Maximizing Funding to Address Health Equity: An Evaluation of the Pacific Hospital Preservation and Development Authority’s Major Grant Decision-Making Process

Abstract

Introduction: With the persistence of health inequities in societies, it is imperative that public health interventions address the social determinants of health to attain the highest level of health for all people. The potential for grantmaking organizations to change systems and promote health equity highlights the importance of evaluating grantmaking processes, which may increase funders’ understanding of their role in addressing the social determinants of health. Purpose: To evaluate and describe the Pacific Hospital Preservation and Development Authority’s (PHPDA) Major Grant decision-making process from 2015 to 2018 and compare characteristics at the agency and program-level for programs that were funded and not funded. Methods: A process evaluation was performed through content review and data abstraction of Major Grant application materials from 2015 to 2018. Results: Over four years, the PHPDA invested over $3.8 million dollars into longstanding, mostly nonprofit agencies to implement various types of programs, which were deeply concentrated toward communities of color. The programs funded by the Major Grant ranged from medical programs that provided direct services to different target populations to outreach and education programs that served as a resource for groups that may have been previously excluded from health-promoting environments as a result of unjust policies. For both funded and not funded applications, the top PHPDA priority area was addressing the cultural, linguistic, economic, and other access barriers to successful utilization of medical and other services. Funded programs were responsive to more PHPDA priority areas and were more likely to have been proposed by agencies that had previously been awarded a PHPDA grant, compared to programs and agencies that were not funded. Across the two groups, there was no difference in the type of program proposed, with both groups having a focus on medical care. Conclusion: The PHPDA established the Major Grant to provide funding to agencies and programs seeking to improve access to health resources for communities and populations in the Puget Sound region. Findings confirmed that the PHPDA’s Major Grant decision-making process emphasized funding agencies and programs aligned with the PHPDA’s funding principles and priorities and mission of promoting health equity. The PHPDA is an example of a grantmaking organization that is “holding truth to power” by exploring the characteristics of their funding decisions. Evaluations are a mechanism for holding funders accountable for their grant awards and should be employed by other foundations and grantmaking organizations. To maximize the benefits of their scarce resources in reducing health inequities, funders must remain informed about their funding portfolios and be accountable to how their investments are or are not in service to the attainment of health equity.