Abstract
Accredited health departments now cover 80% of the US population. A relatively modest proportion of these are small local health departments (LHDs), serving fewer than 50 000 people. Despite comprising more than half of all health departments, only 2% of small LHDs are accredited. This brief report is a qualitative inquiry into the enablers of accreditation for small LHDs. We interviewed health department and accreditation leaders from 9 accredited small local LHDs. Interviews were transcribed, verified, and coded by 2 coders. We found that dedicated funding, prework, clear expectations, and peer examples were strong enablers of accreditation for these groups. Additional resources specific to small LHDs may be necessary to expedite application processes and encourage greater uptake from this group.