Key Points

Between 2013 and 2019, a Maine Health Access Foundation community-based initiative provided place-based funding to communities to address system gaps and inefficiencies that impede the ability of Maine’s most vulnerable individuals to obtain essential services and supports. To rebalance power between the funder and grantees, the foundation introduced grantmaking practices such as long-term, flexible funding and new ways of relating to and supporting grantees. The theory of change guiding the initiative was that systems change is more effective and sustainable when communities develop cross-sector partnerships and engage community members in planning. The foundation guided the evaluation team to conduct a developmental, participatory, and adaptive approach focused on systems change rather than on individual health outcomes.

This article presents findings and lessons learned from an evaluation and learning process that spanned five of six years of the initiative, describing the context in Maine in 2013, the foundation’s grantmaking strategy, the design of the initiative and its theory of change, the evaluation methodology, and key findings. Those findings support the original theory that partnerships contribute to effective systems change and that community-generated ideas spark innovative interventions in such social determinants of health as social isolation, stigma, and poverty.

Learning from the community-based initiative suggests that changing the power dynamic between funders and grantees can facilitate project success. This article concludes with a discussion of what the foundation learned about shifting power away from the funder and closer to the community, how those lessons have informed its current strategy, and what implications this has for philanthropy more broadly.

Open Access