A Sustainability Assessment of the Healthy Communities Access Program Coalitions

We present findings from an extensive survey of the Healthy Communities Access Program (CAP/HACP) grantees that assesses the sustainability of these community health coalitions five or more years after their CAP/HCAP funding ceased. Federal and state governments increasingly use community coalitions as a programmatic approach to address emerging community health issues. The presumption is that successful community coalitions will be able to identify new resources to continue their activities and to sustain their impact in the community beyond the initial grant period. Guided by a conceptual framework of coalition sustainability, we developed a self-administered questionnaire for completion by the 260 CAP/HCAP grantees which represent community coalitions in 45 states plus the District of Columbia and the Virgin Islands. Between 2000 and 2006, CAP/HCAP provided infrastructure and operational funding to coalitions of local providers to strengthen safety net services for uninsured and underinsured Americans. We use the survey data to assess a number of research questions. What proportion of coalitions sustained an organizational structure and/or programmatic activities in their community? What coalition characteristics are associated with sustainability? How does a coalition's sustainability planning and evaluation activities influence sustainability outcomes? Finally, how do coalitions evolve to continue addressing the community's needs over time? The survey results provide government and foundation funders with actionable findings on the factors influencing sustainability, which can be applied as criteria for selecting coalitions for funding, incorporated into award requirements and statements of work for funded coalitions, and utilized for planning training and technical assistance activities for coalitions.