In a qualitative study of four partnerships from the Community Care Network (CCN) Demonstration Program, 1 Alexander et al. (2003) developed a conceptual model of sustainability in community health partnerships and identified potential determinants of sustainability. Exhibit 4.2 presents the sustainability conceptual model. The model assumes that sustainability is built on the value that collaborative capacity adds to the community. The higher the value of the collaborative efforts, the more likely the collaborative efforts will be sustained. The key emphasis of the model is that there are factors associated with value creation and sustainability. These five sustainability-enhancing factors are outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages.
Exhibit 4.2: Sustainability Conceptual Model in Community Health Partnerships
Reprinted from Alexander et al. (2003).
Exhibit 4.2 This exhibit depicts a conceptual model of sustainability in community health partnerships developed by Alexander et al. (2003). The model shows how five factors (outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages) influence value creation and sustainability. This process is also influenced by history/culture, and the political, physical, and economic environment.
Outcomes-based advocacy refers to the partnership’s ability to communicate achievements of the partnership to internal and external stakeholders. The vision-focus balance refers to the ability of the coalition to agree on the long-term vision of the coalition, and its commitment to pursue actions that will move the coalition toward its vision. Systems orientation means that the partnership and its leadership can address complex community health issues using a coordinated multi-sector effort in the community. Infrastructure development refers to the ability of the partnership to develop internal systems to foster participation. Community linkages refer to the partnership’s ability to develop working relationships with institutions and individuals, and incorporate direct community input. These five factors are the emphasis of the Alexander et al. model because they are hypothesized precursors of sustainability.
The model is useful because it takes into account four different contextual factors that affect the partnership: historical/cultural, political, physical, and economic. The sustainability of the partnership is affected by the prior experiences of collaboration in the community (historical/cultural environment), the extent to which governments are involved in policy planning and to which they embrace the community health issue being addressed (political environment), the geographic or other factors that affect the partnership (physical environment), and the economic situation in the community (economic environment).