Cross-Sector Collaboration with an Intermediary Partner
Cross-Sector Collaboration Leverages an Intermediary Partner to Help State Reach All Communities During COVID
The Healthier Together initiative, which started in March 2021, presents a model for how state agencies and philanthropy may work together through an intermediary partner to achieve impact.
Healthier Together was a public-private partnership among the NC Department of Health and Human Services (NCDHHS), NC Counts Coalition, and philanthropies, including the Z. Smith Reynolds Foundation, focused on increasing the COVID-19 vaccination rate among communities of color in North Carolina. Recognizing that people of color were contracting COVID at higher rates following the onset of the pandemic in spring 2020, NCDHHS engaged the the NC Counts Coalition to deploy its network of community-based organization (CBO) partners with experience serving populations that have been historically marginalized and were not being served. NC Counts received both state and philanthropic grants to coordinate the Healthier Together initiative and mobilize its grassroots network to conduct outreach to raise COVID awareness, organize testing and vaccination delivery, and provide other health crisis supports.
What role did each partner play in this partnership?
Angela Bryant, NCDHHS: COVID exposed inequities in the health system resulting in life- threatening outcomes for people of color. NCDHHS was the state’s lead agency in responding to the public crisis. We had experts among our staff—including former NCDHHS Secretary Dr. Mandy Cohen who now leads the Centers for Disease Control (CDC)—and we managed the federal funding the state received. But we needed a tactical and nimble partner to coordinate efforts to engage and educate the community members that have been the most marginalized and were not being served about the vaccine and COVID prevention. NC Counts had an infrastructure, including staff, and a statewide coalition of trusted community-based organizations serving the populations we needed to reach. Our role was to bring all these resources and their expertise together to deploy a bold community engagement strategy.
Stacey Carless, NC Counts Coalition: NC Counts is a 501(c)(3) organization that was established to help prepare North Carolina for the 2020 Census and ensure the participation of communities that have been traditionally undercounted. We engage a network of CBOs who are on-the-ground partners serving these communities and use a regional infrastructure to help them build their capacity to advance equity. With COVID, we recognized the same outreach challenges that we experienced with the Census: the need for trusted messengers, and the need to meet communities where they were. We also recognized that NCDHHS had the funding as well as data, expertise, and resources that we did not have, and that NC Counts had a way to connect with the communities that have been historically marginalized and hardest hit by COVID and a structure for re-granting federal funds to community partners that NCDHHS did not have. I reached out to Jenni Owen, Director of the NC Office of Strategic Partnerships, and she connected me to NCDHHS. That led to discussions about working together to leverage the NC Counts Census infrastructure to help NCDHHS make sure that vaccines were getting into all NC communities. NC Counts became the intermediary between NCDHHS and the community-based partners that created a way for NCDHHS to get funding to CBOs to mobilize them to make sure the communities they served had access to vaccines, testing, experts, prevention information, masks, etc.
“NCDHHS had the funding as well as data, expertise, and resources that we did not have...NC Counts had a way to connect with the communities that have been historically marginalized...and a structure for re-granting federal funds to community partners that NCDHHS did not have NC Counts became the intermediary between NCDHHS and the community- based partners.”
- Stacey Carless, NC Counts Coalition
Sorien Schmidt, Z. Smith Reynolds Foundation: Z. Smith Reynolds (ZSR) Foundation is a private family foundation in Winston-Salem focused on improving the quality of life for all North Carolinians. We are particularly focused on serving communities that have historically been undercounted in the Census and not given the adequate resources needed to ensure that their communities are thriving. At ZSR, we give general operating support, which means that our grants support our partners in carrying out their missions, which are aligned with the goals of Z. Smith Reynolds, and not specific projects. As a private foundation, we can often get money to our grant partners faster than they can normally get it from government, and we give support that grant partners can use however they need to do their work.
ZSR has provided general operating support grants to the NC Counts Coalition for many years. In the early years of the organization, much of their work was focused on the 2020 Census.
When COVID hit, it became clear that the areas of the state that are historically undercounted for the Census were also the areas of the state not getting information about COVID or access to vaccines. Since ZSR had provided NC Counts with funding for general operating support, which is very flexible in nature, NC Counts was able to pivot its efforts from primarily focusing on the Census to primarily focusing on COVID. NC Counts knew what its CBO network partners needed and leveraged its network to conduct COVID outreach in communities with some of the highest need for COVID prevention and response. It had the capacity to apply for government grants and then was able to re-grant those funds to its CBO network members, serving as an intermediary between NCDHHS and the CBOs.
What tips would you offer to colleagues in state government, research, and philanthropy on cross-sector partnerships?
Angela Bryant, NCDHHS: Most importantly, the Healthier Together partnership helped save lives. We were able to get lifesaving treatment and information to communities in an equitable fashion when it mattered the most. NCDHHS’ Health Equity Portfolio oversees a portfolio of work focused on addressing equity and disparities in access, engagement and treatment that had particularly negative impacts during the pandemic. Through Healthier Together, NCDHHS achieved a bi-directional relationship with a network of community partners that we could reach as needed to share new information quickly or get data to track and monitor results and tailor our strategies to eliminate the inequities and disparities we were concerned about. We were also able to help build the capacity of our community partners, giving them some additional clout and authority in their communities because they had the same partnership with the pandemic leaders and experts as the hospitals, health departments and centers, medical society, universities, etc. And since then, we’ve been able to use this model for other statewide work—such as Medicaid expansion and addressing the need for youth behavioral health care—where we need engagement with partners already embedded in their communities.
Stacey Carless, NC Counts: Healthier Together had significant impact on the community-based organizations (CBOs) that were involved in the work. These organizations are trusted messengers and community representatives so having them at the table with NCDHHS from the beginning of the work meant that communities had a voice in planning how the state would work to meet their needs, instead of being brought in at the end for implementation. Also, NC Counts Coalition includes CBOs focused on populations that typically have not had access to government funds, information, and experts as partners. A big challenge we worked through with NCDHHS was how to fold the federal funding that NCDHHS managed with all its red tape and bureaucracy into the NC Counts regranting model to create an equitable process for getting federal monies to CBOs. By the end of the contract, NC Counts regranted over $5.5M in public and philanthropic funding to 75 CBOs, 97 percent of which were led by people of color and had average annual operating budgets less than $300,000. This collaboration got funds to a diverse group of community organizations that had been doing the same work for years without the funding as some of their peers who had the networks to receive more resources. NC Counts Coalition built on the 1.2 million community connections made under the Healthier Together program during COVID outreach to deepen relationships and collaborate with NCDHHS on addressing critical health equity issues. Our work with NCDHHS on behavioral health started with 55 community events that NC Counts and 21 Coalition member organizations hosted in 31 NC counties to engage parents, caregivers, and community members in listening sessions on youth mental health challenges. These sessions, in addition to nearly 3,000 community surveys and assessments from 80 CBOs across 33 counties, highlighted a critical need for mental health services and a gap in trust of government care, driving NC Counts’ efforts to create equitable, community-led solutions. This equitable and inclusive approach to community engagement shows the kind of impact that CBOs can have if government and philanthropy identify and invest in them broadly and fairly as partners.
Sorien Schmidt, Z. Smith Reynolds: NC Counts successfully filled an ecosystem gap by figuring out how to get government dollars into communities, bear some of the burden that public funds carry by simplifying application and reporting processes for community partners, and do the trust building with state government and philanthropy to make it all come together. That's a lot of work. It takes organizational capacity to apply for a government grant, work through the restrictions usually attached to public funds and co-create and implement a fair process for regranting funds to other community partners. The Healthier Together partnership positioned NC Counts to maintain the infrastructure set up for Census outreach and adapt it to do COVID work. That included expanding the regranting program to get state and other government dollars to community-based organizations to do COVID work. This partnership demonstrates how essential it is that philanthropies provide dollars to build and support the infrastructure of community organizations, so the organizations are positioned to approach and apply to state government for funding and figure out a plan for how they can use it.
“This partnership demonstrates how essential it is that philanthropies provide dollars to build and support the infrastructure of community organizations, so the organizations are positioned to approach and apply to state government for funding and figure out a plan for how they can use it.”
-Sorien Schmidt, Z. Smith Reynolds Foundation
What lessons can be gleaned from Healthier Together about how state government, philanthropy, and nonprofit organizations can partners?
Stacey Carless, NC Counts: Trust and transparency are critical to cross-sector partnership. If you're transparent, there's more likely to be trust; when there’s trust you must be transparent. Since nonprofits receive funding from state agencies and philanthropy, the power dynamics can be one-way given contracts and reporting requirements. It becomes less contractual and relational when we are collaborating as partners while respecting that our sectors operate differently and have different capacities. For example, with reporting, government and philanthropy require it and grantees need to provide it; however, reporting should not exceed more than what is needed for reasonable accountability, or what a nonprofit can reasonably provide and still have the capacity to do the work and have the impact in communities that government agencies and philanthropy want nonprofits to have with their resources. State agencies and philanthropy seek nonprofits for a reason, so they need to determine how to trust that we know what we're doing and that we're going to get the job done.
Angela Bryant, NCDHHS: From an agency perspective, one lesson is that effective community engagement requires a paradigm shift in the way that state government thinks about investing money in community partners. Community partners have expertise, and they need to be paid for that expertise. Institutional players traditionally have decided how resources will be used, developed plans, and then sought community partners to implement them. Flipping that script to engage community partners in planning from the start will take ongoing change work. We also learned the kind of impact a coalition model can have. Healthier Together demonstrated the power of partnership. We must build and support cross-sector partnership strategies, such as Healthier Together, to address the big equity issues that we face.
Sorien Schmidt, Z. Smith Reynolds: I would offer a couple of points. First, private philanthropy can be critical to create a partnership between a state agency and nonprofit because 1) it can be faster and more flexible than government if it chooses to be, and 2) private dollars can fill gaps created from restrictions on how government funding can be used. One example of how private philanthropy can help fill a gap with government funding stems from the state’s reimbursement model for distributing grant funds. Few organizations can start and implement a program and wait several months to receive their first government grant dollar after filing all their invoices.
But a nonprofit partner needs to be able to articulate four things to a potential philanthropic partner: 1) a government funding opportunity is available; 2) the way that government funding would meet a community’s need, and preferably, the nonprofit is in conversation with the government agency as it is trying to figure out how to spend that money to meet those needs;
3) the plan for how philanthropic funds will be used to meet the need; and 4) that the nonprofit has engaged other nonprofit and state government experts with experience in cross- sector partnerships to learn about public funding restrictions and implications for using philanthropic funds to fill those gaps
Second, what NC Counts has created does not happen overnight. Healthier Together was not NC Counts’ original vision, but Stacey clearly had developed relationships with government and philanthropy for those sectors to recognize that NC Counts had the capacity to work with state government to help address local needs. Communication and trust are massively important in developing all these relationships.