and report on high-quality, relevant short (i.e., milestones) and long-term (i.e., performance) measures. Once funded, program activities are required to report data to support these measures on a tri-annual basis. Project performance is summarized for COTPER and other CDC leadership at the end of each performance period. In addition, performance is summarized at the end of fiscal year in an annual report. Programs are provided feedback and technical assistance regarding their performance to manage and improve the programs. In addition, past performance is used as a major criterion in determining continuation funding for projects. In addition to managing individual projects, performance data is used to establish and determine overall accomplishment of objectives for upgraded CDC capacity in the areas of epidemiology, laboratory and response operations and for COTPER overall (e.g., progress toward the nine preparedness goals). This information contributes to the development, implementation, and monitoring of the preparedness goal action plan, budget formulation, and annual budget execution priorities.

Evidence: ?? HealthImpact.net documentation ?? IRIS Budget and Performance Integration module documentation ?? FY2007 TPER Spend Plan documentation

Are Federal managers and program partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) held accountable for cost, schedule and performance results?

Explanation: Because performance measures are developed by the projects and self-reported into the PMET system, Federal managers are held directly accountable for their projects performance. Costs are monitored in the system by budget analysts who assure the timely expenditure of funds. Finally, past project performance and fiscal performance weigh heavily in the decision about whether or not to continue funding for projects thus increasing the accountability of Federal managers.

Evidence: ?? PMET FY2005 end-of-year performance report ?? FY2007 Spend Plan Review Guidance

Are funds (Federal and partners') obligated in a timely manner, spent for the intended purpose and accurately reported?

Explanation: COTPER allocates resources according to its annual spend plan process. Funds are obligated immediately when made available to COTPER to projects that have been previously reviewed and selected via a standards-based system. Limited amounts of unobligated funds remain with COTPER at the end of the fiscal year. CDC's Financial Management Office (FMO) ensures that appropriated funds are properly obligated in a timely manner and that mechanisms are in place to ensure that funds are spent for the purpose for which they are intended. This is demonstrated by efforts in the areas of budget execution consolidation, spending plan execution, cancelled year appropriations, and erroneous payments.

Evidence: standard operating procedures of the budget execution branch Spending plans developed at the program level (certify and monitor the status of funds). Risk assessments were completed to determine whether they were susceptible to improper payments exceeding $10 million and a 2.5 percent error rate and required to estimate improper payments under the Improper Payments Information Act of 2002 (IPIA) and the related OMB Guidance.

Does the program have procedures (e.g. competitive sourcing/cost comparisons, IT improvements, appropriate incentives) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: CDC continues to examine agency operations to identify areas where efficiencies may be realized. In addition to competitive sourcing studies to meet the requirements of the President's Management Agenda, CDC has reviewed and reorganized its organizational and reporting structure. CDC has completed several competitive sourcing studies over the past three years, covering such services as Animal Care, Facilities Planning and Management, Library Services, Statistical Support, and Writer/Editor functions. CDC has won 13 of the 14 studies completed. Savings realized from competitive sourcing are reinvested in mission-direct public health activities. FY 2006 efforts to increase efficiencies include two restructuring initiatives, covering administrative and business service functions. Goals of restructuring these functions include alignment with and support of CDC's new organizational structure, as well as targeting greater efficiencies through process improvements and standardization across the agency. The FY 2005 budget execution consolidation within the Financial Management Office will be evaluated for process reengineering, service improvement, and cost savings. Also, the Public Health Integrated Business Services (PHIBS) initiative will result in restructuring of business functions currently carried out in CDC's national centers and coordinating centers/offices. The results of these two initiatives will inform restructuring proposals as alternatives to competitive sourcing competitions. CDC has completed delayering the agency to no more than four management layers. With the elimination of over 200 "sections", a 33% decrease in the official number of organizational units since 2001 has been achieved. Additionally, CDC's supervisory ratio has more than doubled from 1:5.5 in 2002 to over 1:12.6 in January 2006. COTPER has been at the forefront of development of two information technology tools (i.e., HealthImpact.net and IRIS B&PI) for budget and performance integration. These tools are now widely used by a variety of staff and for a variety of purposes, gaining efficiencies in the consolidation of information systems, and reducing the time required to find, collate, and use data. A representative measure of the efficiency gained by this system is the continuous reduction of costs to conduct COTPER's annual spend plan execution process. With all staff using the system, the reduced time required to collect and use data for decision making translates directly into dollars saved. Thus, COTPER can report on the following efficiency measure for all of its budget lines, including the biosurveillance program: Decrease annual costs for personnel and materials development with the development and continuous improvement to the budget and performance integration information system tools.

Evidence: see measure

Does the program collaborate and coordinate effectively with related programs?

Explanation: Seventy-four projects are funded from the budget activity "Upgrade CDC Capacity". However, these projects are part of a single comprehensive vision for CDC's Terrorism Preparedness and Emergency Response (TPER) program that also includes other elements of upgrading CDC and state and local capacity (e.g., biosurveillance, Strategic National Stockpile, state and local readiness grants), funded through four other TPER budget activities. This vision is based in the overarching and 9 subordinate preparedness goals and the goal action planning framework process that is currently underway. Specifically, the development of performance objectives and performance measures for CDC's core functional areas (epidemiology, laboratory, response operations, and surveillance) are applied to all projects so that accomplishments in these areas are accounted for regardless of which funding stream is used to support the activity. In this way, a coordinated effort to upgrade CDC capacity is made based on a unifying strategic plan. Implementation of the strategic plan also contributes to coordination and collaboration across related programs. For example, budget execution processes are developed to examine all projects according to the core functional areas to identify and eliminate overlapping projects, usually through negotiating joint collaborative projects across CDC organizational lines or selecting better prepared projects for funding. The Coordinating Office for Terrorism Preparedness and Emergency Response was created to manage a number of large and related CDC programs. This management structure creates a foundation for collaboration and better integration of high-profile programs such as the Strategic National Stockpile (SNS), State and Local Public Health Emergency Preparedness cooperative agreements, and CDC's Emergency Operations Center. It likewise provides the programs funded to other parts of CDC's organizational structure through the Upgrading CDC Capacity program, to have a strong foundation for relating their programs to an overarching structure and strategic vision for preparedness.

Evidence: ?? Goals documentation ?? HealthImpact.net documentation ?? FY2007 Spend Plan Guidance ?? FY2005 PMET end-of-year report ?? FY2006 first reporting period PMET report

Does the program use strong financial management practices?

Explanation: In April 2005, CDC implemented a new Unified Financial Management System (UFMS). UFMS is an integrated, Department-wide financial system that consistently produces relevant, reliable, and timely financial information to support decision-making and cost-effective business operations at all levels throughout the Department. UFMS replaced the legacy mainframe-based financial system, which was over 15 years old. UFMS provides the program with more real-time financial data, improved financial reports that allow managers to make timely decisions, and streamlined financial processes. UFMS will help the Department continue to achieve unqualified audit opinions. The HHS FY 2005 Performance and Accountability Report noted a material weakness related to the transition to UFMS, but full implementation will eliminate this material weakness.

Evidence: the HHS Performance and Accountability Report

Has the program taken meaningful steps to address its management deficiencies?

Explanation: All COTPER programs are reviewed quarterly and annually through program reviews with COTPER leadership to assure that priority activities are clearly stated, specified and monitored. Management of the budget execution and performance monitoring for the biosurveillance program is subjected to this review as are all other budget lines within the Terrorism Preparedness and Emergency Response allocation. Annual activities, such as conducting PART reviews, the budget execution process, and the budget formulation process are reviewed annually by senior COTPER leadership to assure sound, scientifically-based approaches are being used. In addition, performance of all funded programs from the TPER allocation is monitored through the use of HealthImpact.net.

Evidence: ?? FY2005 end-of-year PMET report

Has the program demonstrated adequate progress in achieving its long-term performance goals?

Explanation: Achieving upgraded CDC capacity for preparedness requires defining the endpoint, identifying how current investments will drive toward that endpoint, identifying gaps, establishing priorities and a commitment to change funding patterns to address those priority areas given stagnant or falling budgets. CDC has identified current CDC investments toward the goals and performance measures. Status is completed. By July 30, 2006, will develop draft endpoints for core functional areas that relate to the nine preparedness goals. Status is in progress. Draft performance measures are reported in question 2.1 with targets and baseline data to be drafted by July 30, 2006. By December 2006, CDC will identify gaps in investments that will strategically improve capacity for preparedness. By April 2007, CDC will establish priorities among current and strategic investment opportunities. Additionally, CDC is developing output based performance data, which can be viewed in the measures section.

Evidence: ?? Upgrading CDC Capacity PowerPoint presentation 05.10.06 ?? PMET FY2005 end-of-year report ?? Draft FY2006 first reporting period PMET report

Does the program (including program partners) achieve its annual performance goals?

Explanation: Although the program has established long-term and annual measures, data collection to establish baselines is still underway. Once baselines and targets are established, the program can begin reporting on actual data to demonstrate achievement of annual targets

Evidence:

Does the program demonstrate improved efficiencies or cost effectiveness in achieving program goals each year?

Explanation: COTPER has been at the forefront of development of two information technology tools (i.e., HealthImpact.net and IRIS B&PI) for budget and performance integration. These tools are now widely used by a variety of staff and for a variety of purposes, gaining efficiencies in the consolidation of information systems, and reducing the time required to find, collate, and use data. A representative measure of the efficiency gained by this system is the continuous reduction of costs to conduct COTPER's annual budget execution process. With all staff using the system, the reduced time required to collect and use data for decision making translates directly into dollars saved. Thus, COTPER can report on the following efficiency measure for all of its budget lines, which includes the "Upgrading CDC Capacity" budget line. See measures section.

Evidence: ?? Upgrading CDC Capacity PowerPoint presentation 05.10.06 ?? BearingPoint contractor data ?? HealthImpact.net improvements documentation ?? IRIS Budget and Performance Integration improvement documentation

Does the performance of this program compare favorably to other programs, including government, private, etc., with similar purpose and goals?

Explanation: No comparable Federal, state, local government, or private sector programs exist to upgrade CDC capacity for emergency preparedness.

Evidence:

Do independent evaluations of sufficient scope and quality indicate that the program is effective and achieving results?

Explanation: Independent evaluations of this budget activity have not been done.

Evidence: