Key Points

The REACH Healthcare Foundation created its Rural Health Initiative to encourage the development of innovative strategies to improve access to health care and reduce health inequities in three rural counties in Missouri and Kansas. The intent was to develop a systematic, sustainable, and coordinated approach to community change that would increase the odds of breaking through the persistent barriers to health care access for the rural poor and medically underserved in these counties.

This article discusses the foundation’s original approach to the initiative and how it adjusted that approach in response to its rural partners’ experiences. It reflects on the challenges encountered in rooting the four conditions and capacities of community change and innovation – supports for implementation; foundational structures; skills and processes; and community engagement – into the work of community health improvement.

The article also describes lessons learned and new roles for funders interested in assisting communities that are seeking to deepen and extend capacity and innovation and forge a new identity.

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