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65 added that this is a continuing process, and asked what assurance do we have that this Board of Health is the Board to do what we ask? Discussion ensued between Commissioners Gustaveson and Walker con- . cerning the different policies and the philosophy which the Board of Health should have. Commissioner Walker stated that'he felt the Board was pursuing the health needs of citizens, that the measure of effective- ness depended an the philosophy of the Berard . Commissioner Gustaveson stated that there was a feeling that this body, which is a public body, is not actively involved in setting policy. He added that erne of his problems was how to move from a Board which was used to working one particular way in the past and which now must make a change to be•active and take seriously the concerns of citizens. Commissioners Walker responded that the District Board was trying to do the things which had been pointed out. He added that the Orange County Board must take the District Health Berard on their word. Commissioner Pinney stated that as long as Orange County was getting its share of programs and services, it could form its own mini-board and work with this arrangement. Other concerns which Mr. Gustaveson pointed out were the serious problems with inter-agency coeperation, and the high turn over of per- sonnel within the Health District. He said there were structural pro- blems in the administration in terms of how the staff is involved in carrying on programs and in staff training. Commissioner Walker stated that the Board should decide if its concerns were health needs, the philosophy of the Board, administrative, or what. Commissioner Gustaveson stated that all of these issues should be concerns of the District Board. Chairman Whitted stated that with the responsibility of the Cammis- sioners to appropriate monies to the District Health Department on an annual basis, that the local Boards should have some indication of how effective programs are. He added that information of this sort is not being received and the Commissioners have no way to measure the effec- tiveness of health services in Orange County. The Chairman stated further that with all the discussions with the District Board, they still failed to see the problems. He continued that just one problem can nvt be cited, there is a broader range of problems. Commissioner Pinney suggested that an outside evaluation be made of the programs within the District Health Department. Mr. Gustaveson stated that there were State Consultant Teams available to undertake studies of this type. Commissioner Gustaveson summarized at this point, what problems had been cited thus far by Commissioner Willhoit and the solutions: 1. Lack of administrative leadership. Solution - The Nixing of a professional health director. 2. Need for an active policy making Board of Health with 35 percent representation for Orange County. Solution - To adolish or re- organize the present Board and establish an active Board. 3. The slowness of hiring a Health Director. Solution - to establish a Search Committee to find a competent Health Director. 4. Failure to utilize available resources of UNC Schools of Public Health, Medicine and Nursing. Solution - To organize a task force to explore ways in which the district can utilize these resources so that both the University and the District would mutually benefit. Commissioner Gustaveson proceeded to add to the list the following: 5. The problem of Tnter-agency cooperation between Health Depart- ment personnel and other service agencies within the community.