In 2021, the Health Team refreshed our program strategies to include a focus on Community Health Ecosystems that endeavors to reach beyond health infrastructure improvements to simultaneously support the people, relationships, institutional practices and environments that ensure safe and holistic systems of care. Anchored by our longstanding Emerging Leaders in Public Health program for local public health professionals, and a new partnership with Human Impact Partners, our aim is to shift community power and health institution accountability, support diverse and robust health workforce pipelines and infrastructure, and expand community-centered health programs.

With this focus, we want to make explicit the critical contributions that communities—residents, leaders and organizations—make to strengthen and sustain systems of care. Community and health institution partnerships are critical to this work because they enable us to complement our grantmaking with investments, communication resources and convenings intended to help sustain local health ecosystems where communities are safe, served and healthy.

Recognizing both the centrality of partnerships to our work, and our limited view of community health ecosystems across U.S. cities, we decided to release a Request for Information (RFI) in 2022 to help shape this new focus area.

Bright Spots
We announced the RFI to experiment with an alternative way of learning from the field through ideas and examples that would help us think critically about how to strengthen and leverage our partnerships, center community priorities and further develop our Community Health Ecosystems focus area. Rather than a request for funding proposals, the RFI was a call for information that could guide how we could support communities in addressing the social needs and structural barriers that impede community well-being and coordinated systems of care. Our priority was to learn from field practitioners using different approaches and collaborations at various stages of development that might not otherwise be connected to the Health program.

We received submissions from organizations in 12 states and the District of Columbia. Several described their use of partnerships to actualize their goals, as well as how they used medical-legal education, coalition building and organizing, policy advocacy, workforce development, data use and stewardship, and community-centered care models to advance equitable community health ecosystems.

From the RFI we learned about some of the ways that communities and collaboratives across the country were acknowledging and prioritizing social and structural determinants of health. We were reminded that community voices need to be centered, uplifted and compensated to achieve trust and effect change. And we considered how the RFI process, including its structure and the terminology we used, may have hindered the range and depth of work described though the submissions.

Yet from the varied and seemingly disparate responses, important themes emerged.

Partnerships and Areas to Explore
First, the submissions helped us identify additional partnerships and issue areas to explore as we build out our Community Health Ecosystems focus area. In addition to strengthening our partnerships with federally qualified health centers and community clinics, governmental public health departments and community-based organizations, we can explore partnerships with non-traditional community-based health professionals (e.g., violence prevention professionals, doulas), recovery community organizations, and allied health practitioners as thought partners.  We realized that a diversity of partners—thought leaders, trainers, technical assistance providers and grant-funded partners—can help expand our view of core issues.  For example, our work to support health workforce pipelines and infrastructure can consider data interoperability and technical solutions as well as diverse health professions education and training models.

Expanding Our Reach
Second, the examples described in the RFI submissions motivated us to consider how to intentionally expand the geographic reach of our work beyond our focus cities. We can, for example, align our local, regional and national approaches according to our Community Health Ecosystem strategies and the established priorities of current and prospective partners in those geographies. Importantly, the submissions reminded us how vital it is to make our focus on population health explicit, in part, through efforts to improve the conditions that adversely and disproportionately affect the health of Black, Brown and Indigenous children, young people, and families. In addition to our grantmaking, we can strategically deploy our convening, communications and organizational relationships through a more focused geographic and population approach.

Learning and Evaluation
Third, the RFI provided us with a wide range of impact outcomes and progress indicators to consider as we develop the Community Health Ecosystems learning and evaluation priorities. While necessarily context-specific, the success measures and lessons learned that were shared included different multi-level approaches, systems change and funding considerations. Policy wins, new programs, quality of care, transformational resource access, frequency and quality of community co-creation efforts, sustained health workforce pipelines and resident engagement were some examples of the progress indicators used by the organizations and collaboratives that responded.

New Directions, Future Opportunities
In addition to providing new directions to help guide our development of this focus area, the RFI also enabled us to reflect on process improvements for future information gathering activities. Some of the key insights and future opportunities surfaced during our team discussions included:

• Acknowledging the barriers to participation and identifying resources to minimize these barriers.
• Expanding outreach to partners to assist with RFI dissemination.
• Partnering with organizations and conferences that target young adults.
• Providing ways for groups to include anecdotal experiences, including through listening sessions.
• Clarifying our asks of organizations to get further into the “how” rather than the “what”.
• Conducting outreach to gather information from newer and BIPOC-led organizations that may have limited capacity to respond relative to their more established counterparts.
• Prioritizing targeted outreach in specific geographic areas including the Pacific Northwest, Midwest, and majority of the Southern U.S.
• Engaging in more intentional goal setting that emphasizes the type of information needed versus what already exists.

With these insights, examples and ideas we intend to engage in more focused information gathering activities that will help us refine our Community Health Ecosystems strategies, expand our partnerships, and inform how we decide to allocate our resources.