The Utility of Large Coalitions for Community Health Programs

This commentary makes the argument and advocates for large-scale community engagement coalitions to address community health issues. Taking this position, one must consider the goal of enhanced citizen participation, ideal size, and membership make-up of community coalition partnerships for addressing health conditions at the county level. For many years, community organizers and coalition conveners have pondered the question of the appropriate mix of individuals and organizations for inclusion in coalition membership and the size of coalition partnerships to be efficient and effective.¹ This commentary takes the position that large and representative coalition partnerships facilitate community-wide health interventions and support services for families within a county. In this context, large is defined as 40 or more participating organizations and or individuals. While 40 is not a magic number or a silver bullet, the magnitude of 40 gives the latitude for a broad base of inclusion.

Both macro agencies, community-based organizations, and local citizens should be included and have a pivotal role in governance and decision-making for improving the quality-of-life among the citizenry. In this context, improved quality-of-life can be measured by lifestyle changes (e.g., dietary habits, routine exercise, knowing the importance of drinking water and hydration, behavior modification related to smoking, alcohol consumption, use of illicit drugs, and engagement of pre-natal health education for pregnant mothers).

Some of the key tenets central to building and sustaining a successful coalition include appropriate and comprehensive orientation of new members, clarity of coalition mission, advocacy for a shared leadership approach, ongoing training and technical assistance for coalition members, transparency of coalition resources, processes for conflict management and resolution, credible leadership and use of memoranda of understanding.

The ideal size and membership mix of community coalition partnerships for health promotion continues to be discussed among public health practitioners.^1,2 Some coalitions are as small as 10 members while others may have 40 or more. Some coalitions are dominated by health providers where professionals make major decisions about programs and then politely inform community members about the nature, scope, and implementation plans. Other coalitions include a mix of health practitioners and consumers, while consumers are the majority and have the controlling vote in event that a decision is based on membership category. Consumer-dominated coalition partnerships represent a more genuine engagement and acknowledgement that power and control involving lay-citizens builds ownership of health problems and the solutions to such health problems. Many externally-funded coalition partnerships are effectively using consumer-dominated or practitioner-dominated models.³ From our perspective the large consumer-dominated coalition partnerships along with numerous segments of a community (business, health and human service, education, housing, criminal justice, faith and youth) show the greatest potential for shared leadership and institutionalization of programs, especially once funding has dissipated. An example of this type of membership mix was evidenced by the 122 members of the Augusta Partnership for Children in Augusta Georgia. In this case, coalition size increased the likelihood of building a more representative and comprehensive set of strategic plans and community action plans.²

Critical to any coalition partnership is the orientation of new members. New members must be appropriately acculturated to the values, mission, and practices of the coalition. Such an orientation decreases the likelihood of sabotage and agent provocateur behavior within the ranks. Secondly, clarity of coalition mission is pertinent to sustainability. One's mission sets the boundaries of operation and can often be used as a hallmark document for guiding the partnership initiatives that emerge. Some organizations experience mission drift and consequently lose focus. This can become a bone of contention among members with diverse opinions relative to programmatic engagement. To minimize mission drift and to maximize coalition clarity coalition partnership members should frequently revisit the coalition's mission and engage in a strategic planning process by identifying the organization's strengths, weaknesses, opportunities, and threats (a so-called SWOT analysis).

Also critical to the success and sustainability of a coalition partnership is the notion of shared leadership. Shared leadership has its interface with the organizational...