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The California Endowment Clinic Consortia Policy and Advocacy Program Evaluation














Annette L Gardner, PhD, Sara Geierstanger, MPH, Claire Brindis, DrPH and a team of UCSF researchers conducted an eight-year, multi-site evaluation of an initiative to expand clinic consortia advocacy capacity. As part of its commitment to increasing access to high quality and affordable health care for underserved Californians, The California Endowment provided funding to 15 California local and regional community clinic associations and four statewide clinic organizations in order to increase the collective infuence of community health centers. These articles, issue briefs, case studies, and reports describe clinic consortia advocacy strategies and policy gains to strengthen California’s safety net and increase access to care for medically underserved Californians.


'Expanding Organizational Advocacy Capacity: Reflections from the Field' (Foundation Review, 2010). 

Gardner, Geierstanger, Nascimento, and Brindis share findings from the 9-year evaluation and conclude that building organizational advocacy capacity can be done effectively, resulting in a significant return on investment. With this new work by Gardner et al, funders now have a pathway from building grantee capacity, through analyzing policy targets, to evaluating results.


Gardner A, Geierstanger S, Brindis CD, McConnel C. 'Clinic Consortia Media Advocacy Capacity: Partnering With the Media and Increasing Policymaker Awareness.' Journal of Health Communication 15:293-306, 2010.


Evaluation Executive Summary 
This Summary describes the Program evaluation results for the years 2004-2006.The evaluation focused on the program outcomes by the grantee population as a whole, including sustaining key programs and policies benefiting clinics and their target populations.


Moving Beyond Traditional Allies: Building and Sustaining Partnerships

This Brief describes how clinic consortia developed and strengthened partnerships with their traditional allies in the community health center arena and with diverse health and non-health organizations. Grantees were successful despite several challenges, including limited organizational capacity and differences in priorities among partners. Partnerships are especially important as organizations establish themselves as players in new local, state, and federal policy arenas, and they ultimately result in benefits to underserved populations.

Strengthening California’s Health Care Safety Net to Meet the Needs of the Medically Underserved 

This Brief describes the findings from an analysis of 17 clinic consortia initiatives that achieved longer-term outcomes, including increased services for the underserved and uninsured and improved health outcomes for targeted communities and populations. The brief also illustrate the linkages between short-term advocacy outcomes and longer-term program outcomes, such as grantee education activities that increased policymaker support for policies or programs to increase access to care for clinic patients. 

Local Advocacy to Secure Funding Under California’s Mental Health Services Act (Prop 63) 

This Brief describes these overall achievements of clinic consortia that targeted Mental Health Services Act (MHSA) funding from 2007-2009, including the types of advocacy activities undertaken, key partners, policymaker support, funding secured, ($13.6 million in new funding) as well as benefits to clinics and their target populations. 

Achieving Clinical Financial Stability: Follow the Money
This Brief highlights how the clinic consortia successfully increased their financial and operational stability and that of their member clinics. The brief concludes from 2001-2006, grantees increased funding secured on behalf of clinics and consortia by a total of $753 million.

Policymaker Relationships: From Education to Partnerships
This Brief describes how the clinic consortia created successful partnerships with policymakers, resulting in policy changes that benefited member clinics and underserved Californians.

Media Advocacy Evaluation Findings
This Brief highlights how the clinic consortia successfully secured coverage by the media—newspaper, television, and radio—of clinic policy issues, such as the increase in the uninsured. From 2001-2006, grantees undertook diverse strategies to successfully educate decision makers and the public but there is no one-size-fits-all approach.



In 2010, UCSF developed 17 case studies, which describe grant-funded initiatives to expand coverage for medically underserved Californians and achieve policy gains benefiting community clinics and their target populations. These cases illustrate the advocacy strategies used by grantees as well as longer-term outcomes of these initiatives.

Alameda Health Consortium (AHC)
Securing Mental Health Services Act Funding for Community Clinics in Alameda County, California. This case study describes the role of AHC in securing local funding for community clinics and their target populations under California's Mental Health Services Act (MHSA), expanding access to culturally appropriate mental health services.


Alliance for Rural Community Health (ARCH) 
A Public/Private Partnership to Expand Coverage for Uninsured Children in Mendocino County, California. This case study describes ARCH’s role in planning and implementing Healthy Kids Mendocino, an insurance program that targets uninsured children in Mendocino County, CA.

California Planned Parenthood Education Fund (CPPEF)
Achieving a Policy Win During Challenging Times: Securing Increased Medi-Cal Funding for Family Planning Services. This case study describes the successful multi-pronged, statewide advocacy campaign undertaken by CPPEF to increase funding for reproductive health services targeted for low-income and uninsured Californians. CPPEF successfully educated decision makers on the importance of state funding during a state budget shortfall, as well as created a potent network of advocates.

California Family Health Council (CFHC)
Securing Title X Funding on Behalf of Medically Underserved Californians. The case study describes advocacy and education efforts to secure Title X Funding, ensuring continued access to reproductive care for low-income, uninsured Californians, including grassroots and partner mobilization that can be used for future advocacy efforts. 

California Primary Care Association (CPCA) 
Addressing California’s Community Clinic Infrastructure Needs: Strengthening and Implementing The Community Clinic Grant Program of 2005. This case study describes CPCAs role in representing clinic interests before and during implementation of statewide policy to allocate $40 million to California’s community clinics to expand facilities and services.


California Rural Indian Health Board (CRIHB)
Speaking Truth to Power: Using Research to Inform Indian Health Care Advocacy. This case study describes how CRIHB developed and used its research expertise in health status and health care services to advocate for improved public policies on behalf of American Indian/Alaska Natives (AI/ANs) nationwide.


Capitol Community Health Network (CCHN) 
Expanding Coverage to the Homeless: The Sacramento Healthcare Access Program. This case study describes the role of CCHN in planning and coordinating a program to enroll homeless individuals in the Social Security Administration’s Supplemental Security Income (SSI) program, reducing the barriers to care for populations with physical and/or mental health disabilities.

Central Valley Health Network (CVHN)
Promoting Healthy Lifestyles in California: Advocating for Nutrition Education for the Medically Underserved. This case study describes the role of CVHN in advocating for and expanding education on healthy eating and active living to low-income residents in California's Central Valley, Northern California, and Inland Empire regions.

Coalition of Orange County Community Clinics (COCCC) 
Increasing Access to Care: Planning and Implementing a Medi-Cal Auto-Assignment Policy.This case study describes the role of COCCC in modifying the process for assigning Medi-Cal clients to community clinics and linking uninsured residents in Orange County to a medical home.

Community Clinic Association of Los Angeles County (CCALAC)
Expanding the Private-Public Partnership Program (PPP) to Meet the Needs of the Medically Underserved in Los Angeles County, CA. This case study describes the role of CCALAC in increasing local funding for an organized system of public and private primary care clinics, expanding clinic capacity to serve the county's low-income and uninsured populations.

Community Clinic Consortium serving Contra Costa and Solano Counties (The Consortium)
Sustaining Access to Health Care in the Face of County Budget Cuts. This case study describes how The Consortium secured $1.5 million in local funding for clinic services for 5,000 undocumented immigrants in Contra Costa County.

Community Health Partnership (CHP) 
The Patient Advocacy Program: Educating Policymakers on Clinic  Policy Issues and Community Health Care Needs. This case study describes the role of CHP in launching and managing a multi-year program to train and support clinic-based patient advocates being an effective voice on behalf of their communities.


Council of Community Clinics (CCC)
An Innovative Model of Mental Health and Primary Care Services Integration. This case study describes the role of CCC in supporting community clinics that provide mental health services, including administering MHSA funds and developing collaborative mental health strategies.

North Coast Clinics Network (NCCN)
Improving Access to Care for Medically Underserved Californians: Securing Health Professional Shortage Area (HPSA) Designations. This case study describes NCCN’s role in increasing health care provider capacity in Northern California through completing HPSA applications on behalf of its member clinics. A successful workforce initiative, HPSA designations greatly facilitate provider recruitment in areas where it is difficult to attract health care professionals.

Redwood Community Health Coalition (RCHC)
Expanding Access to Care for Uninsured Californians: Clinic-Based Enrollment in Health Insurance Programs. This case study describes how RCHC developed and implemented a countywide outreach and enrollment initiative targeting uninsured families and children in Sonoma County. RCHC provides support to clinic-based Certified Application Assistors (CAAs) who have processed over 83,000 health insurance applications since 1998.

San Francisco Community Clinic Consortium (SFCCC) 
Healthy San Francisco: Community Clinics Partnering for Systems Change. This case study describes SFCCC’s role in planning and implementing Healthy San Francisco, a program that provides low-cost primary care services to uninsured San Franciscans.

Shasta Consortium of Community Health Centers (SCCHC)
The Mental Health Assessment and Redesign Collaborative (MHARC): Community-based Effort to Strengthen the Mental Health Safety Net in Shasta County, CA. The case study describes the role of SCCHC in facilitating a community-based approach to addressing the gaps in the County’s mental health system and integrating behavioral health and primary care.​

For more information:

Annette L Gardner, PhD, MPH

Evaluation Director

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