Sustainability is neither accidental nor last-minute. It requires thoughtful, purposeful, and timely planning.
Sustainability can be defined as initiatives that continue because they are valued and draw support and resources. Sustainability does not necessarily mean that collaboratives, programs, or activities continue in the same form as originally conceived, funded, or implemented. Rather, initiatives often evolve over time to adjust to the changing levels of support and needs of the community. Organizations or collaboratives may start with one approach, but end up sustaining a different model after testing it in the community. This vision for sustainability includes being responsive to a changing environment and flexible to adapt to new opportunities.
Sustainability extends beyond just financial resources to continue. Sustained impact may not even be dependent on the continuation of a program or initiative. These impacts could include changes in the way that agencies or organizations work together to serve community members or in local capacity; cultural shifts and practice changes; changes in knowledge, attitudes, and practices of community members and providers; and policy changes.
What Does It Take to Be Sustainable?
For more than 20 years, the Georgia Health Policy Center has been studying what it takes for programs and collaboratives to be sustainable. Most recently, through an assessment of Federal Office of Rural Health Policy grantees, the center determined that the “DNA” of sustainability is less about fixed traits and more about adaptive behaviors.
Programs most likely to sustain shared certain behavioral and strategic characteristics, including:
- Leadership: Sustainability-associated leadership includes someone with a very clear, strategic purpose and who will make commitments to provide resources (e.g., human, funding, or policy) to sustain the effort.
- Collaboration: A driver of sustainability is recognition that this work cannot be done well and sustained by one organization alone and that all partners are clear on the purpose of the program, its connection to their own organizational missions, and share responsibility and risk during and after the initial period.
- Alignment Between Need and Demand: Sustained initiatives have a “local” orientation and are close to the community served. This builds programs that are right-sized and well-received within the community.
- Data Demonstrates Impact: Data can tell the story of program impact and drives sustainability by providing evidence to garner resources to continue to support the program.
- Attuned to Policy and Context: Some leaders and collaboratives are especially gifted at “reading the policy context tea leaves” and can position their initiative to succeed in the current policy environment.
What Does This Mean For Local Wellness Funds?
Given the scant number of wellness funds and the fact that most have been established recently, there is little evidence directly of factors affecting sustainability of local wellness funds. Over time, the sustainability of two of the nation’s largest wellness funds, the federal Prevention and Public Health Fund and the Massachusetts Prevention and Wellness Trust Fund, due to waning appropriations, has become increasingly fragile. Yet, many of the elements recognized to be crucial to sustainability generally, are in the control of local wellness funds.
Local wellness funds want to ensure their efforts are creating positive change in the community they serve and those providing resources to the local wellness funds (e.g., philanthropy, government, etc.) want to ensure their investments are creating sustained value.
Long-term sustainability is possible with effective planning beginning in the early, initial design phase of a new initiative. Some actions local wellness funds can take include:
The local context undoubtedly impacts sustainability, but there are some tools that local wellness funds to begin thinking about long-term sustainability from the beginning of their efforts.
Establishing a Local Wellness Fund: Early Lessons from the California Accountable Communities for Health Initiative
This brief, by the California Accountable Communities for Health Initiative, documents early insights on critical dimensions of wellness fund development, including governance, funding sources, and administrative models and key capacities. CACHI sees wellness funds as a way to unlock new partnerships and strategies for sustainably addressing complex health and health equity priorities. These insights may help local wellness funds address sustainability in their own local context.
Sustainable Funding for Healthy Communities Local Health Trusts: Structures to Support Local Coordination of Funds
This summary, provided by Trust for America’s Health, was the result of convening focused on how to financially sustain community health improvement efforts. The key takeaways include suggestions for what needs to happen at the community level and policy recommendations to facilitate the coordination of various funding streams to drive outcomes and sustain population health initiatives over time. These strategies may assist local wellness funds in designing or assessing their structure for long-term sustainability.