Strategies to support community-based approaches to health
It can be particularly challenging for U.S. donors to identify and support smaller nonprofits based overseas, given their lack of visibility to international donors, as well as U.S. tax implications. Yet, smaller, placed-based nonprofits are often the ones that most need philanthropic support. Donors looking to assist community-based health delivery nonprofits in communities outside the U.S. should consider the following:
Intermediary groups such as the Haiti Development Institute can help funders navigate issues such as locating and vetting effective organizations in a different country, providing support and capacity building to local nonprofits, and receiving tax benefits for donations.
Look for “friends of” options to give to nonprofits based in other countries through a U.S.-based 501(c)(3) that is a partner organization.
If you are looking for other organizations using a community-based approach, foundations that are giving to such groups can be a good starting point. Donors can piggyback off the foundations’ lists of funded organizations or consider learning from donor groups such as Big Bang Philanthropy, that focus on reducing global poverty. For example, a member of this peer learning group—the Segal Family Foundation—supports two of our profiled organizations, Lwala and Last Mile Health.
Donors can also employ other philanthropic strategies in community-based health beyond funding direct service delivery. There are many additional ways to support community-based approaches to health including:
Pitfalls to Avoid
• While tools such as diagnostics and medications are important, don’t ignore the systems that deliver them. The most critical funding gaps are often for components such as community health worker salaries, trainings, supervision, data/communication.
• Make sure the community health program is aligned with the local government strategy and integrates with other partners operating there. Otherwise, programs risk duplication, wasted resources, and confusion when community members see multiple, disease-specific (e.g., malaria, HIV) health workers who don’t coordinate with each other.
Treat and prevent now
Besides giving to nonprofits that directly serve communities long-term (such as those mentioned in this guide), donors can also support organizations that provide technical assistance to governments and smaller organizations. For example, large international NGOs such as Save the Children, World Vision, Catholic Relief Services, and Jhpiego build the capacity of local health systems by training nonprofit and government staff in community-based approaches. They also conduct research studies to strengthen the evidence base, and support quality improvement of programs. In humanitarian crises, NGOs such as International Rescue Committee (IRC) and Médecins Sans Frontières (Doctors Without Borders) train community health workers and deliver emergency services at the community level to displaced populations.
Invest in innovation and research in community-based health
There are many exciting opportunities to develop new tools, treatments, and diagnostics that community health workers can use in low resource settings around the world. Particularly promising are new mobile health platforms by groups such as D-Tree that can provide treatment algorithms and mobile support for health workers in remote locations. Organizations such as Living Goods have adapted BRAC’s door-to-door health worker model to East Africa and have tested entrepreneurial sales approaches to incentivize CHWs and cover salary and distribution costs. Donors can also help bring community approaches to other health problems such as chronic disease management (e.g., diabetes and high blood pressure) or the extremely neglected area of mental health.
Build systems and train health workers
Millions of health workers—nurses, doctors, and especially community health workers—need to be trained in these approaches to reach and care for the poorest communities. For example, Last Mile Health has launched a Community Health Academy to use a digital platform-based approach to train and support thousands of new health workers. Partners in Health has helped develop the University of Global Health Equity in Rwanda and CRHP Jamkhed has a long standing International Institute for Training & Research where organizations from around the globe can learn community-based approaches.
Share best practices and policies
Initiatives such as the new International Institute for Primary Health Care in Ethiopia are well-positioned to share what they have learned about how community health programs can expand to national levels. Funded by the Gates Foundation and others, the Last 10 Kilometer (L10K) project is an example of how philanthropic donors have supported a low income country government (Ethiopia) as they build their national community health worker program. Donors can also support field-building membership organizations such as CORE Group, an association of more than 100 U.S.-based international health and development NGOs. CORE Group’s mission is to end preventable maternal, newborn, and child deaths by creating and sharing knowledge of best practices in community-based health. Member organizations can join CORE Group’s Community Health Network, develop Working Groups that offer specialized practices in eight different topic areas, and attend a variety of conferences, trainings, and workshops to strengthen their work in community-based health.
Bringing Community-Based Health to the U.S.
Community-based approaches are not only for low resource settings abroad. In fact, more and more organizations are adapting these same approaches for improving the health of vulnerable populations in the U.S. For example:
- Partners in Health works with the Justice Resource Institute on the Boston-based Prevention and Access to Care and Treatment (PACT) Project, which serves HIV patients through CHWs. PACT also provides technical assistance and training to other healthcare organizations.
- Nurse-Family Partnership (NFP) operates across the U.S. to match a registered nurse with a low-income woman, pregnant with her first child. Starting from early pregnancy through the child’s second birthday, NFP provides in-home counseling about healthy practices, childcare, planning for future children, and employment.
- The Penn Center for Community Health Workers developed its IMPaCT model for CHWs in Philadelphia to address health needs in their own communities. A 2017 randomized clinical trial showed that the model can improve health impacts and reduce hospital admissions by 28% among high-risk individuals.
- Global to Local (G2L) operates community health programs in Seattle and shares their learnings to address health and economic development disparities across a range of diverse, low-income populations nationwide.
Additional web-based tools and resources for donor giving in community health:
Map the health status in a country: Global Burden of Disease
On Global Burden of Disease’s website, you can find the health profiles of each country, quantify health loss over time, and compare them to other nations: http://www.healthdata.org/gbd
Look at current progress and health goals: Countdown to 2030
To determine the progress of maternal, newborn, and child health over time, visit Countdown to 2030. Here, the coverage levels of different health interventions are tracked in 81 low- and middle-income countries. http://www.countdown2030.org
Estimate impact of health tools and behaviors: Lives Saved Tool
To model the potential health impacts of evidence-based interventions, consider using the Lives Saved Tool (LiST) which pulls from the latest country data to show how many deaths could be averted when maternal, newborn, and child health programs are scaled-up. In order to assess program potential, organizations like the Children’s Investment Fund Foundation use LiST to model the potential health impacts of increasing the coverage of proven interventions. www.livessavedtool.org/