1993
Public Health Service
Primary Care Policy Fellowship

"Community-Provider Partnerships"

Reni Courtney, R.N., C.F.N.P., Ph.D.
Associate Professor of Nursing
University of Texas at Arlington

Kevin Hardwick, D.D.S., M.P.H.
Associate Deputy Director, Office of Science and Epidemiology
Bureau of Health Resources Development
Rockville, Maryland

Maureen A. Kelley, C.N.M., Ph.D.
Assistant Professor and Program Director
Nurse-Midwifery Education Program
Nell Hodgson Woodruff School of Nursing
Emory University

Evan Kligman, M.D., F.A.A.F.P.
Associate Professor and Head
Department of Family & Community Medicine
University of Arizona

Gail Povar, M.D., M.P.H.
Professor and Associate Chair
Department of Health Care Sciences
George Washington University Medical Center

Ivan C. A. Walks, M.D.
Psychiatrist
Integrated Health Resources
Los Angeles, California

C. Edwin Webb, Pharm.D., M.P.H.
Director, Government Affairs and Health Policy
American Association of Colleges of Pharmacy

Community-Provider Partnerships

We believe that community/provider partnerships must be a fundamental element in evolving health care systems. Current discussions of health care reform have recognized the need for improved primary health care. In addition, policy makers acknowledge that patients and communities must play active roles in that care. However, few existing health care organizations engage in a truly participatory model with their communities to identify needs and to implement change.

Functional community-provider partnerships, exemplified by many Community Health Centers, are essential, for such partnerships can lead to a more effective and responsive system of primary health care. Not only do partnerships present the opportunity to truly identify the needs of a community and to create programs that address those needs, but it has been demonstrated that extensive community involvement in all stages of planning and execution, in and of itself, contributes to improved community health.

Such partnerships are characterized by and depend upon SHARED P.O.W.E.R.

Planning

• Community members and health professionals learn from each other about their values, cultures, and capacities.
• Community members and health professionals work with each other to identify the needs and resources of the community.

Organization

• Governance structures having policy-making and fiduciary responsibilities should exhibit broadly balanced representation of community members and health professionals.
• Community members and health professionals share in the establishment of programmatic goals, priorities, and desired outcomes.

Work

• Community members and health professionals share involvement in implementation of services, including training and participation of community members in outreach, administration, and services delivery.

Evaluation

• Community members and health professionals participate in a continuous process of assessment and interventions to assure expected goals and outcomes.

Responsibility

• Community members and health professionals share responsibility for effectiveness. When programs fail to meet expected goals and outcomes, both community members and health professionals contribute to improving the processes of health care.

Community-provider partnerships based on these concepts of shared P.O.W.E.R. should play a role in the foil range of primary health care activities. We believe that the Department of Health and Human Services can play a pivotal role in achieving this goal. We would like to propose the following specific policy initiatives.

1. Establish funding incentives to encourage models in which fiduciary responsibility rests with shared community-professional governance structures.

   Example: The Kellogg Foundation insists on shared community/provider boards in its project on community-based academic health centers. Community Health Centers have historically operated under community boards. In addition, the recently developed Community Health Council represents a collaboration of the community and the local health department.

2. Make funding available to communities to use for the development of the skills and knowledge they require to participate effectively in these partnerships.

   Example: Jimmy Carter’s Atlanta Project is one initiative of this sort. Private Corporations support the skill development of community-identified leaders. In a somewhat different model, the CISS program in HRSA’s Maternal and Child Health Bureau is a community-federal agency partnership designed to enhance the development of service systems at the community level in order to assist communities to better meet their self-identified needs.

3. Assign funding preferences and priorities for health professionals education programs providing formal training in community relations, large and small group interaction, community outreach, and the concepts and processes of needs assessment, including epidemiology, ethnography and other quantitative and qualitative methods.

   Example: Current PHS programs use this mechanism to encourage curricular reforms in such areas as quality assurance and AIDS.

4. Fund NON-CATEGORICAL Projects to develop and study models of community-provider partnerships charged with comprehensive primary health care.

   Example: Community Health Centers have historically prodded a broad range of services. Both the Atlanta and Los Angeles projects noted above are examples of non-categorical programs. And finally, although categorical, HRSA’s Ryan White provides another model of community-provider partnerships working on delivery of a broad range of services, albeit in this case limited to addressing HIV infection.

   Non-categorical funding projects will encourage local health departments to work to tailor programs to their communities’ needs, rather than to regulatory requirements.

5. Evaluate HHS funded programs on the basis of community-specific goals and objectives developed collaboratively by local partnerships and the federal agency.

Example: We are proposing a uniformly administered, formal collaboration and joint articulation of objectives between the partnerships and the federal representative. Again, the goal is to promote flexibility in the development of evaluations, and to move away from more rigid bureaucratically established criteria.

In conclusion, the Department of Health and Human Services has at its disposal a variety of policy options to further the generalized adoption of community-provider partnerships. We believe that such arrangements should no longer be isolated phenomena found in a patchwork of private and public programs. Instead, community-provider partnerships should be the cornerstone of primary health care throughout the United States.

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