Local public health agencies (LPHAs) are faced with many challenges in their role as an integral part of the public health system. It is important to better understand the demands on and the capacity of LPHAs to respond to these challenges. Determining what factors can improve LPHA performance is critical to helping LPHAs face their challenges.The objective of this study was to determine what factors are associated with LPHA performance improvement in North Carolina from 1999 to 2004. In North Carolina, several data sources regarding predictors of LPHA performance, including LPHA workforce, LPHA characteristics, public health expenditures, and population characteristics, are available. Improvement in LPHA performance was measured by nine indicators across diverse services that were collected over multiple years. Linear regression was used to evaluate the significance of predictor variables.Our findings indicate that workforce characteristics such as occupational classification and experience of the workforce, LPHA characteristics such as number of full-time employees, as well as population characteristics are important predictors of LPHA performance.This study provides insight into what is needed to better address LPHA performance improvement. More importantly, study findings indicate which workforce characteristics can be targeted to enhance LPHA performance improvement over time.