Evaluation of Foundation for a Healthy Kentucky's 6-year public-policy initiative offers lessons for other health philanthropies

An independent evaluation of a six-year Foundation for a Healthy Kentucky initiative offered some useful lessons that can be applied to other philanthropic organizations that work on population health, the foundation said in a news release.

The study, conducted by the Center for Community Health and Evaluation, looked at the foundation's $7 million "Promoting Responsive Health Policy" initiative, which focused on ensuring a smooth implementation of the Patient Protection and Affordable Care Act and passing a statewide smoke-free law. The initiative began in 2012.

"Intervening state and federal elections shifted the political environment and state legislative priorities," the study report said. "The new governor proposed significant changes in how the ACA would work in Kentucky and it became clear that a statewide smoke-free law was far less likely to pass by the end of the initiative," says the release. Republican Gov. Matt Bevin, elected in 2015 to succeed Democrat Steve Beshear, has said smoking bans are a local issue.

The foundation's initiative also focused on improving children's health and strengthening local public health. The evaluation thoroughly examined how the foundation addressed each of its priorities, evaluated its interactions with its grantees, and issued a report that includes lessons to inform the field of health philanthropy. They include:

• Clearly identify policy priorities and understand the trade-offs between specific and broad policy goals. Too broad a goal may limit impact because it spreads resources too thin and makes it hard to develop a "fully cohesive grantee cohort."
• Make your role as funder clear. Ensure that everyone involved in your organization understands their role in advancing policy.
• Build flexibility into the grant structure. Consider a variety of grant strategies to inform and influence policy at multiple levels, allowing for some flexibility to allow grantees to respond to changes in the political environment.
• Build awareness of the broad spectrum of strategies needed. Use a developmental evaluation tool to identify and map your strategy. "The foundation's initiative included grants to advocacy organizations, as well as to nonprofit media outlets to increase coverage of health policy issues; other strategies included targeted research on the impact of policy changes and convenings that brought together diverse groups to align their goals," says the release.
• Consider long-term grants to build capacity. "The foundation gave one-year grants renewable for up to five years, and allowed mid-year adjustments, to enable grantees to build their own infrastructure and skills so they could be more effective, both during the grant period and beyond," says the release.

Under the initiative, the foundation provided grants to: Kentucky Voices for Health, an umbrella group of organizations supporting federal and state health reform; the Kentucky Equal Justice Center; the Kentucky Center for Smoke-free Policy at the University of Kentucky College of Nursing; the Kentucky Population Health Institute; Kentucky Youth Advocates; Louisville Public Media; Kentucky Educational Television; Kentucky News Connection, part of the Public News Service; and the UK School of Journalism and Media's Institute for Rural Journalism and Community Issues, to publish Kentucky Health News.

In addition, the foundation commissioned a study assessing the implementation of the ACA in Kentucky. The cost of the initiative, including grants, staff support, programs, conferences, training and research, totaled $7,035,101. Click here for a copy of the report.