Findings from this study have implications for community coalitions at all stages of development, as well as evaluators and funders of coalitions. Findings suggest that coalitions should invest time and resources into developing characteristics and capacities that facilitate sustainability. Such actions might include identifying leaders with experience working in the community and committed staff that are highly effective managers; incorporating diverse, multi-sectorial partner organizations with a shared sense of mission and a willingness to invest in the coalition’s success; pursuing diverse funding sources that will finance both the coalition’s programs and its operations; and investing in robust outcome evaluations that demonstrate the coalition’s performance and impact.
For federal and community planners, this study demonstrates the value of using community coalitions to achieve community health goals. Post-initial federal funding, 113 (68%) of the HCAP community coalitions were sustained, and nearly half of the sustained coalitions are addressing all of their original goals from the HCAP grant. These coalitions are still actively pursuing a range of activities in their communities, and have achieved both individual-level impacts (e.g. increasing access to primary and specialty care, increasing enrollment into health insurance plans) and other policy and system impacts (e.g. streamlined eligibility systems, new processes for care coordination across community providers). Federal and community planners should consider using community coalitions when developing community-level interventions. Given their ability to sustain themselves, and their resiliency, the HCAP coalitions have demonstrated the power of community coalitions as a vehicle for creating lasting community change.
Findings also speak to the risks associated with over-engineering sustainability plans, when it is action that matters. Sustainability actions such as developing plans, holding meetings, and convening special sustainability committees are not enough to sustain a coalition. Rather, this study found that a coalition’s time is best spent taking discrete action steps towards sustainability—whether that is securing funding or institutionalizing some program activities in other organizations.
This study also supports the importance of evaluation and using performance data to demonstrate outcomes. The federal government and other funders regularly require community coalitions and other programs to develop SMART goals and evaluation measures to track their progress and outcomes over time. To the extent that coalitions can invest in outcome evaluations, they will be better able to respond to funders’ evaluation requirements and also demonstrate the return on investment of their programing to coalition partners and other community stakeholders.
Finally, coalitions should discuss sustainability expectations with their funders, and define their sustainability goals at the outset. This study defined sustainability in terms of the continuation of the coalition and its goals. However, funders may choose to define sustainability in terms of the continuation or institutionalization of specific coalition activities. The conceptual framework developed as part of this study can help community coalitions have this conversation with both their funders and members, and define expectations—which will, in turn, help to direct their sustainability actions.
This study also has implications for researchers and practitioners who evaluate the sustainability of community coalitions. In crafting program evaluations of coalition sustainability, evaluators must carefully identify their definition of sustainability and use this definition to shape their study. Is the evaluator interested in the sustainability of the coalition or in the sustainability of its activities and impacts? The answer to this question will impact the evaluator’s research questions, hypotheses and activities. Additionally, findings from this study suggest that, when assessing coalition sustainability and outcomes, evaluators should pay close attention to the presence of specific characteristics and capacities that facilitate sustainability. This study presented numerous comparisons of the characteristics and capacities of sustained and not sustained coalitions, which may provide a useful starting point for framing future evaluation studies.
The study also has implications for funders of community coalitions. The federal government and foundations continue to invest in coalitions to improve health and other outcomes at the local level. When providing initial program funding for community coalitions, funders must consider whether they expect the coalitions to continue post-grant. If so, funders and coalitions can collaborate during the grant period to lay the necessary groundwork for sustainability.