Public health is one of few segments of the health sector that lacks accreditation of its principal organizations and health departments. The Multistate Learning Collaborative (MLC) and the Exploring Accreditation Project (EAP) are jointly examining the feasibility of a national public health accreditation system by selecting five states (Illinois, Michigan, Missouri, North Carolina and Washington) to participate in an experiment. Each state will function as an "operational public health laboratory." This paper reviews and summarizes the collective knowledge regarding accreditation and assessment programs in these five states.

Across these states, the accreditation/assessment programs have commonalities and differences. Most rely upon both internal and external assessments, conformance with standards as demonstrated through documentation and 3–5 year review cycles. All the MLC grantees acknowledged that cost/benefit considerations of the accreditation system had been inadequately defined and evaluated. State funds were the usual source of underwriting the cost of an accreditation program, which can be substantial: North Carolina's program cost $700,000 in 2006.

In addition to the five grantee states, 13 other states applied for the program, indicating strong support for this program nationally. The authors express confidence that continued study and review by the MLC and early adopter states will inform the development of a national system of public health agencies that relies on continuous quality improvement principles.