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Volume
2:
Special Issue, November 2005
COMMUNITY CASE STUDY
Energizing Community Health Improvement: The Promise of Microgrants
Mary Bobbitt-Cooke, MPH
Suggested citation for this article: Bobbitt-Cooke M. Energizing
community health improvement: the promise of microgrants. Prev Chronic Dis
[serial online] 2005 Nov [date cited]. Available from: URL:
http://www.cdc.gov/pcd/issues/2005/
nov/05_0064.htm.
PEER REVIEWED
Abstract
Background
The Healthy Carolinians community microgrants project provided microgrants to
community-based organizations (CBOs) across North Carolina. These grants
were made to serve as a catalyst to engage the CBOs in health promotion
activities that addressed Healthy People 2010 objectives. The purpose
of this initiative was to increase the awareness of Healthy People 2010
objectives, mobilize resources, and create new partners in community health
improvement.
Context
In 1993, Healthy Carolinians, a statewide network of public–private
partnerships, was established at the county level to address North Carolina’s
health objectives that aligned with national Healthy People 2010
objectives. This network of Healthy Carolinians partnerships provided the
vehicle for distributing the microgrants.
Methods
Funding was distributed to 32 Healthy Carolinians partnerships that, in
turn, awarded 199 microgrants ($2010 each) to CBOs to address state and
national health objectives. Each CBO selected its own objectives based on Healthy
People 2010 objectives and designed its own interventions. Surveys of the
CBO project managers and final reports were used for evaluation. A survey of the Healthy Carolinians partnership
coordinators provided additional insight.
Consequences
Of the 199 surveys mailed to CBOs, 153 (77%) responded. Nearly half (43.7%)
of the microgrants were used to focus on three major health risk factors: 27.1%
on physical
activity and fitness, 13.1% on nutrition and overweight, and 3.5% on tobacco use. At the
end of the project, 96.1% of the respondents reported that they were familiar with the Healthy
People 2010 objectives. Final reports showed that an estimated 52,739 hours of CBO staff
and volunteer time were contributed to microgrant programs. All Healthy Carolinians partnership coordinators responded to a survey; 100% stated that they had new access to priority populations
within their community.
Interpretation
The Healthy Carolinians microgrant project demonstrated a cost-effective,
alternative approach to funding community-based health promotion and injury control activities. This model was decentralized,
so it empowered
communities and CBOs to be responsible for community health improvement.
Public health professionals with limited funds should consider this alternative approach,
which mobilized existing community organizations and effectively addressed
national and state health objectives.
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Background
In 2001, the Office of Healthy Carolinians/Health Education (OHC/HE) within
the Division of Public Health, North Carolina Department of Health and Human
Services, was awarded a $510,000 grant from the Office of Disease Prevention
and Health Promotion (ODPHP), U.S. Department of Health and Human Services. The
purpose of the Healthy Carolinians microgrant project was to
increase public awareness of Healthy People 2010 objectives and broaden
participation of community-based organizations (CBOs) in innovative efforts to
promote healthy behaviors, access to care, and other projects to support
national health objectives (1-3).
This initiative was designed to use existing community organizations rather
than to build infrastructure at local and state health departments. Instead of
sending funding to a community public health agency to implement a community
health promotion project, this initiative sought to determine whether
small grants ($2010) to CBOs could serve as a catalyst for increasing
awareness and mobilizing resources to address national Healthy People 2010
objectives. By investing small grants in CBOs, critical capital was provided
in areas where people learn, work, play, worship, and live. These funds, applied to
health improvement projects, could potentially empower small agencies and
groups to respond to the health needs of their community.
Chronic diseases such as heart disease, stroke, cancer, and diabetes are
among the most prevalent, costly, and preventable of all health problems (4).
Unintentional injuries, which are preventable, represent the leading cause of death for
people aged 1 year
to 34 years; about 50% of unintentional injuries are related to motor vehicles (5). The challenge was to determine whether microgrants could
effectively stimulate communities to promote health and
safety, thereby preventing chronic disease and injury. The idea of providing microgrants to CBOs for
community health promotion is consistent with
the 1997 report from the Institute of Medicine, which called for a community
health improvement process mobilized by a coalition that is centered in the
community and includes groups interested in health outcomes (6).
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Context
Since 1991, North Carolina has addressed the national Healthy People
objectives through the Healthy Carolinians initiative, a network of
community-based, public–private partnerships across North Carolina. By
executive order in 1991, the Governor’s Task Force for Healthy Carolinians
was established to develop North Carolina’s health objectives and ensure
that these objectives aligned with national Healthy People objectives
(7). In 1992, the health objectives for North Carolina were published, and the
Governor’s Task Force challenged all counties in North Carolina to mobilize
community resources to address the problems identified in the state and
national objectives. The Governor’s Task Force believed that if communities
determined their own health priorities, they would mobilize to address them
(8,9). The Healthy Carolinians network of partnerships placed resources,
decision making, and accountability where health decisions are created and supported —
in the community.
Across North Carolina, communities have embraced the idea that they can
decide what their health challenges are, how to fix their problems, generate
or redirect resources, and implement their own community-devised solutions.
Healthy Carolinians partnerships, now in more than 90 counties, represent
health departments, hospitals, schools, churches, businesses, media, human
service organizations, and civic groups. The Governor’s Task Force certifies
each partnership using a rigorous set of criteria and holds the partnerships
to standards that are proven to support successful health outcomes (10).
Within this context, the concept of microgrants was tested in North Carolina
through the Healthy Carolinians microgrant project.
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Methods
The Healthy Carolinians microgrant project included the following three
overarching goals:
- To provide microgrants ($2010 each) to a wide variety of CBOs conducting
activities related to Healthy People 2010 objectives
- To demonstrate the advantages of the statewide Healthy Carolinians
network
- To evaluate the concept of using microgrants as an alternative method
for increasing awareness and mobilizing resources for addressing Healthy
People 2010 objectives
In 2002, the OHC/HE distributed $439,790 to 32 Healthy Carolinians
partnerships representing 35 counties in North Carolina (an average of $13,743
per Healthy Carolinians partnership). Each partnership receiving the funding
participated in an orientation video conference and received a toolkit that
included the following guidelines for administering the project: a description
of methods for soliciting applications for the microgrants (e.g., sample press
releases in English and Spanish, advice on how to run a community meeting);
microgrant applications and instructions for completing the applications in
English and Spanish; guidelines and criteria for selecting CBOs from the
applicant pool; reporting forms; and background information on Healthy
People 2010. Each of the 32 Healthy Carolinians partnerships used the same
application form and selection criteria. Partnerships were evaluated on
uniformity in selecting grantees and reporting information. The partnerships
were given $200 for each microgrant that they administered to cover expenses
for meetings, postage, site visits, and other items. Four to nine microgrants
were awarded in each of the participating counties for a total of 199
microgrants.
Healthy Carolinians partnership coordinators informed local CBOs
about the availability of microgrants through electronic mailing lists, print
and broadcast media (including paid advertising and public service
announcements), and word-of-mouth. Healthy Carolinians partnership coordinators
held community meetings to explain the microgrant project and help CBOs
understand the application process. A panel established by each partnership made award decisions.
More than 275 CBOs applied for a microgrant. Microgrants were awarded to
CBOs representing organizations that traditionally work with local public
health departments (e.g., churches, schools, cooperative extensions, preschool
centers) and organizations that are not traditional partners with the local
public health department (e.g., Boy Scouts, neighborhood and community
development organizations). Large CBOs (e.g., United Way agencies) did not
apply for these small grants. The pool of proposals came primarily from small
organizations, with more than one third (39%) indicating that this was the
first time they had ever applied for a grant.
Because the CBO applicants decided the health objectives on which
to focus, they determined the health priorities of the Healthy Carolinians microgrant project. The project allowed CBOs to set their own project goals
using Healthy People 2010 objectives for guidance.
Table 1 shows that
nearly half (43.7%) of the microgrants were used to focus on the three major health risk
behaviors outlined by Healthy People 2010: 27.1% of the microgrant
recipients addressed physical activity, 13.1% addressed nutrition and
overweight, and 3.5% addressed tobacco use among children and youth.
Table 1 reports the types of objectives selected by the CBOs. The populations
addressed most often by the microgrant programs were children (52%), racial or
ethnic minorities (36%), and low-income individuals (33%). (Categories may
overlap.)
Each microgrant program was designed to run for 9 months; none was
expected to provide health outcome data to the OHC/HE. Thus, the evaluation of
the Healthy Carolinians microgrant project was not designed to measure health
outcomes. Instead, the evaluation of the microgrant project focused on 1)
testing the effectiveness of the Healthy Carolinians partnerships in
distributing microgrants to a wide variety of CBOs, 2) identifying components
of the model that could be used by other states, and 3) analyzing the benefits
of using existing community infrastructure (CBOs) for community health
improvement. Evaluation data were attained through surveys and final reports.
CBO project managers and Healthy Carolinians coordinators were asked questions
about their experience with the microgrant project. The feedback was used to
answer the initial question of the project: can microgrants serve as a
catalyst for increasing awareness and mobilizing resources for addressing Healthy
People 2010 objectives?
Survey of CBOs
A two-page survey with a self-addressed stamped envelope was mailed to the
program directors of all 199 microgrant-recipient CBOs after the programs were
completed. Eleven survey questions addressed familiarity with the objectives of Healthy Carolinians and Healthy People
2010 and asked respondents to rate their satisfaction with such aspects
of the microgrant
project as the application
process, reporting requirements, ease of recruiting volunteers, and working
relationship with Healthy Carolinians partnerships. Seven other yes-or-no questions asked about future relationships with Healthy Carolinians
partnerships, current and future experience with grant writing, mobilizing
volunteers, and continuing activities beyond the $2010 microgrant project.
CBO final reports
Each CBO was required to submit a uniform final report. This report requested information about
expenditures, number of staff engaged in the microgrant activities, number of
volunteers involved in the project, and number of hours that both staff
and volunteers spent on the project. Through open-ended questions, the final
report also provided an opportunity for CBOs to comment on their experience,
describe achievements, and discuss their plans (if any) to continue the
project and their relationship with the Healthy Carolinians partnerships after
the project expired.
Survey of Healthy Carolinians partnership coordinators
The 32 Healthy Carolinians coordinators who managed the community microgrants project
also completed a survey at the end of the project. They
could complete the survey online or print the survey, complete a hard copy, and
fax or mail it to the OHC/HE. Survey questions were ranked on a 4-point scale
with 1 indicating strongly agree; 2, agree; 3, disagree; and 4, strongly
disagree. The survey asked questions about the following:
- Orientation and support provided by the OHC/HE to the Healthy Carolinians
coordinator during the microgrant project
- Management of the microgrant project (e.g., adequate time to promote the
microgrants in the community)
- Rules about CBO eligibility being clear and fair
- Guidance provided in the microgrant toolkit
- Adequacy of the $200 allowed for administration of the microgrant
- Help they provided to the CBOs
- How their Healthy Carolinians partnership benefited from the microgrant
project (Did the microgrant project diversify the partnership’s
membership? Did it improve access to priority populations? Did it provide
the partnership positive exposure in the community?)
The survey of Healthy Carolinians coordinators also provided an opportunity
for coordinators to comment on the project as a whole or any specific part as
well as to make recommendations for changes.
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Consequences
CBO survey results
Of the 199 questionnaires mailed, 153 (77%) were returned. Overall, the CBO
respondents provided positive feedback about the microgrant project
(Table 2).
CBO final report results
The final reports from all 199 CBO microgrant projects provided
insights into the ingenuity and determination of the CBOs during the project.
The survey asked CBO microgrant recipients to describe their achievements. The
following is a sample of the achievements, with the corresponding Healthy
People 2010 objectives provided in parentheses (3). This list demonstrates
that a significant amount of work was accomplished with relatively small
investments used strategically in communities.
- The Crossroad Sexual Assault Response and Resource Center reached 3818
people through its program and has 20 new volunteers working with it
(Objective 15-36).
- Carson Community Development Center leveraged the $2010 to raise more
than $90,000 in community donations and grants to build a walking track
and multisport playing field at a local elementary school. This walking
track is close to an industrial park and a residential home for
older adults; it is used by a wide range of children and adults
(Objectives 22-4, 22-6, and 22-12).
- Phi Beta Kappa used a puppet skit to educate 2200 youth about the health
risks of tobacco and will continue this program (Objective 27-2).
- South Macon Elementary School Parent–Teacher Organization provided
fluoride sealants to 1887 children (Objective 21-8).
- Pitt Council on Aging delivered 673 meals to 26 shut-in seniors for 6
months and identified new funds to continue this initiative (Objective
19-18).
- Hispanic Coalition of Salisbury, with assistance from the sheriff’s
department, provided and installed car seats for more than 50 Hispanic
families and obtained a $1000 grant for additional car seats from a local
store (WalMart), which indicated that it will continue to support this
program (Objectives 15-20, 15-15, and 15-17).
- The Ashe County 4-H Club established a physical activity program for
home-schooled children — the first such program in the state (Objectives
22-6 and 22-12).
- The Lake Users Association, Swain County, purchased a boat and other
equipment to clean a lake that was polluted after a major flood. It is now
clean enough for recreational purposes (Objective 8-8).
Several CBOs bought physical activity equipment for their churches, youth
agencies, or own organizations; provided a health fair for their community; or
offered training sessions.
The final report provided the opportunity for the CBOs to identify
challenges as well. The themes identified as challenges or barriers to the
project were weather, scheduling of project activities, staffing, time
constraints, funding delays, excessive reporting requirements, recruiting
volunteers, and finding Spanish-language materials. The weather was a
particular challenge for projects in the mountains. The unusually wet winter
and spring in North Carolina (2002–2003) led to many outdoor project delays.
The 9 months allotted for project implementation was not enough for some
projects. In addition, the North Carolina Department of Health and Human
Services had problems distributing funds at the beginning of the project.
The problems were eventually resolved, but funding was delayed initially.
Finally, because funds were distributed before expenditures were made, the
North Carolina Department of Health and Human Services required the CBOs to
file monthly expense statements.
There were only a few responses related to lessons learned, such as, “I would make
a weather contingency plan” and “I should have used the funds to leverage
other funds. Now I have to start from scratch to find new funds to keep the
project going.” Most responses to the question on what CBOs would do
differently were related to project administration: for example, allowing more time
for planning, increasing staff and volunteers, offering their program to a
wider audience, ordering materials earlier, advertising and promoting the
program, and involving participants in selecting equipment.
The CBOs were asked how the Healthy Carolinians partnerships helped them in
their work. This question was important to determine whether the microgrant project
could be replicated and, if so, what type of support would be needed. The
following are the most often reported services provided by the Healthy
Carolinians partnerships:
- Networking with other nonprofit agencies
- Providing skills on how to leverage microgrants to secure other funds
- Providing resource materials and information (e.g., Internet sites,
funding sources)
- Planning and evaluating projects
- Promoting the project and CBO, using newspapers and radio to increase
visibility
- Increasing awareness about community health issues
- Supporting administrative functions (e.g., completing reporting forms,
purchasing supplies, identifying vendors)
The final reports also provided information about the amount of resources
that each CBO contributed to its own project. The CBOs were asked to indicate
how many of their staff members had participated in the project, how many
volunteers they had recruited, and the approximate number of hours that both
staff members and volunteers contributed. The following was reported:
- 2486 CBO staff members worked on microgrant programs.
- 4409 volunteers were recruited.
- 52,739 hours (estimated) of CBO staff and volunteer time were spent on microgrant programs.
When the 52,739 hours are multiplied by $16.54/hour — the average value of a
volunteer hour according to the nonprofit research group Independent Sector
(12) — the total CBO in-kind labor contribution to the microgrant project is
valued at $872,303, almost a 200% return on the $439,790 awarded in microgrants.
Healthy Carolinians partnership coordinator survey results
Twenty-eight of 32 (88%) Healthy Carolinians coordinators responded to the
survey. Twenty-one of 28 (75%) coordinators indicated that they would want
more time than the 2 months allotted to adequately advertise the funding
opportunity and recruit CBOs to complete an application. When asked about how
the microgrant initiative affected their Healthy Carolinians partnerships, the
coordinators responded as follows:
- 93% (26 of 28) stated that the microgrant project helped to diversify
the partnership’s membership.
- 100% (28 of 28) stated that they had expanded their access to priority
populations within their community.
- 96% (27 of 28) stated that the microgrant project helped their
partnership gain positive community exposure.
- 96% (27 of 28) stated that, given the opportunity, they would like to
participate in another microgrant project.
- 89% (25 of 28) thought that the microgrant toolkit was useful.
- 43% (12 of 28) stated that the proposal reviewers needed
guidance, training, or both to review the CBO proposals.
- 14% (4 of 28) stated that rules about allowable expenses were not clear.
When asked how they helped the CBOs during the funding period, the most
common responses from the Healthy Carolinians coordinators were as follows:
- Linking the CBO with other agencies and resources in the community
- Identifying funding sources to help the CBO continue their projects
- Providing publicity and media exposure
- Helping with project planning and budgeting
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Interpretation
The Healthy Carolinians microgrant project was successful in distributing
small grants of $2010 to 199 CBOs. The CBOs self-selected their initiatives
and designed their own projects. Almost half (43%) addressed the three major
risk behaviors that contribute to chronic disease — physical inactivity,
poor nutrition and overweight, and tobacco use. This finding demonstrates that many
partners already in place at the community level are aware of major health
risk behaviors and are eager to mobilize themselves and their communities to
address these problems. The answer to the question, “Is this an effective,
alternative method to funding community health promotion?” is clearly yes.
With an average of $13,743 for each partnership ($439,790 divided by the 32
Healthy Carolinians partnerships) with an average of six unique projects, this
approach to community health improvement appears to be highly cost-effective.
This is an alternate funding mechanism to states and local public health
agencies to spread limited funds across the community.
The Healthy Carolinians microgrant project was a catalyst for increasing
awareness and mobilizing underused and previously untapped community
resources. These small investments stimulated health promotion and injury
control activities linked to Healthy People 2010 objectives. The small
CBOs were creative with their funds, and many were able to reach pockets of
the community that are priority populations. The skill with which the CBOs
mobilized additional resources — both funds and volunteer help — yielded a
high return on the original modest investment.
The Healthy Carolinians partnerships were perfectly positioned to be grant
makers in their communities by providing the structure and support for
microgrants. In most cases, Healthy Carolinians partnerships and CBOs
continued their relationships after funded programs were completed. The
relationship between the CBOs and the Healthy Carolinians partnerships was
mutually beneficial. Not only did CBOs have access to new funds but the
project managers also learned new skills (e.g., proposal development) and
networked with other CBOs in their community.
The Healthy Carolinians microgrant project demonstrated a cost-effective,
alternative approach to funding health promotion and injury control activities
at the community level. This model was decentralized, and it empowered communities
and CBOs to be responsible for community health improvement. Public health
professionals
with limited funds should seriously consider this alternative approach, which
mobilizes existing community organizations to address national and state
health objectives.
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Acknowledgments
The author thanks the coordinators of the 32 Healthy Carolinians
partnerships whose leadership at the community level made this project
possible. Additionally, the author thanks the staff of the Office of Disease
Prevention and Health Promotion, particularly Sue Martone, for her creativity
and support of this program. The author acknowledges Terry
Foley for her technical assistance in the evaluation phase of the program.
This study was conducted with financial support from the Department of Health
and Human Services, Grant HPU-01002-01-0.
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Author Information
Corresponding Author: Mary Bobbitt-Cooke, MPH, Director, Office of Healthy
Carolinians/Health Education, Division of Public Health, North Carolina
Department of Health and Human Services, 1916 Mail Service Center, Raleigh,
NC 27699-1916. Telephone: 917-707-5150. E-mail: Mary.Bobbitt-Cooke@ncmail.net.
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