Section 7. Developing and Increasing Access to Health and Community Services

• What are the barriers to access to health and community services?

• How do we remove barriers and increase access to health and community services?

• How do we find private funding sources?

• How do we improve physical and communication access?

• How do we make sure our program is effective and accessible?

• How do we reduce barriers to participation?

A service can exist and still be difficult or impossible for some people to use. A person with a disability may encounter an inaccessible building, website, or communication system. An immigrant or refugee community may face a long waiting list for English-language learning. A pregnant adolescent may live in a community with limited prenatal care or family supports. A workforce program may be located far from reliable transportation. A youth program may be available but may not provide the kind of support young people say they need.

In each case, the issue is not simply whether a program exists. Meaningful access also depends on whether people can find the service, reach it, afford it, understand it, use it, and receive support that is effective and respectful.

This section looks at barriers to health and community services and explores ways organizations and communities can reduce those barriers.

What are the barriers to access to health and community services?

Barriers to health and community services can take many forms. Funding may limit whether a service exists or has enough capacity. Physical, digital, or communication barriers may prevent people with disabilities from participating. Program design, outreach, eligibility requirements, cost, quality, or institutional practices may also limit access. Finally, circumstances in people's daily lives -- such as transportation, work schedules, childcare, language, housing instability, or concerns about trust and privacy -- can affect whether participation is realistic.

These barriers often overlap, so improving access usually requires looking at both the service itself and the broader conditions affecting the people who might use it.

Funding-related barriers to access

Adequate funding can affect both the availability of services and whether existing services have enough capacity to meet community needs.

Availability of services

Once a community priority or service gap has been identified, an important question is whether appropriate programs and resources exist to address it.

If they do not, possible reasons may include:

• Limited local resources. A community, county, state, organization, or other potential provider may not currently have the financial resources to establish or expand the service.
• Limited awareness of the need or priority. Decision-makers may not have accurate information about gaps in education, health care, transportation, housing, prevention, or other community services.
• Uncertainty about how to respond. Community challenges such as violence prevention, environmental contamination, housing instability, or gaps in health care may involve several causes and systems. Organizations may recognize the concern but need assistance identifying realistic strategies.
• Competing priorities or unequal influence. Governments, organizations, or funders may direct resources elsewhere, and communities with less political, economic, or institutional influence may have greater difficulty securing investment even when needs are well documented.

Decisions about funding are shaped by priorities, evidence, public attitudes, political processes, and available resources. Bias and discrimination can also affect which communities or issues receive attention. Community members who are directly affected should have meaningful opportunities to describe their experiences and participate in decisions about priorities and resources.

Whatever the reason for a service gap, understanding the cause can help communities determine whether the response should focus on funding, policy, public awareness, partnerships, service design, or several strategies at once.

Adequacy of available services

A service may technically exist but still lack enough capacity to serve the people who want or need it. Programs need sufficient staff, space, technology, equipment, supplies, accessibility supports, and other resources to provide timely and effective services.

Long waiting lists, limited hours, staff shortages, complicated intake procedures, or insufficient accessible options can all reduce meaningful access.

For example, an English-language learning program may have strong instruction but far more interested learners than available classroom space. Expanding access might involve additional instructors and classes, community-based or online options, conversation groups, partnerships with other organizations, or other approaches developed with learners themselves.

Physical, digital, and communication barriers to access

People with disabilities may encounter barriers in buildings, transportation, communication, technology, policies, or program design. Accessibility involves much more than providing a ramp.

Depending on the service and participants, access may include:

• Accessible entrances, routes, restrooms, seating, and emergency procedures
• Accessible parking and transportation
• Sign language interpretation and other effective communication supports
• Captioning and assistive listening systems
• Accessible electronic documents and websites
• Materials in large print, Braille, audio, plain language, or other appropriate formats
• Reasonable modifications or accommodations
• Accessible registration, scheduling, and communication systems

Accessibility should be considered during planning rather than addressed only after someone encounters a barrier. Organizations should also understand the disability-access requirements that apply to their programs and facilities.

Cost and limited resources can make accessibility improvements challenging, particularly for small community organizations. Even so, accessibility should be treated as an essential part of service delivery rather than an optional addition.

Programmatic barriers to access

Even when services exist and are physically accessible, aspects of the program itself may limit participation.

Limited outreach capacity

Programs may not have enough staff time, funding, relationships, or communication resources to make community members aware of available services. Outreach may also be overlooked during program planning.

Ineffective outreach

Outreach may be extensive but still fail to connect with the people the program hopes to engage. Information may be shared through communication channels people do not use, may not be available in relevant languages or accessible formats, or may not clearly explain what the service provides.

Strong outreach starts by asking community members how they prefer to receive information and which messengers, organizations, and communication channels they trust.

Limited trust or concerns about the program

People may hesitate to use a program because of previous experiences with the organization or similar institutions. Concerns may involve disrespectful treatment, discrimination, confidentiality, immigration or legal concerns, poor-quality services, cultural mismatch, inaccessible practices, or other experiences.

Rather than assuming that community perceptions are simply incorrect, organizations should listen carefully, determine whether changes are needed, and demonstrate accountability through their actions.

Affordability, eligibility, and administrative requirements

Fees can make services inaccessible to people who cannot afford them. Transportation, childcare, unpaid time away from work, technology, and other indirect costs can also affect affordability.

Eligibility rules can create additional barriers. A funding source may limit services according to income, insurance status, age, geography, or another requirement. Programs should explain eligibility clearly, avoid unnecessary documentation requirements, and help people connect with other resources when they do not qualify.

Program quality

A program that exists but does not provide useful, respectful, safe, or effective services does not offer meaningful access.

Areas to examine include:

• Staff preparation and support. Staff need the knowledge, skills, supervision, compensation, and professional development necessary for their roles.
• The effectiveness and relevance of programming. Organizations should examine what services are offered, when and where they are provided, whether they are accessible, whether they reflect current evidence when appropriate, and whether participants find them useful.
• Organizational culture and philosophy. Participants should be treated as partners with knowledge, strengths, goals, and agency. Organizations should avoid paternalistic approaches in which professionals are assumed to know what is best without meaningful participant input.
• Participant voice. People who use the program should have opportunities to provide feedback and influence how services are designed, delivered, and improved.

Individual and household circumstances that can affect access

People's daily circumstances can affect whether they are able to use services even when those services are otherwise available. These circumstances should not automatically be treated as personal shortcomings. Many are influenced by broader economic, social, organizational, or infrastructure conditions.

Transportation

Long travel distances, limited public transportation, transportation costs, inaccessible transportation, unreliable vehicles, or unsafe travel routes may all make services difficult to reach.

Program location

A location may be physically difficult to reach or may not feel welcoming, safe, familiar, or private to participants. Schools, government offices, health facilities, or other institutions may also carry different meanings for people depending on their previous experiences.

Ask participants which locations are convenient and comfortable rather than assuming that one site will work for everyone.

Program schedule

Work schedules, caregiving, school, transportation, religious observance, health needs, and other responsibilities can affect when people are available. Offering evening, weekend, flexible, virtual, or multiple scheduling options may improve access.

Childcare and caregiving

Parents and other caregivers may be unable to participate without reliable and affordable care for children, older adults, or family members with disabilities. Programs should consider whether on-site care, childcare assistance, family-friendly participation, scheduling changes, or partnerships with care providers could reduce these barriers.

The service may not reflect people's priorities

People may decide not to use a service because they do not consider it relevant or useful to their current goals. That does not necessarily mean they misunderstand the problem.

Programs should listen carefully to community members and ask whether the service addresses something people actually want support with. Sometimes additional information may help people make an informed decision. In other cases, the service itself may need to change.

For example, workers may decide that an education program is not currently useful to them because they are satisfied with their jobs and have other priorities. Rather than assuming that they are making the wrong choice, a program can clearly explain the opportunities the credential may provide while respecting workers' decisions about whether and when to participate.

Stigma, privacy, and trust

Some services carry stigma, or people may worry that seeking support will expose private information or lead others to judge them. Concerns may arise around public assistance, food assistance, literacy, mental health, substance use, sexual health, disability, housing, or other services.

Organizations can respond by protecting confidentiality, using respectful and non-stigmatizing language, clearly explaining privacy practices, treating participants with dignity, and involving people with lived experience in program design.

Cultural and language considerations

Language, cultural practices, religion, family expectations, previous experiences with institutions, and community norms may all influence how people experience a service. These considerations vary widely within every community and should not be reduced to assumptions about an entire culture.

Potential barriers may include:

• Information, registration, or services that are not available in languages participants understand
• Health, religious, family, or cultural considerations that affect how an individual views a particular service
• Program practices that conflict with a participant's responsibilities, values, privacy needs, or family circumstances
• Previous experiences that make people more comfortable seeking support through family, community networks, faith communities, or other trusted sources

Cultural humility means asking, listening, and adapting where appropriate rather than assuming that staff already understand another person's needs or beliefs.

How do we remove barriers and increase access to health and community services?

Improving access requires identifying which barriers are actually affecting participation and deciding which changes are within the program's or community's ability to make.

Some barriers require additional funding. Others may be reduced through changes in program design, partnerships, accessibility, outreach, scheduling, transportation, communication, or organizational practices.

Advocacy for recognition and funding

When expanded public funding or policy change is needed, organizations and community members may engage in advocacy to share information about the issue, explain the need for services, and participate in public decision-making.

Legislative advocacy

Depending on the issue, advocacy may include:

• Organize. Build a coalition or network of people and organizations that care about the issue and can coordinate their efforts.
• Develop relationships with policymakers and staff. Learn who works on the issue and how to communicate relevant community information to them.
• Understand the legislative and budget process. Learn when and where relevant proposals are considered and how members of the public can participate.
• Include people directly affected by the issue. Community members who choose to participate should have opportunities to speak for themselves and help shape the advocacy strategy rather than being used simply to illustrate someone else's message.
• Identify policymakers who are willing to engage with the issue.
• Provide clear information. Share relevant data, community experiences, program results, and information about service gaps or barriers.
• Inform and engage the broader community. Public meetings, media, community organizations, digital communication, and other channels can help people understand the issue and decide whether they want to participate.
• Contribute specific recommendations. When appropriate, organizations may provide policymakers with suggested policy or budget language based on their expertise and community input.
• Make participation accessible. Provide community members with clear information about public hearings, comment opportunities, meetings, or other appropriate ways to communicate with elected officials.

Local government advocacy

Local advocacy follows many of the same principles. Learn which elected officials, departments, boards, commissions, administrators, and staff have responsibility for the issue.

• Build a broad and well-organized group around the issue
• Understand which local officials and agencies have relevant responsibilities or authority
• Establish relationships with elected officials, appointed officials, and staff
• Share evidence and community perspectives about the need
• Provide accessible information to community members
• Use appropriate public processes to place issues before local decision-makers
• Encourage residents to participate in public decision-making through appropriate channels

Community advocacy

Community advocacy can help people understand an issue, identify possible solutions, and decide whether and how they want to participate.

• Share information. Use community meetings, organizations, newsletters, media, social media, websites, presentations, and other appropriate communication channels.
• Build relationships with trusted community partners, including resident leaders, faith and cultural organizations, businesses, service providers, and other networks relevant to the issue.
• Create meaningful ways to participate. Community members might join a coalition, provide testimony or feedback, help collect information, participate in planning, volunteer, or take other roles that fit their interests and capacity.

How do we find private funding sources?

Private funding can supplement or, in some cases, provide an alternative to public funding. Potential sources include foundations, community foundations, corporate philanthropy, individual donors, community fundraising, membership, fees for appropriate services, and partnerships with other organizations.

Foundations

Private, family, corporate, and community foundations fund many types of community initiatives. Finding an appropriate funder requires understanding both the community priority you hope to address and the funder's goals and requirements.

• Research potential funders. Foundation directories, philanthropy networks, community foundations, funder websites, and nonprofit resource centers can help organizations identify opportunities.
• Build appropriate relationships with funders. When funders invite communication, conversations with program officers can help organizations understand funding priorities, eligibility, and proposal requirements.
• Share information about the community priority and proposed response.
• Write a proposal that follows the funder's guidelines and clearly explains the need, community involvement, proposed activities, expected outcomes, budget, and evaluation plan.

Community foundations can be especially useful partners because they focus on particular geographic communities and may have strong knowledge of local organizations and priorities.

Community fundraising

Community organizations use many different fundraising approaches:

• Individual giving. Organizations may invite donations in person, by mail, through digital campaigns, recurring-giving programs, or other methods.
• Membership. Some organizations invite supporters to become members through annual contributions at one or more giving levels.
• Community events. Concerts, festivals, walks, community dinners, cultural events, and other activities can raise funds while also strengthening community relationships.
• Services, training, or products. When consistent with an organization's mission and legal requirements, earned revenue from consulting, training, educational materials, or other services may support programs.
• In-kind contributions. Businesses, organizations, and individuals may contribute space, equipment, supplies, professional services, technology, transportation, or other resources.

Fundraising strategies should reflect the organization's mission, capacity, legal responsibilities, and relationship with the community. Organizations should not assume that volunteers, participants, or community partners can continually provide unpaid labor or resources that should reasonably be included in a program budget.

How do we improve physical and communication access?

Improving accessibility may require financial investment, but it should also be part of routine organizational planning.

• Work with property owners and qualified professionals. When a rented facility creates accessibility barriers, discuss necessary improvements with the property owner and determine what changes are required and feasible.
• Plan accessibility improvements carefully. Structural changes should meet applicable building, safety, and accessibility requirements. Volunteer or donated labor may be helpful when appropriate, but accessibility work should not bypass professional expertise, permits, or safety standards.
• Provide appropriate accommodations and alternative service options. Depending on the circumstances, this may include relocating a meeting, providing remote participation, offering qualified sign language interpretation, captioning materials, providing accessible documents, or making other modifications that provide equitable access.
• Address digital access. Websites, forms, documents, videos, virtual meetings, and other digital tools should be usable with assistive technologies and designed with accessibility in mind.

Alternative service arrangements can be helpful when immediate barriers cannot be removed, but they should not become a permanent substitute for making regular services and facilities accessible whenever accessibility can reasonably be achieved.

How do we make sure our program is effective and accessible?

Funding alone does not guarantee meaningful access. Programs also need adequate capacity, effective outreach, community trust, strong service quality, accessibility, and ongoing participant feedback.

Increasing program capacity

Capacity may involve sufficient space, staffing, funding, technology, materials, language services, accessibility supports, and partnerships.

Space

Possible approaches include:

• Seeking donated or subsidized space from community organizations, institutions, businesses, or other partners
• Negotiating reduced rent or other shared-cost arrangements when appropriate
• Sharing space with another organization
• Offering services in multiple neighborhood locations or through mobile, virtual, or hybrid approaches when these improve access

Staff

Strategies for strengthening staffing may include:

• Sharing staff or specialized expertise with another organization
• Developing a volunteer program when the responsibilities are appropriate for volunteers and adequate training, supervision, and support can be provided
• Developing joint funding proposals with partner organizations
• Partnering with another organization to provide complementary services
• Investing in professional development. Staff may benefit from training, education, mentoring, credentialing, or other opportunities to strengthen skills needed for their roles.

Community-based organizations sometimes grow from volunteer or grassroots efforts into larger programs with new professional or credentialing requirements. When this happens, organizations should plan for the transition thoughtfully. Long-time staff and community members may bring valuable relationships, lived experience, and institutional knowledge, while some positions may also require specific professional qualifications. Training, career pathways, role redesign, and transparent communication can help organizations balance these needs.

Materials and equipment

Equipment, supplies, technology, and other resources may be purchased, shared with partner organizations, donated, leased, or included in grants. Plan for maintenance, replacement, accessibility, security, and staff training as part of the cost.

Developing effective outreach

People cannot use services they do not know about. Outreach should make information easy to find, understandable, accessible, relevant, and available through communication channels community members actually use.

Develop your outreach capacity

• If possible, designate staff members, community health workers, peer navigators, volunteers, or others with responsibility for outreach and relationship building
• Use communication channels appropriate to the community, including community media, social media, newsletters, websites, text messaging, local events, and other relevant options
• Work with organizations and networks that already have trusted community relationships
• Invite current and former participants who choose to do so to share information about the program, without pressuring them to disclose personal experiences
• Build relationships with resident leaders and other trusted community partners
• Use multiple approaches and adjust them based on community feedback

Watch for ineffective outreach

If outreach is not connecting people with services, examine both the communication strategy and the service itself.

• Provide information in relevant languages and accessible formats, using qualified interpretation and translation when appropriate
• Use plain, direct language that clearly explains what the program offers, who can participate, what it costs, and how to get started
• Share information in places and networks community members already use
• Use communication channels identified by community members as useful and trustworthy
• Partner with residents and community organizations that understand local communication networks
• Ask participants how they learned about the program and use that information to evaluate outreach strategies

Concerns about or lack of trust in the program

If community members have concerns about your organization or service, begin by listening.

• Ask what experiences or concerns are shaping people's views, take those concerns seriously, and make changes when needed
• If important information about the program is unclear or inaccurate, provide transparent information about what the program actually does rather than dismissing concerns as simply a misunderstanding
• If concerns reflect real problems, acknowledge them, explain how the organization will respond, involve affected community members in improvement efforts, and follow through
• Maintain ongoing communication rather than reaching out only when the organization needs participation or support

Affordability and eligibility

Organizations can explore sliding-scale fees, scholarships, subsidies, third-party reimbursement, grants, or other funding approaches to reduce direct costs to participants.

Eligibility rules should be explained clearly and applied consistently. When different funding sources allow different eligibility criteria, organizations may sometimes combine funding streams to expand access, provided that they follow all financial, grant, and reporting requirements.

Organizations should also consider whether accepting a particular funding source would create restrictions that conflict with the organization's mission, community commitments, or ability to provide equitable access.

Program quality

Program quality is central to access. A program may be available, affordable, and easy to reach but still fail participants if services are ineffective, disrespectful, unsafe, or poorly matched to people's goals.

Conduct an evaluation of your services

Evaluation can include outcome data, participant feedback, staff reflection, service-use information, accessibility reviews, and community feedback.

Ask:

• Are participants receiving useful and respectful services?
• Are participant-defined goals being supported?
• Do participants feel safe, heard, and included?
• Who is using the service, and who may still face barriers?
• Are staff adequately trained and supported?
• Are there patterns in who leaves the program or is unable to participate?

If evaluation identifies concerns, address them

Evaluation is useful only if organizations are willing to learn from what they find. When concerns are identified, develop a plan, assign responsibility, make changes, and continue gathering feedback.

• Review relevant research and evidence. Research can help identify approaches that have been effective in comparable situations, while community context and participant experience help determine whether those approaches fit locally.
• Learn from other programs. Examine how similar organizations design services, involve participants, support staff, address accessibility, and evaluate outcomes.
• Ask current and former participants and staff what would improve the program. Include their feedback in redesign and decision-making.
• Implement changes and continue evaluating. Give new approaches enough time to be assessed while remaining willing to adjust them when evidence or participant feedback indicates that changes are needed.

Program improvement may also require examining underlying assumptions. If participants are treated only as recipients of services rather than people with expertise and agency, changing forms or procedures alone may not be enough. Organizations may need to shift toward greater partnership, shared decision-making, and respect for participant-defined goals.

How do we reduce barriers to participation?

People may be balancing employment, caregiving, housing costs, health needs, transportation, education, and many other responsibilities. Programs can increase participation by understanding those circumstances and reducing unnecessary barriers rather than expecting participants to adapt entirely to the program.

Transportation

Transportation solutions will vary by community.

• Provide or coordinate transportation. Some programs operate vans or shuttles when resources, licensing, insurance, accessibility, and staffing allow.
• Support ride-sharing or mileage reimbursement. Organizations may help participants coordinate rides or reimburse transportation costs according to current organizational policies and applicable requirements.
• Provide public transportation support. Bus passes, transit cards, or transportation vouchers may reduce participation costs.
• Consider safety as well as availability. Ask participants what transportation arrangements would help them feel comfortable traveling to and from services.
• Partner with other transportation providers or organizations.
• Bring services closer to participants. Satellite sites, mobile services, home-based services, and accessible virtual options may reduce transportation barriers.

Program location

Choose locations based on accessibility, transportation, privacy, safety, familiarity, and participant preferences.

Avoid assumptions that particular neighborhoods or institutions will automatically feel unsafe or intimidating to everyone. Ask community members directly how they experience different locations and why.

Some organizations successfully bring services into trusted community settings such as libraries, schools, community centers, faith communities, neighborhood organizations, housing sites, or participants' homes when appropriate.

Example: Community-based conversations

A substance use prevention program seeking stronger relationships with Spanish-speaking residents might partner with trusted community members to hold small conversations in homes, community centers, faith communities, or other familiar settings.

Rather than arriving only to deliver information, outreach workers could listen to community concerns, answer questions, provide information in Spanish, and learn what additional resources participants would find useful. Community partners could help shape both the content and format of future sessions.

The strength of this approach is not that a particular culture prefers home meetings; it is that services are designed through trusted relationships and offered in settings community members identify as comfortable and accessible.

Program schedule

Schedule services around participants' availability whenever possible. Employment, school, transportation, caregiving, health, religious observance, and family routines may all affect attendance.

Rather than assuming that particular groups -- such as mothers, women from a particular culture, or shift workers -- are available at specific times, ask participants which schedules would work best.

Options might include morning, evening, weekend, rotating, drop-in, virtual, or hybrid schedules.

Childcare

Childcare can be a significant participation barrier. Programs may be able to:

• Partner with licensed or qualified childcare providers
• Help participants identify trusted childcare resources or community networks when appropriate
• Provide on-site childcare that meets applicable safety, staffing, licensing, accessibility, and facility requirements
• Provide childcare subsidies or reimbursements when funding permits
• Design family-friendly activities in which children can participate when appropriate

Ask parents and caregivers which arrangements would actually help rather than assuming that one childcare option will work for everyone.

The service does not align with community priorities or perceived needs

If people do not see a reason to participate, start by asking why.

• Listen to community members. They may identify priorities that differ from those assumed by program staff or funders.
• Work with trusted community partners. Community organizations and residents can help explain available services and can also tell the organization when its message or service does not fit community needs.
• Provide clear information. Give people enough information about possible benefits, limitations, costs, risks, and alternatives to make their own decisions.
• Be willing to change the service. Low participation may sometimes indicate that the service, rather than the community, needs to change.

Stigma, trust, and concerns about using the service

Some people may have concerns about how they will be treated, whether their information will remain private, whether the service will respect their identity and circumstances, or what participation may communicate to others.

Listen to those concerns without describing participants as resistant, hostile, embarrassed, or unwilling. Build trust by providing respectful service, protecting privacy, following through on commitments, and making changes when community feedback identifies problems.

Trust generally develops through repeated experience rather than a single outreach campaign. Organizations should maintain relationships with communities even when they are not actively recruiting participants.

Cultural and language considerations

Cultural responsiveness begins with humility and relationship-building rather than assumptions about what a particular group believes or needs.

• Recruit and support staff with relevant community relationships, language skills, and lived experience. Do not assume that one staff member represents everyone who shares a particular identity.
• Provide ongoing learning opportunities for staff. Cultural humility, anti-bias practices, disability inclusion, language access, and community history may all be relevant.
• Provide language access. Use qualified interpreters, translated materials, bilingual staff, accessible communication, and other appropriate approaches.
• Question your assumptions. Ask community members what works for them and remain willing to change organizational practices that create unnecessary barriers.

In Summary

Meaningful access to health and community services depends on more than whether a program exists. Funding, capacity, physical and digital accessibility, affordability, eligibility rules, transportation, childcare, language, scheduling, service quality, trust, and other conditions can all influence whether people are able and willing to participate.

Improving access therefore requires looking at both community circumstances and the design of services themselves. Organizations can advocate for resources, build partnerships, strengthen accessibility, improve outreach, reduce practical barriers, evaluate program quality, and involve participants in decisions about how services are designed and improved.

Most importantly, avoid assuming that low participation means something is wrong with the people the program hopes to serve. Ask what barriers exist, listen to community members, recognize their strengths and priorities, and be willing to change the program when necessary. Access improves when services are not only available, but also affordable, accessible, effective, respectful, trustworthy, and responsive to the communities they are intended to support.