As we move further along the path for a systematic approach to ensuring public health agency capacity and performance through accreditation, the hope of integrating accreditation with strategies to enhance workforce competency is emerging. In some respects, developing a comprehensive approach to credentialing the public health workforce is even more challenging than agency accreditation itself.1 The attempt is crucial, if difficult, because professionalizing the workforce is necessarily entwined with accrediting public health agencies. Strengthening the workforce-the most important component of public health organizations-will go a long way toward strengthening those organizations and the broader public health infrastructure. Some promising steps have been taken, which may point the way toward a comprehensive approach.

1. Review of existing credentials as part of the accreditation process: Some accreditation programs, such as ours in North Carolina, require agencies to present evidence of licensure and credentials of their employees for certain categories of the public health workforce (http://www2.sph.unc.edu/nciph/accred/). As recently noted by Gebbie and Turnock,2 we would benefit from a consistent categorization of the public health workforce across the nation and uniform use of competency-oriented job descriptions. They recommend that "accreditation requirements must include standards for workforce composition and competence."^2(p932) By incorporating a review of the status of the agency's workforce, as a part of the accreditation site visit, a first step is taken along the path.

2. Development of workforce standards and guidelines: To take this process to the next level, we will need workforce standards and guidelines against which to benchmark the status of the public health workforce within an agency. To some extent, such standards already exist. For example, in Illinois, a board3 was established to credential public health managers and administrators using methods linked to practice performance standards for local public health systems. In certain occupations, such as for public health educators,4 standards and a process leading to formal credentialing exist. In North Carolina, as in other states, environmentalists must be certified and recertified by the North Carolina State Board of Sanitarian Examiners to assure that their skills are kept up to date. A National Board of Public Health Examiners has been recently created to develop, prepare, administer, and evaluate certification examinations for graduates of accredited schools and graduate programs of public heath (http://www.nbphe.org).Suffice it to say, we have a few good programs, but the overall system of standards is best described as a "patch work." Some may advocate having a credential for every member of the public health workforce, while others may suggest using existing credentials that are discipline specific. Do we need some combination of each approach? Moving ahead with competency-based workforce standards and guidelines should help as another step toward a more comprehensive system.

3. Addressing gaps in training and education: To achieve a credential or a certification, a public health worker must demonstrate competency and show evidence of having completed formal training and education. Schools of public health have an important role to play in this regard, by providing access to programs that can meet the needs of currently-employed workers who seek to improve their competency and to participate in targeted training and education experiences. Without access to lifelong learning opportunities, the current workforce cannot achieve the levels of competency needed to merit credentialing and certification.

4. Identifying incentives: In addition to increasing access to learning opportunities, provision of incentives for public health workers to be credentialed is key. Since most current public health workers lack a formal credential, the task of credentialing the workforce seems unlikely in the absence of meaningful incentives. It would appear that by formally linking agency accreditation to individual credentialing, a system of incentives could be developed. Incentives that work at the individual level and relate directly to job security, upward mobility, and higher salaries will also be needed. Precedents exist in the healthcare field for doing exactly this: hospitals must demonstrate that their employees have the appropriate licensure and certification to be accredited. Why should this not be a feature of public health agency accreditation?

Conclusion

In conclusion, linking workforce credentialing to agency accreditation may emerge as a new strategy to enhance agency performance as well as ensuring individual competence. Small steps are being taken today by incorporating documentation of employee credentials into agency accreditation reviews and by enhancing access to training and education. Developing standards and guidelines to benchmark workforce credentialing and formalizing incentives seem to be the next steps along the way. Eventually, we may see a comprehensive national system in which public health agency accreditation and workforce credentialing are the norm across the nation. The journey toward that goal will be difficult, but perhaps not impossible.

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