Findings from this study have implications for community coalitions at all stages of development, as well as evaluators and funders of coalitions.
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. Taking discrete action steps towards sustainability—from securing funding to institutionalizing some program activities in other organizations—was more important than only making plans for sustainability.
In setting expectations of coalition sustainability, both funders and evaluators must carefully identify their definition of sustainability. The conceptual framework developed as part of this study illustrates the importance of defining what is meant by sustainability. Is the funder or 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 funder or evaluators’ research questions, hypotheses and activities. Additionally, 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 funding period to lay the necessary groundwork for sustainability. Findings from this study also 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. For example, sustained coalitions were significantly more likely than not sustained coalitions to have diversity in the types of members involved, both within the health sector and across sectors. Future studies may further explore the sustainability of multi-sectorial coalitions, specifically.
Community coalitions are a promising approach for implementing key aspects of the Affordable Care Act.The Affordable Care Act established a Prevention and Public Health Fund for public health activities, which states and communities are using to support community and clinical prevention activities. Coalitions are a natural fit for implementing key prevention activities through the Prevention Fund given their focus on applying evidence-based, population-based, and culturally-appropriate interventions. Additionally, policymakers have an opportunity to leverage diverse, multi-sectorial networks that have the ability to effectively enroll individuals into the health insurance exchanges. Community coalitions—and the organizations that participate in them such as community and faith-based organizations—are particularly well-suited to enroll individuals into these exchanges and provide guidance during the enrollment process. Further, community coalitions that serve the most vulnerable populations will be particularly important in this process, given that these populations traditionally trust the organizations that participate in the coalitions.
Key facilitators of community coalition sustainability and coalition building should be considered when developing future programs. Policy makers may consider investing in local leaders and building leadership capacity in communities across the country through technical assistance and training opportunities. The most effective and highly sustainable coalitions were led by leaders with prior experience working within their community, suggesting that leadership training in community-based participatory approaches may be valuable. Policy makers should also consider investing in other mechanisms for supporting sustainability, such as funding rigorous data collection and evaluation to encourage results-oriented planning and assist coalitions in appealing to additional funders. Finally, while capacity building activities may wane over time, policy makers should structure funding to account for an ongoing investment in these activities throughout the life of the coalition.