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Section 7. Working Together for Healthier Communities: A Framework for Collaboration Among Community Partnerships, Support Organizations, and Funders

  • A focus on community (and systems) change

  • What makes it work: Seven key factors in community change

  • Who is involved?

  • A proposed"Memorandum of Collaboration"

To improve our communities -- to make them places where people are healthy, safe, and cared for -- takes a lot of work. As community organizers, we know all too well that we can't do it alone. The ability to partner effectively with other individuals and organizations -- both inside and outside the community -- is absolutely essential to doing what we like to call "the work" of building healthy communities.

However, these partnerships don't materialize out of thin air. And once they do occur, the players involved aren't always sure of their roles, or how those roles can come together in a manner meets everyone's needs and interests. In short, there's often a knowledge gap, even when everyone wants to work together for the same outcomes.

In this section, we'll try to address that gap. We outline a modest proposal for how three key groups -- community partnerships, support and intermediary organizations, and grantmakers -- might work together to make the most of everyone's investments in the work.

We'll start with a brief look at why we focus on community (and systems) change and what we believe are seven key elements in effective community work. This understanding, although laid out elsewhere in the Community Tool Box, forms the basis for later ideas in this section. Then, we will explain who the key players in community work are, and follow up with an understanding of how they can best work together to make the most of everyone's efforts.

Our hope is that, when adapted in local dialogue, this model "memorandum of collaboration" will help guide future community investments.

A focus on community (and systems) change

When we talk about building healthier communities, we mean the process of people working together to address what matters to them -- whether that is reducing violence, revitalizing an urban neighborhood, or promoting child health. Civic engagement is promoted among all of the members of the community. By community, we mean people who share a common place, such as a rural community or urban neighborhood, or experience, including being an adolescent or a member of an ethnic minority group.

To address what matters to community members, we need to change the conditions in which we live, with the hope that changing those conditions will change people's behavior and more distant outcomes. For example, a community organization might make it more difficult for teens to buy cigarettes, with the hope that those changes will result in fewer teens smoking, and fewer related deaths.

We believe that collaborative partnerships should focus on environmental changes -- bringing about those community and systems changes that modify local conditions. That's because we believe these changes are an intermediate outcome in the long process of community health improvement. Community and systems changes fall in to one of three categories, all of which should relate back to community-determined goals:

  • New or modified programs -- for example, after-school programs or prevention services
  • New or modified policies -- for example, higher fines for selling illegal products to minors or family-friendly policies in businesses
  • New or modified practices -- for example, improved access to health services or increased opportunities for academic responding in schools

What makes it work: Seven key factors in community change

Our research and experience -- and that of many others -- suggests that there are seven essential ingredients that contribute to community change.

  • Clear vision and mission -- those initiatives with a clear and specific focus, such as increasing rates of childhood immunization or lowering the rate of unemployment, bring about much higher rates of change than broad "healthy communities" efforts which lack a targeted mission and objectives. The vision and mission may reflect a continuum of outcomes, including:
    • Categorical issues (e.g., adolescent pregnancy),
    • Broader interrelated concerns (e.g., youth development), and/or
    • More fundamental social determinants of health and development (e.g., children living in poverty).
  • Action planning -- Identifying specific community changes (that is, new or modified programs, policies, and practices) to be sought may be the single, most important practice that can be implemented. The action plan should be quite precise, specifying with whom, by whom, how and by when each action step should be carried out.
  • Leadership -- A change in leadership can dramatically affect the rate of change brought about by a community group. The loss of strong leadership can be particularly difficult for an organization.
  • Resources for community mobilizers -- Hiring community mobilizers or organizers can aid in following up on action plans. It can be very difficult to maintain an organization without some paid staff. Paid organizers can help fan the flames and keep the level of excitement about the organization and its goals at a consistently high level.
  • Documentation and feedback on the changes brought about by the organization -- It's also very important that people keep a record of what they have done and how they have done it. Having this history can be an invaluable guide for the organization's work. Looking regularly (at least quarterly) at what the group has done, how quickly it has occurred, and outside events that affect the group's work has been shown to spur groups onto even greater heights.
  • Technical assistance -- Outside help with specific actions, such as action planning or securing resources, is also a way to support a group's efforts to transform its community.
  • Making outcome matter -- Finally, grantmakers also have the ability to increase rates of community and systems change through offering incentives or disincentives to their grantees. For example, the annual renewal of multi-year awards or the offering of bonus grants could be based on evidence of progress or accomplishment by the community group.

Who is involved?

Transforming the conditions that affect community health and development requires a broad collaborative partnership among several key players. Three distinct groups emerge as playing vital, interdependent roles:

  • State and community partnerships
  • Support and intermediary organizations
  • Grantmakers - Private foundations

State and community partnerships -- those doing the work of community and systems change -- link together people and organizations that have the same goals. For example, a community partnership for universal access to health care might bring together representatives from health care with representatives of groups who have traditionally not had access. Together, they might work to make changes throughout the community that would affect access for all. Specific changes might be made in local community-based organizations, health organizations, businesses, schools, the government, financial institutions, and the faith community -- all with the overall goal of access to health care for all.

Support and intermediary organizations -- such as university-based research centers and community-based organizations, help community partners develop the skills they need to be effective. Often, these groups concentrate on improving community members' understanding of the core competencies necessary to do this work. Examples of these competencies include community assessment, strategic planning, community action and advocacy, community evaluation, and securing resources to sustain the effort.

Grantmakers - Foundations -- help create conditions for success by using requests for proposals to bring people together for a common purpose, such as reducing domestic violence or improving arts education for children. They can also broker connections among groups working in the same community or on the same issue. Finally, they can leverage funding and resources through relationships with other grantmakers and help make outcome matter.

A proposed "Memorandum of Collaboration"

Our question in this section is, how can these three groups work together most effectively? What are the roles and responsibilities of each that, taken together, will help make our communities healthier places to live?

On the next few screens, we'll look again at each of the seven key elements for effective community work that we discussed above. For each point, we will offer a timeline for how long the action should take to complete, and the specific role that each of the three partners can have in completing that step. These roles and responsibilities are summarized in a table in Tool #1. A model "Memorandum of Collaboration" is outlined in Tool #2, with links to related how-to sections in the Community Tool Box.

Refining and targeting the partnership's vision, mission, and objectives

How long? This step should take approximately four to six months.

  • Community partnership: The community partnership is responsible for selecting a workable (i.e., fairly modest) number of broad goals, such as improving nutrition among students, reducing crime and violence, or increasing the rate of immunization. By specifying these goals, the group can better define and focus their work.
  • Support organizations: Support organizations can assist the community partnerships in developing a broad-based vision, and then in framing their objectives in a manner that is both specific and workable. For example, if the community group is interested in education but does not have a specific idea about what should be done, a support organization might suggest the following goal statement:

By 2010, the graduation rate for youth entering local high schools will increase by 40%. Support organizations will also work with the community partnership to identify community-level indicators that are most likely to give an accurate and sensitive picture of how effective the partnership's efforts have been.

  • Grantmakers: Grantmakers can help applicants find the funders who are most appropriate for their work. They can also offer longer-term grants (for example, at least several years) so that grantees can have the long-term support they need to really make a difference. Finally, grantmakers can offer investments that look holistically at the community and its situation.

Developing an action plan for bringing about community and systems change related to community-determined goals for health and development

How long? This step takes approximately six to eight months for the original development, and will then be ongoing through the life of the initiative.

  • Community partnership: Building on earlier efforts, collaborating partners should identify specific changes to be brought about. These changes in programs, policies, and practices will be sought throughout the community (for example, in schools, government, business, health and human service organizations, the faith community, and so on). Specific action plans that complement one another should be developed for each objective the community partnership has chosen.

It's very important that the planning process is inclusive, involving people who have significant influence in the community (for example, elected officials), as well as the people who are most affected by the concern (such as residents of low-income neighborhoods). Finally, it is often helpful to organize members in working committees for each specific objective, such as creating a Task Force on Substance Abuse. This coordinates and focuses efforts so they will have the greatest possible impact.

  • Support organizations: Support organizations can assist with action planning by suggesting possible actions, and making members of community partnerships aware of "best practices" (successful actions taken by other community groups) for each objective. They can also be very helpful in supporting the early stages of action planning. For example, they might organize and run planning retreats for the community group.
  • Grantmakers: Grantmakers can help community groups get in touch with other organizations with special expertise in specific goal areas. For example, if one of the goals a grantee has is to promote caring relationships for children, the grantmaker might get the group in touch with another of their grantees doing similar work in another community or state. Grantmakers can also assist in bringing about broader changes, such as implementing more effective grantmaking practices; or helping change regional planning policies that concentrate on poverty in a few urban neighborhoods. These "systems changes" can work to improve the conditions under which community improvement efforts occur.

Developing and supporting leadership within communities

How long? This is an ongoing task.

  • Community partnership: Members of the partnership can enhance and support existing leadership through mechanisms such as meetings and retreats. They will also seek to develop new generations of leadership by creating opportunities for new leadership to develop, through mentoring newer leaders, and by supporting local youth in leadership roles.
  • Support organizations: Support organizations can use direct personal assistance, support groups, and print and web-based resources to support local leadership in their efforts. They can also help to develop formal (e.g. courses) and informal learning communities (e.g., support networks).
  • Grantmakers: Grantmakers can support partners in acquiring additional resources for leadership development. Using traditional face-to-face gatherings and new communications technologies such as teleconferencing and online forums, grantmakers can help community partnerships connect leaders to each other across distance and topic area. They can also connect them to additional resources to support their work.

Documenting the process of community change and improvement, and using feedback to improve and celebrate efforts

How long? This is an ongoing task that should occur on a monthly basis.

  • Community partnership: Using a documentation and evaluation system, members of the partnership will gather information on changes facilitated by the partnership. They will also assist in obtaining other information to help understand and be accountable for their work, including success stories and community-level indicators related to their objectives.

Finally, they will review data on intermediate outcomes (community and systems change) at least quarterly, and data on more distant outcomes (community-level indicators) at least annually. This will help guide improvements and promote the celebration of accomplishments.

  • Support organizations: Support organizations can facilitate a conversation about what are important markers of success. They will establish and maintain a system for documenting community and systems changes. Finally, they will help local documenters in clarifying and interpreting information, and in communicating important news to funders and the broader community.
  • Grantmakers: Grantmakers can request and accept information on progress made by the community group for its grant status reports and grant applications. To maximize efficiency, they should work with other grantmakers and organizations to encourage acceptance of the same data for different reports the community group will be responsible for. If needed, they can help secure access to data on community-level indicators. Grantmakers can also help document their own contributions to local efforts (such as facilitating systems changes or brokering access to resources).

Securing and providing technical assistance for local groups' efforts

How long? This is an ongoing task.

  • Community partnership: Members of the partnership should look for help from organizations with specialized knowledge, such as those which specialize in an issue that the partnership is interested in (for example, HIV/AIDS prevention or child abuse and neglect). In addition, the partnerships should develop their own capacity to provide technical assistance, such as in action planning or documentation, for other communities working on similar issues.
  • Support organizations: Support organizations can provide technical assistance to community partnerships, in implementing and documenting their work. This might include providing training materials and/or workshops in skills such as community assessment, action planning, leadership development, and evaluation.
  • Grantmakers: Grantmakers can help fund support organizations, and they can also foster relationships between support organizations and the community partnerships that might benefit from their help.

Securing and providing financial resources for work in local communities

How long? We recommend an initial ten-year commitment that is potentially renewable; further, we suggest multi-year grants with their renewal based on evidence of progress.

  • Community partnership: As appropriate, partners will hire and support community organizers responsible for helping bring about the community and systems changes identified in the group's action plan. In applications for grant funding, the partners should provide evidence of the need for (and value of) community investment. This includes using quantitative information on community and systems change and improvement through community-level indicators, and qualitative information such as success stories.
  • Support organizations: Support organizations can assist local documenters in analyzing, interpreting, and communicating data for use in grant status reports and "progress to date" sections of grant applications. This and related qualitative information such as success stories can be used to help leverage resources as the community's accomplishments are marketed to prospective funders.
  • Grantmakers: Grantmakers can facilitate the development of grant proposals that support a long-term, comprehensive community change and improvement effort. Grantmakers can also help the community partnership make necessary connections with other funders to help generate the resources needed for the effort. This is particularly important because often, effective community work takes a substantial amount of money and other resources -- quite possibly, more than a single grantmaker is willing or able to invest.

Making outcome matter in working with local communities

How long? This is an ongoing task.

  • Community partnership: The partnership should agree to submit annual status reports that include information on evidence of community and systems change as well as progress towards affecting the bottom line. To be fully accountable, they should agree to share evidence of accomplishments (and needed changes) with funders and the broader community.
  • Support organizations: Support organizations should assist the community partnership in documenting, analyzing, and communicating data on the process of community change and improvement for grant status reports.
  • Grantmakers: Grantmakers can require annual grant status reports that include evidence of progress. To maximize accountability to the community and to grantmakers, grantmakers can try to "make outcomes matter" in three ways.

First, annual renewal of multi-year awards can be based on the evidence of progress. Initially, progress should be judged largely on community involvement and on the rate and kind of community and systems change facilitated by the community partnership. In later years, improvement on community-level indicators will serve as additional evidence of success.

Second, bonus grants (up to one-third of the grant award) may be earned for outstanding accomplishments, such as high rates of changes on issues that are important to community members. For example, the community might show a markedly decreased rate of teen pregnancy that can be traced back to the partnership's efforts.

Third, outcome dividends could be made available to enhance accountability for longer-term community-level outcomes, such as a lowered rate of substance abuse or improved school performance. The "outcome dividend" is a cash bonus that is calculated based on cost-benefit estimates associated with improvements. The outcome dividend will be deposited in a local "Community Trust Account" and reinvested by the community partnership for work on community-determined goals.

In summary

Community health -- the well being of the people who share a common place or experience -- requires changes in both the behaviors of large numbers of individuals and in the conditions that affect their health. Although community members are best positioned to determine their concerns and strategies, other partners are needed to help with technical support, and in obtaining financial and other needed resources. In this section, we recommend adjusting the related roles and responsibilities of community partnerships, support organizations, and grantmakers. The aim is to build the capacity of community members to address what matters to them. Our hope is that these ideas for a new "social contract" will stimulate dialogue and enhance collaboration among those committed to building healthier communities.

Contributor 
Stephen B.Fawcett
Vincent T. Francisco
Adrienne Paine-Andrews
Jerry Schultz

Online Resources

The County Health Rankings & Roadmaps Take Action Cycle, especially Work Together, provides tips on how to engage diverse stakeholders from all sectors, and work with others to establish a coalition to address common goals.

Independent Sector provides an excellent example of creating partnerships. It is a national coalition of foundations, corporate giving programs, and nonprofit organizations that joined together to strengthen the nonprofit sector. It sponsors initiatives and highlights research and policy news related to advancing the public good.

Working Together to Create Healthy Communities is a compilation of presentations from the 2012 Place Matters event that was held to discuss how people can work together to create healthy communities.

Tobacco-Related and Other Chronic Diseases Community Assessment is a Community Assessment tool designed for Healthy Community counties and their community health advisory councils. This process creates a foundation to guide the rest of the Healthy Communities process and identifies priorities for county work plans.

The Healthy Community Checklist consists of a 40-item quick assessment of a community’s health environment related to promoting and supporting physical activity, healthy eating and weight, as well as tobacco-free lifestyles.

The Community Health Assessment and Group Evaluation (CHANGE) Tool was developed by CDC’s Health Communities Program and provides community leaders with a snapshot of local policy, systems, and environmental change strategies currently in place within their community. The tool also helps identify areas where such health strategies are lacking.

Print Resources

This Community Tool Box section is an adaptation of the following:

Fawcett, S. B., Francisco, V. T., Paine-Andrews, A., and Schultz, J. A. (1999). Working Together for Healthier Communities: A Research-Based Memorandum of Collaboration. Public Health Reports, Supplement on Healthy Cities/Healthy Communities. Publisher: Place.

This report is based on lessons learned with an array of partners in communities, support organizations, and grantmaking institutions. For a summary of this work, see:

Fawcett, S. B., Francisco, V. F., Hyra, D., Paine-Andrews, A., Schultz, J. A., Russos, S., Fisher, J. L., and Evensen, P. (in press). Building healthy communities. In A. Tarlov (Ed.), Society and population health reader: State and community applications. New York: The New Press.

Francisco, V.T., Paine, A. L., and Fawcett, S. B. (1993). A methodology for monitoring and evaluating community coalitions. Health Education Research: Theory and Practice, 8 (3), 403-416.

Fawcett, S. B., Sterling, T. D., Paine-Andrews, A., Harris, K. J., Francisco, V. T., Richter, K. P., Lewis, R. K., and Schmid, T. L. (1995). Evaluating community efforts to prevent cardiovascular diseases. Atlanta, GA: U. S. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.

Fawcett, S. B., Paine-Andrews, A., Francisco, V. T., Schultz, J., Richter, K. P., Berkley-Patton, J., Fisher, J. L., Lewis, R. K., Lopez, C. M., Russos, S., Williams, E., Harris, K. J., and Evensen, P. (in press). Evaluating community initiatives for health and development. In I. Rootman, D. McQueen, et al., (Eds.), Evaluating health promotion approaches. Coopenhagen, Denmark: World Health Organization-Europe.

Fawcett, S. B., Lewis, R. K., Paine-Andrews, A., Francisco, V. T., Richter, K. P., Williams, E. L., and Copple, B. (1997). Evaluating community coalitions for the prevention of substance abuse: The case of Project Freedom. Health Education and Behavior, 24 (6), 812-828.