Accessing care: Tackling immediate needs

Click here to view a general explanation of Tackling Immediate Needs

Many donors place a high priority on meeting the immediate needs of low-income communities by helping individuals access primary health care services. 

In most communities, certain populations experience significant barriers to care, financial or otherwise.  These populations may include the homeless, children and youth, and immigrants. 

Sustaining and expanding the delivery of health care services.  If you are interested in improving access to health care services, helping to sustain or expand delivery of services by safety net providers, including community health centers and other nonprofit providers.  These providers piece together operating budgets through an array of public and private sources.  Rarely, however, are these sources sufficient to cover actual costs or meet the true magnitude of need. 

Some services, like dental care or health education, are chronically under funded.  Private investment can make a huge difference in these programs.

In San Pablo, California, for example, the Brookside Community Health Center operates a dental clinic for both children and adults.  Prior to the opening of the clinic, the dental needs of low-income residents went largely unmet.  Once the doors opened, priority was given to emergency cases.  With an infusement private funds, the clinic was able to expand its services, to provide preventative care for patients, both young and old. Helping patients learn the importance of good nutrition, regular brushing, flossing, and screenings meant fewer emergency visit--and ultimately saved public funds that had been earmarked for emergency cases. 

Connecting “hard-to-reach" populations to services.  Supporting efforts to connect vulnerable populations to services is another way to enhance access to care.  Mobile clinics are one successful means of taking medical care to “hard-to-reach” patients such as the homeless, migrant workers, or isolated seniors.  Salud Family Health Centers, serving northeastern and north central Colorado, offers comprehensive services to migrant and seasonal farmworkers and their families through a mobile health unit.   

In many immigrant communities, new residents are often unfamiliar with available services and have difficulty navigating through complex systems.  Community-based organizations play a role by connecting bilingual, long-term residents with new immigrants from the same country to help them access available programs and services.  Supporting these “navigators” is an especially effective strategy for increasing access to care.    

Tapping the power of volunteers.  In many communities, volunteer health professionals have banded together to try to meet the critical need for basic health services. 

RotaCare Free Clinics is a national organization that operates weekly clinics around the San Francisco Bay Area, Seattle, Washington, and New York State.  RotaCare is a coalition of over 1,500 Rotarians, physicians, nurses, pharmacists, social workers, interpreters and other volunteers who provide free medical care to underserved populations.  Through collaborative efforts with hospitals, clinics, community and social service organizations and service groups, RotaCare provides an excellent example of local volunteers making a significant cumulative difference.

Expanding insurance coverage.  Among low-income populations, there are a significant percentage of both adults and children who are eligible for government-sponsored insurance programs, such as Medicaid or the State Children's Health Insurance Program (S-CHIP), but not enrolled.  In fact, Medicaid-eligible children account for up to a quarter of all uninsured children.

Barriers to enrollment are numerous:  lack of information about the programs, literacy or language issues, lack of time, complex administrative hurdles, fear over how enrollment may impact immigration status, and stigma. 

Many states and local communities have launched outreach and enrollment efforts targeting children and adults. Community-based organizations play a key role in these efforts by informing and assisting community residents, in a culturally and linguistically appropriate manner, to enroll in programs for which they might be eligible.

For example, community enrollment specialists will help determine program eligibility, fill out the application, gather the required documents and ensure that applicants become enrolled. They can also explain how the program works, help applicants choose a health plan and even select a doctor.

Sign Up Now is an initiative created by the member organizations of the Virginia Coalition for Children's Health.  Sign Up Now is a statewide outreach project that includes agency and community-based organization representatives from the City of Richmond and several counties.  It aims to be a resource to community-based organizations, as they help the families of eligible children enroll in and benefit from Virginia's health insurance programs for children.  Sign Up Now also helps groups to learn about and stay abreast of insurance program rules and regulations and learn about best practices by providing information, training and technical assistance.

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Before you give...  Giving to programs that directly serve low-income populations in need of health care can have a dramatic impact on community well-being. 

Questions to consider before you give:

1. Are there particular kinds of people you want to help access health care?  What types of assistance are you most interested in supporting?  
2. What local programs come closest to meeting those needs?
3. Do you have a clear sense of how your support will be used?  
4. What specific activities fall into the group's direct service?
5. Are former or current consumers of the services asked for input and to help design services? 
6. Does the group have any methods for seeking consumer feedback?
7. How does the group define success? Is this in keeping with your notion of success?
8. How many individuals/families are served on a monthly, annual basis? 
9. What are the costs of services?  Are costs in line with your expectations or conversely, do figures seem low in light of the group's goals?
10. What percentage of the group's budget is spent on operations, program delivery, fundraising?  Does the division seem appropriate to you?
11. What is the group's reputation with other funders?  Other nonprofits?
12. How does the group raise funds? Is there a long-term strategy for support? 
13. Does the group work with other groups or government programs serving the same constituency? If so, how? If not, why not?
14. Does the group's board mirror the diversity of the community?
15. Does the board actively take part in fundraising or mission-oriented activities? 
16. Does the group have a range of donors - local individuals, government, foundations, etc?
17. Does the group have a strong volunteer base?
18. In addition to grant money, are there other ways you can assist the group in  meeting their goals?

You may find some questions irrelevant or have a few questions of your own, not listed here. This list is not meant to be exhaustive. 

Try using the questions as a springboard for lively and respectful conversation between you and a potential grantee. Or as a way of discussing a grant proposal with your fellow trustees, your family or other board members.

Related Reading

Other Ways to Take Action in Accessing care

• 2010 Health Care Reform: SmartLink Breaks It Down

  As a donor, you may be wondering how health care reform will affect individuals and families served by nonprofit health care providers, as well its impact on nonprofit organizations themselves. SmartLink has developed an overview of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act. Consider this summary a starting point. Over time, we will learn much more about how donors and communities can influence the health care for low-income communities.

• A FEW WORDS WITH Atum Azzahir

• Advocating for change

• Developing new programs

• Organizing for change

• Strengthening community groups