Learning Outcomes
By the end of this section, you should be able to:
- 20.5.1 Define sustainability.
- 20.5.2 Consider the influence of efficiency, value, and cost on program continuity and sustainability.
- 20.5.3 Examine how external and internal funding streams and levels can influence program continuity.
- 20.5.4 Explain the relevance of creating a sustainability plan early in the planning and implementation stages.
The goal of health promotion and disease prevention is to deliver community health programs that effectively and efficiently meet community needs. Funding and resources are required to deliver community health programs. The program team must address funding needs and program sustainability at the beginning of the program planning process and before the end of the initial funding cycle. Sustainability is the continuation of community health programs because the program is valued, cost and resource efficient, effective, and supported by the community (Georgia Health Policy Center, 2011; U.S. Department of Housing and Urban Development [HUD], 2012). The program team enhances sustainability by decreasing dependence on one funding source and shifting to one or more new funding streams. Sustainability goals may differ depending upon the developmental stage of the program. For example, newer programs focus on the continuation of activities once the initial funding stream ends, and experienced programs may focus on expanding program reach, building new partnerships, and promoting policy initiatives (HUD, 2012). Additionally, sustainability does not refer to the continuation of a program using the original strategies and activities. Most often sustainable programs evolve over time to adjust to changing funding, support, and community needs (Georgia Health Policy Center, 2011). Sustainability is influenced by (HUD, 2012):
- Efficiency and effectiveness of program activities
- Community support
- Partnerships that maximize use of resources
- Funding diversification
- Ability to draw new funds and partnerships
- Understanding of the overall cost savings associated with program implementation and improvement of community health status
External and Internal Funding Streams
The program team must identify funding to support new and continuing community health programs. The nurse must be aware of possible external and internal funding streams and have experience with soliciting funds for community health programs (see Table 20.9). Frequently, community health programs begin with funding support from one stream that does not continue throughout the program’s lifetime, so it is necessary to identify diverse funding streams to enhance program sustainability.
| Funding Stream | Description | Nurse’s Role in Acquiring Funds |
|---|---|---|
| Grants | Funds provided by a government source or private foundation for a specific purpose and for a specified time frame | The nurse may locate potential grants, write grant applications, communicate with funders, and carry out activities, or deliverables, specified within the grant. |
| Indirect funding | Resources, such as volunteers, equipment, materials, or funding, provided by an external source | The nurse may solicit or recruit volunteers, materials, etc. |
| Contributions or sponsorships | Businesses, social and civic clubs, churches, or individuals make financial or resource donations. | The nurse may provide presentations or communicate with potential sponsors to solicit funds. Sponsorships and contributions are often communicated as funders in program messaging and materials. |
| Government budgets | Local, state, and federal monies are factored into the annual budget and are set aside for community health program funding. The funds are usually acquired via taxes and fees to community residents. | The nurse may advocate for additional annual monies to be provided for community health programs and health promotion activities. |
| Fundraising events | Sporting events, such as golf outings or marathons, or lunch/dinner events are held to raise funds to support community health programs. | The nurse may plan and implement events. |
| Earned income | Funds earned through internal streams, such as fee for service, consultation, reimbursement from second party payers, or product sales are used to support community health programs. | The nurse may provide services that contribute to the internal streams, such as vaccination clinics. |
Theory in Action
Funding Public Health Projects
The nurse must understand how to procure funds for public health programs. This video introduces funding for public health projects and describes how funding agencies and funding cycles are structured.
Watch the video, and then respond to the following questions.
- Why should the nurse understand the funding agency’s objective before applying for a grant?
- What is the general process of grant application and funding?
Sustainability Planning
The program team begins intentionally planning for sustainability during program planning and development. The sustainability plan is supported by program evaluation and achievement of program objectives. The program team uses evaluation data to decide which program activities will continue following a grant period or when initial funds have been depleted (Georgia Health Policy Center, 2011). Sustainability efforts are strengthened if a program demonstrates effectiveness, positive results, strong leadership, and community engagement (HUD, 2012). Program growth and sustainability are promoted when the program team focuses on evaluation and continuous quality improvement, organizational capacity, expansion of partnerships, systems or policy change, identification of new funding streams, and diversification of sources of funding (RHIhub, 2022). Studies have shown that sustainable programs are adaptable, have leadership that develops a clear, strategic purpose for grants and commit to providing resources, include cross-sector partnerships, consider community needs and demand, use data to show program impact, and align with the current social and political environment (Georgia Health Policy Center, 2020).
The nurse and program team can use the Georgia Health Policy Center (2011) step-by-step workbook to guide sustainability planning. Generally, the program team answers the following questions when planning for sustainability (Georgia Health Policy, 2011; HUD, 2012):
- What criteria will be used to determine continuation? For example, criteria could include that the program
- meets community needs,
- is valued by the community,
- has positively impacted participants and the community,
- achieves objectives and goals,
- uses cost-effective program delivery,
- has a return on investment,
- has sufficient partner and community support, and
- can access needed resources.
- Has the program met sustainability criteria?
- What will continue to be offered—all or part of a program?
- Who is needed to continue the program (leadership, staffing, and partnerships)?
- Can support for the program and partnerships be expanded? How?
- What is the cost of the program (budgeted line items and overall cost)?
- What are current and potential funding strategies?
- Are the funding strategies diversified?
RHIhub (2022) offers several resources for sustainability planning, including toolkits for specific types of community health programs. For example, the maternal health toolkit lists potential federal, state, and other funding sources.
To successfully implement and sustain community health programs, the program team must consider facilitators and barriers to program implementation to plan interventions that will enhance facilitators and reduce barriers. Participant recruitment and retention is an important consideration. Without program participants, a program would not effectively meet its goals and objectives. Recruitment and retention are facilitated when sociocultural and linguistic needs are met. Systematic evaluation of the community health program provides evidence of efficacy, effectiveness, and efficiency in order to make decisions about the current and future programs. Program evaluation strategies depend upon the needs of the program team and community partners and on the developmental level of the program. Outcome evaluation should occur regardless of the developmental level. Most often process evaluation occurs along with outcome evaluation so that the program team can make inferences about outcome results. Effective communication, diverse funding streams, and sustainability planning are key in promoting and maintaining community health programs.