Community projects (health)

Across Canada, thousands of projects have improved individual and sometimes community health.  Typically, they are relatively small in scale and scope, but result in significant benefits to participants.  Some are better designed than others, and that shows up in the results.  They are led by community organizations, with support usually from the state, private foundations and sometimes local businesses. They come in many forms - pre-natal nutrition, community gardens, box schemes, counseling and advocacy, community food infrastructure, school food, community kitchens, food hubs and centres, community markets - and most struggle to be effective .  But over the last 25 years, we've learned alot about what makes them successful (Sante et Services Sociaux Quebec, 2008; BC Provincial Health Services Authority, 2008; Evaluation of the Canada Pre-natal Nutrition Program, 2004-09).  The challenge now is to scale them up and out (Johnston and Baker, 2005).

These projects face many challenges:

  • identifying the core problems to be addressed; many projects are designed around the periphery of the challenge rather than its central elements
  • designing for the population most in need, including their specific cultural and socio-economic circumstances; often projects focus on those that they can reach and that isn't necessarily those most in need
  • accessing the most pertinent research on the problem and the solutions; many projects are designed without a thorough review of experiences elsewhere
  • constructing the most effective design given the resources; resource constraints frequently constrain project construction and implementation
  • engaging the target audience during the design phase; beneficiaries are sometimes excluded from the design phase and there is no clear evaluative scheme
  • getting community buy-in; if the initiative requires changes to community processes and infrastructure, discussion doesn't always happen in advance
  • finding appropriate partners; too many organizations try to "go it alone" when collaboration is required, especially important when attempting to reach vulnerable and highly at risk groups
  • securing long term funding; most projects are forced to rely on intermittent grants
  • monitoring individual and community health impacts as part of continuous improvement; few have the skills and resources to carry this out effectively which means programs are often stagnant in the face of elements that don't function that well.

While all these elements are significant, inadequate resources is a theme affecting most of them.  Although there are some longer-term funding successes, such as the Canada Pre-natal Nutrition Program, there's an urgent need to reduce reliance on government and foundation grants to offer such programs.  They can be supplemental but not core to project operations, as they have been for much of the last 30 years.  They can help with testing new ideas but should not be the basis for long term initiatives that are effective.  Like any relationship, both parties are responsible for the failures of the NGO - granting cycle and the grey literature is full of the accounts of such failures. More secure funding creates the possibility of higher skills and capacity within  organizations to run effective operations.

What's to be done to create more sustainable funding for these initiatives?  There appear to be three primary options:

1. Public contracts for important service delivery, both established and new promising programming.  Most food system community projects are providing either community health, employment or environmental benefits, and often combinations of the three. Such benefits may reduce long term government expenditures on health care and environmental protection and NGOs can often be more skilled at delivering than governments. Rather than grants, governments should let 5-year renewable (based on performance) contracts to deliver these services.  Government and NGOs have to agree on project/program design and the measures that will help determine effectiveness, with room for adjustments as the project unfolds.  Governments have a long history of contracting with third party organizations to provide services that are better delivered by others, so this is consistent with that approach.  The key policy shift is acknowledging the limitation of the granting (contribution agreement) approach.

2. Mixed social entrepreneurship - public, foundations, market and individual donors.  Many food NGOs have been moving in this direction, because of the problems of relying on government and foundation grants.  It works when the project has both market and non-market dimensions, often the case with food initiatives, and when the primary target is people who are not acutely income marginalized.  Typically, the initiative generates some revenue from food sales, but usually at below market prices.  Anecdotally, a few organizations taking this approach report that they can generate up to 30% of their budget from market sources.  If the organization has a donor base, it can be also help with revenue diversification.  One of the challenges though is the legal status of the organization, especially its purposes and charitable status.  Administered by the Canada Revenue Agency, under the authority of the Income Tax Act (s.149.1), this mixed model  challenges long-standing ideas about how charities work, where their revenue comes from, and to what charitable activities that revenue is dispersed.  Since section 149.1 does not address specifically this model, there are on-going questions about what activities might violate charitable status.  Given that 149.1 has specific sections for specific charitable structures, it makes sense to amend the section to accommodate this model.

3. Social impact bonds (SIB). This is a new approach to public - private - NGO partnerships that so far has limited uptake and remains controversial, but could have application at the Efficiency stage of food system change.  In this model, private investors finance a project that is designed to deliver certain social benefits.  The benefits must be specified and if they are achieved, a government agrees to pay the investors a specified return.  At some point, again if the targets are achieved, the government also returns to the investors the original investment.  Alternately, the money could be rolled over for a new phase of the same initiative and another return on investment percentage agreed to with targets met.  This model could be useful under the following conditions:

  • there is a clear link between the food intervention and improved health outcomes for specified populations;
  • data exist and can be collected to support evaluation of performance;
  • success is readily definable;
  • non-governmental actors are more skilled at design and delivery than government;
  • the governance of the project does not permit private investors to pressure those doing program delivery to target groups with high likelihood of positive outcomes at the expense of those with more challenging circumstances.

This is obviously a narrow range of circumstances, and probably only applies at this stage of transition since Substitution and Redesign stage initiatives, by definition, are more complex to implement and often without such direct relationships between action and outcome.