An Assessment of the Sustainability and Impact of Community Coalitions once Federal Funding has Expired. Funding and Resources


Funding and resources are critical facilitators of sustainability in community coalitions. This section discusses several significant differences between sustained and not sustained coalitions in terms of their funding and resource structures. Next, we present findings on the coalitions’ financial resources, the stability and flexibility of coalition funding, diversity of funding and in-kind resources, and trends related to full-time equivalent coalition staff.

Financial resources. In terms of sources of financial resources, as shown in Exhibit 14, local health departments and foundations were the most commonly cited financial sources for both sustained and not sustained coalitions. Faith based organizations were the least common sources, cited by less than 20 percent of sustained and not sustained coalitions. Sustained coalitions were significantly more likely to receive resources from state level agencies and departments (other than the health department), local health departments, foundations, and community-based organizations. In some cases, sustained coalitions named their state senators as being critical during the end of HCAP funding in getting earmarks for the coalition. Other sources of funding mentioned by coalitions included direct support from member organizations, local donations, and support from local hospitals. The mean number of financial sources for sustained coalitions was 3.9, which is significantly higher (p<.05) than the mean for not sustained coalitions of 3.0.

Exhibit 14: Financial Sources

*p<.10; **p<.05, two-tailed difference of proportions test

Exhibit 14: Financial Sources
Financial Source % Sustained % Not Sustained
*Indicates p<0.10, two-tailed difference of proportions test
**Indicates p<0.05, two tailed difference of proportions test
State Health Dept. 30 18
Other State Agency/Dept* 30 16
Local Health Department* 49 32
Other Local Agency/Dept 31 29
United Way 25 16
Foundations** 57 37
Health Insurers/ Managed Care Organizations 25 19
Businesses 28 24
Univerisities/ Academic Institutions 26 22
Community Based Organizations* 34 20
Faith Based Organizations 16 18
Other 32 27

Twenty-four percent of sustained coalitions were still receiving financial resources from HHS.3 For example, one coalition that participated in a site visit was able to secure funds from two different HHS agencies post-HCAP, allowing them to continue all of their HCAP programming. This coalition received funding from the Office on Women’s Health to continue the behavioral health aspect of their program, and HRSA to develop a comprehensive electronic health network (EHR) that builds on their HCAP work. Several of these sustained coalitions noted that their federal funding has helped them to continue activities related to eligibility or enrollment into entitlement programs.

Stability of funding. The sustained and not sustained coalitions varied significantly (p<.05) in terms of the stability of their funding. Forty-four percent of sustained coalitions and 54 percent of not sustained coalitions said that in general their funding was stable from year to year. However, 32 percent of sustained coalitions report funding that fluctuated year to year compared to 8 percent of not sustained coalitions. Thirty five percent of not sustained coalitions reported funding that decreased over time compared to 14 percent of sustained coalitions. Only 10 percent of sustained coalitions and 2 percent of not sustained coalitions reported funding that generally increased over time.

Flexibility of funding. Sustained and not sustained coalitions reported similar levels of flexibility for how they can allocate financial resources. On average, sustained coalitions had 50 percent of their funds dedicated to programmatic activities, with 19 percent dedicated to funding coalition operations, and 31 percent of funds that could be used for both. Similarly, on average, 48 percent of not sustained coalitions’ funds were dedicated to programmatic activities, 23 percent to operations, and 30 percent that could be used for both.

Diversity in funding sources. Sustained coalitions reported on the current characteristics of their funding situation compared to the HCAP period, as shown in Exhibit 15. For almost all categories, sustained coalitions reported having less than during the HCAP grant. The one exception being diversity of funding, in which 50% of sustained coalitions reported having more diverse funding now than they did during the HCAP grant.

Exhibit 15: Sustained Coalitions' Current Funding Characteristics Compared to HCAP Period
  Less than during HCAP grant Same as during HCAP grant More than during HCAP grant
Diversity of funding sources (n=111) 38% 12% 50%
Funding earmarked for programs, services, or activities (n=110) 43% 20% 37%
Funding for coalition operations (n=109) 58% 25% 17%
Flexibility to allocate funds wherever they are needed or can be most effective (n=109) 40% 28% 32%
Certainty about sources of future funding (n=110) 62% 20% 18%

Because of spending cuts, coalitions utilize creative solutions to securing funding. Rather than applying for large-scale grants, sustained coalitions aim to secure smaller grants or "funding opportunities that others may not be looking for." A leader of one sustained coalition that is focusing on building infrastructure in the community noted that their strategy has been to secure smaller grants: "We don’t go for the large grants very often because they are very competitive and a lot of funders don’t see us as being very important because we don’t provide services directly."

In-kind resources. There were few differences in terms of the types of in-kind support received by sustained and not sustained coalitions. As shown in Exhibit 16, facilities such as office space and equipment, and supplies such as computers or health educational materials were the most common type of in-kind support received by over two-thirds of sustained and not sustained coalitions. The least common types of in-kind support, received by less than 40 percent of sustained and not sustained coalitions, were evaluation support and fundraising and development support. Other types of in-kind services included donated pharmaceuticals, donated clinical services such as radiology, and data management and analysis support. Sustained coalitions received significantly more (p<.10) types of in-kind support with a mean of five types compared to a mean of four types for not sustained coalitions.

Exhibit 16: In-Kind Support

Exhibit 16: In-Kind Support


Exhibit 16: In-Kind Support
In-Kind Support % Sustained % Not Sustained
Facilities 77 82
Equipment and Supplies 71 67
Salary Sharing/Time Coverage 49 53
Volunteers 63 50
Administrative Staff or Services 60 57
Provider Staff or Services 55 48
Grant Writing 59 53
Fundraising/ Development 35 28
Evaluation Support 40 35
Other 19 10

Full-time equivalent staff. Additionally, in terms of full-time equivalent (FTE) staff, sustained and not sustained coalitions differed very little. The median number of FTEs for sustained coalitions was three with a range [0, 125]. Similarly, not sustained coalitions had a median of four FTEs, but a smaller range [0, 12]. Sustained coalitions were also asked if the size of the FTE staff changed since the end of the HCAP grant. Thirty one percent (n=34) reported "more staff now than during the HCAP grant;" fifty percent (n=55) had fewer staff; and 20 percent (n=22) report "the same number of FTE staff now as during the HCAP grant."

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