Concerns regarding the Portsmouth Health District’s operational challenges were raised in a recent column published on November 18, 2023. The article suggested that Virginia’s health leaders are neglecting the district. In response, the Virginia Department of Health (VDH) emphasized its commitment to addressing the district’s needs and acknowledged the hard work of its staff.
The issues facing the Portsmouth Health District stem not from political neglect or funding cuts but from structural challenges, including workforce shortages and high turnover in leadership. Over the past decade, the district has seen eight different district directors, leading to instability. Such turnover complicates efforts to attract qualified candidates, a challenge exacerbated by the complexity of the role and competition from the private sector.
In efforts to stabilize leadership, VDH is actively supporting the recruitment of a new permanent district director. An acting director is currently assessing the district’s needs and collaborating with district leadership and VDH’s central office to identify necessary skills and qualities for the new position. The district has faced significant staffing challenges, with vacancy rates ranging from 24% to 38% between July 1, 2024, and November 1, 2025. This is among the highest vacancy rates across VDH’s local health districts.
Moreover, contract workers currently account for 45% of the district’s total staff of 74. Key clinical, nursing, and administrative positions remain unfilled, further straining resources. Employee feedback indicates issues such as unclear role definitions, communication barriers, and unmet expectations from leadership.
To mitigate these challenges, VDH has assigned dedicated personnel, including a medical officer for clinical operations and another for infectious disease specialization, along with a human resources business partner. These roles are intended to enhance clinical services throughout the district. VDH’s central office continues to provide ongoing support, including multi-year interim leadership and technical expertise for various programs.
Despite the staffing shortages, essential services such as those addressing HIV, sexually transmitted infections, maternal and child health, and harm reduction remain fully operational. Any reductions in service delivery are attributed to workforce vacancies rather than political or funding decisions. The district actively participates in initiatives such as the Perinatal Health Hub Pilot Program and recently received $200,000 to recruit community health workers aimed at addressing maternal mortality. As of October 2024, two community health workers have been hired, with additional funding secured for fiscal year 2026 to ensure continuity.
Claims regarding disproportionate resource allocation, suggesting that wealthier districts receive preferential treatment, have been disputed. Over the past three fiscal years, Portsmouth has underspent its state general fund allocation by an average of $204,000 annually. This underspending is not a result of disinterest but rather reflects the challenges of utilizing funds when critical positions remain vacant. Concurrently, state funding has increased by approximately 16% from fiscal year 2020 to the projected fiscal year 2027, while Portsmouth’s required local contribution has decreased proportionately.
VDH is committed to promoting health equity and supporting high-need communities like Portsmouth. The focus remains on stabilizing leadership, rebuilding capacity, and strengthening service continuity. Efforts are underway to recruit a permanent district director, along with qualified nursing and clinical staff. These rebuilding initiatives aim to restore trust, refine internal processes, and enhance collaboration within the district.
Dr. Susan Fischer Davis, who has served as the Chief Deputy Commissioner for Community Health Services at VDH since January 2024, has extensive experience in public health across local, state, and federal levels. The VDH and district leadership are dedicated to ensuring that Portsmouth possesses the necessary stability, talent, and infrastructure to meet the public health needs of all residents.
