This article was co-authored by Jennie Riley (Executive Director, Rx Foundation), Megan Cook (Manager of Programs and Operations, Rx Foundation) and Ms. Cynthia J. Finch (President and Founder, New Direction Health Care Solutions). It originally appeared in Grantmakers in Health’s Views from the Field on April 25, 2023.
The Rx Foundation launched a rapid response Vaccine Equity grant program in March 2021 as it became clear that communities had unequal access to newly available COVID-19 vaccines (ASPE 2021). The goal was to fund organizations that were positioned to improve access to vaccines for groups marginalized by or unable to access existing systems and to do outreach and have conversations with people about their vaccine concerns and questions. The Foundation relied on its existing network of grant partners to help identify leaders and organizations that were doing this critical work and directed grants of $25,000 each to 14 Black, Latinx, and immigrant-led organizations in nine states. New Direction Health Care Solutions (NDHCS) in Knoxville, TN, with a focus on health disparities in rural communities of color, is one such partner, and we collectively believe that the following lessons should guide the field in current and future crises.
Relationships and Trusted Messengers Are Essential
Rx Foundation is a limited asset funder with a small staff. Activating an existing network of trusted grant recipient partners and asking them to recommend organizations with an established presence in communities with unmet COVID-19 vaccination needs made it possible to forge connections with organizations that likely would not have happened through a traditional RFP. These Vaccine Equity grants reached community-based organizations with deep roots and trust in neighborhoods without pharmacies or clinics, urban cities, rural counties, faith-based networks, and immigrant communities.
Relationships were also the most important factor in developing a COVID-19 vaccine movement in predominantly Black neighborhoods and communities in East Knoxville and surrounding rural counties. Between hosting vaccine events and keeping a list of names in a notebook, NDHCS leadership estimates that they have so far helped more than 100,000 people get vaccinated. They created the VACImpact initiative to inform, engage, and build trust in communities of color regarding the COVID-19 vaccine. Their vaccine clinic and community health events were well attended and successful, and NDHCS strongly believes that members of the community seeing teams of nurses and doctors in white coats who looked like them contributed to this success.
Furthermore, NDHCS helped other hospitals, organizations, and agencies establish relationships, building trust and a physical presence, in communities where previously there was very little connection. Examples include the Chief Medical Officer and a team of nurses from East Tennessee Children’s Hospital participating in a Mega Vaccine Clinic hosted by NDHCS in the predominantly Black neighborhoods of Knoxville, and a new partnership with the UT Medical Center to bring mammogram buses to an NDHCS-hosted free clinic.
NDHCS’ pandemic response also demonstrated the value of collaborating with the faith community to expand the reach of trusted messengers. Early in 2020, NDHCS established a weekly Faith Leaders Initiative conference call of 40 local churches and invited medical experts including Dr. Keith Gray, Chief Medical Officer of the University of Tennessee Medical Center, and Dr. Lisa Fitzpatrick of Grapevine Health to speak with faith leaders about health and safety issues. These meetings created a flow of accurate data and information between local health officials and the community and supported local faith leaders in figuring out what actions to take and to recommend. This group still meets regularly in 2023.
Be Thoughtful, Intentional, and Flexible
The Rx Foundation created a largely conversation-based process for Vaccine Equity applications and reporting that minimized the paperwork burden on organizations and maximized the flexibility with which they could utilize grant funds.1 This reduced the barrier for organizations without dedicated development staff, and an unanticipated bonus for the Foundation was developing deeper relationships with grant recipients and building a greater understanding of their reality on the ground. This led to a second round of grants to the same cohort in 2022, designated Vaccine Plus: Community Health and Power in recognition of the ongoing holistic work to meet a spectrum of health and social needs that included the COVID-19 response.
The flexibility of this funding made it possible for organizations to respond nimbly to evolving needs and gaps in their communities. Many used Rx Foundation funds to host outdoor community events that included onsite vaccination, other health education and screening, healthy food, and a fun and safe way for people to come together. Whereas other funding sources sometimes worked on a reimbursement model or prohibited spending to rent tents for pop-up clinics or purchase gift cards as vaccine incentives, the Rx Foundation provided upfront funding and trusted organizations to know best what was needed to maximize their outreach and engagement in the community.
NDHCS began working in East Knoxville in 2017, and systemic barriers like requiring a certain number of years of existence or a specific grants management infrastructure have sometimes prevented this demonstrably effective organization from qualifying for grant funding. They used Rx Foundation grant funds to host and partner with numerous organizations on events to educate on and facilitate access to vaccinations, and multi-year funding made it possible for NDHCS to expand their reach to Latino communities and rural communities further outside of Knoxville, as well as supporting learning and redesign along the way.
Funding Community-led Organizations and Trusted Messengers Advances Long-Term Health Equity Goals
Though Vaccine Equity grants were set up to respond to urgent needs, grant recipient partners including NDHCS, El Centro in Kansas, and La Casita Center in Kentucky report that they see a shift toward more practical applications of health equity more broadly in their communities. This includes new equity-focused staff at organizations and agencies and health equity task forces and coalitions that are persisting and expanding their areas of focus. The community-based and community-led organizations who received Vaccine Equity grants demonstrated the importance of having trusted community voices at these tables, and continued funding for these trusted messengers will be critical to ensuring that we maintain momentum for action on health equity and justice.
In part due to their active pandemic response, NDHCS built a reputation and trust in the community that makes them sought after for input and partnership by local government, schools, businesses, hospitals, and the faith community. Recent examples include invitations to provide vaccines at events hosted by the Knoxville-Knox County Community Action Committee and Centro Hispano, a nonprofit serving the Latino population in East Tennessee. NDHCS continues to play a role in creating connections between communities and those in control of resources and have found that systems are now more aware of the need to be inclusive to address inequity. They are deeply committed to advancing health equity in rural communities of color and to capturing the hard-won lessons of the COVID-19 pandemic. To this end, they are working to establish the New Direction Health Equity Institute to design and lead community-driven research contributing to health equity, inclusion, and access for all.
The Road Ahead
The Rx Foundation partnership with New Direction Health Care Solutions is one powerful example of the opportunities that were created by the Vaccine Equity and Vaccine Plus grants. These directed resources to trusted and effective messengers in communities that faced significant barriers to accessing COVID-19 vaccines and related funding and created an opening for a more trust-based grants process that yielded benefits both for community-based organizations and for the Foundation. The Rx Foundation intends to carry forward and apply these lessons to our funding practices more broadly, and we invite you to read more about this partnership and connect with us about your own lessons.
Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services. “Disparities in COVID-19 Vaccination Rates across Racial and Ethnic Minority Groups in the United States.” April 2021.
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