A M o d e l M e m o r a n d u m of
Collaboration: A Proposal
The authors are with the Work Group on
Hcalth Promotion and Community
Development. Un~versltyof Kansas.
Lawrence. Dr. Fawcett is the Director of the
Work Group and D~stlngu~shed
Professor of
Community Leadersh~p.Drs. Francisco,
Pame-Andrew$, and Schultz are Assoc~ate
Directors of the Work Group
Address correspondence to: Dr. Fawcecc
Work Group on Health Promotion a ~ d
Cornm. Devpt, 4082 Dole Center, Unw. of
Kansas, Lawrence KS 66045; tel. 785-864-
0533, f;lx 785-864-5381 e - ~ l l
<sfawce@hlcon.cc.ukans.edu~
The authors propose a mudel mtmuwndum of collaboration for u s e by
state and community partnerships, support organizations, and
grantmakers in working together to build httalthler communities.
Described as an idealized social contract, the model mcrnvrandum lays
out interrelated rc.sponsibllities for the key parties.
B ullding hea1thit.r cnmmunities is the process of people working
together to address what ~ n a t t ~to
r s them-whether that is reduc-
ing vlulance, improving environmental quality, nr prornotlng child
health. This process lnvolves altering social and ~nvirrmmentalcond~tions
to effect wtdespread bzhavlor change and related population-le~elout-
comes :;uch as inlury or employment rates It promotes cwic engagement
atnong people who share a common place, such as a rural comlnunlty or
urban neighborhood, or experience, ~ncludingbeing an i~dolrscentOK a
member of an ethnic minor~tygroup
Collaborative parrnershlps Eocus on bringlng abutlt comrnunrty and
systems change, a n ~ntcrl-cd~atenutcome In the long process of commu-
nlty hcalth improvernerit ( l a r n r n r ~ n ~(and c-rr~clude
t ~ syst~>n'~sI new
&; m E r : l i ~ i $ @ unmple. after-school proernms. prevciitlo~~ ser-
fLCL4,~+ (I'nr u.an1!k_ dressed fines t'nr - s 1lleg;ll !,roducrs tr,
W + I bb d . d P T ~ C ~ I C L(for
S example,
irnpruved access co health services) related to community- (including with udiorn, by whom, and by when)
de term~nedgoals. may be the single most important pract~cethat can
A growing body of hteraturc documenis the lunction- be implemented.
Who's doing what by when
Lng oF collaborative partnerships for community health
and development. Although the evidence r ~ eEfect~v~-
f 3 . Leadershp. A change in (or loss OF) key leadership
ncss is limited and muted, researchers and practitioners can dramatically affect rates of community m d sys-
are beginning to come to an agreement an some key fea- terns change.
tures of community-based in~tiatives Of particular Inter-
est are the components and elrments that: contr~buteto 4. Resources for cornmunl~ymob~llzers,Hirlng corn-
success. rnunity mobilizers or organizers can aid in following
up on action plans. Mobilizer = "Coordinator"
S U M EF A C T O R S A F F E C T I N G
C O M M U N I TCYH A N G E 5. Docurncntatian and feedback on interrnedlate
outcomes. Regular (at kast quartcriy) comrnunica-
For mort. than a dccade, ocrr University of Kansas research tion about rates of community change, and events
team has used a common measurement systemM to docu- that affect it, is also corrclatcd wjth higher rates of
ment the unfolding of community and systems change, success. quarterly communication re: rates of change
and related events, over tlme. In a
muItiple case study design with 6 . Technical assistance. Tech-
more than 20 different community- Transforming the nical assistance. such as
partnerships, we have looked for with action planning or help-
dircontinuir~er in rile patrcrn of conditions that affect ing secure resources, is to be
community and systems change s upporrive of change efforts.
and for events sssociatcd ~ l t h community health and Coordination vs technical assistance
marked increases and dttcrcaszs ~n 7. Making outcomes matter.
rates of change. For example, we development requires a Grantmakers can accelerate
noted char following cumplctiw of rates OE community and sys-
action plans, there is typically a broad collaborative terns change with incentives
marked increasc in the rate of com- and disincentives such as
munity change, a relationship that partnership among annuaI renewal uf multi-year
was found ~n many different con- awardsB or boilus g r a n t s
texts. By using the logic OF multiple several key players. L a s e d u n e v i d e n c e of
time series (quasi-experirnental) progress or acco~~ipl~shrncnt.
designs, we identified several types
of events that appear to affect rates of community TO WARD A B R O A D
change. C O L L A B O R A ~P~A~RVTEN E R S H I P
Our overall analysis, consisterlt with the work of 0th-
trs, suggests seven factul-s that facilitate the prucess of Transforming the conditions that af k c t conimunl ty
community change and ~inproverntli~t ' h e a l ~ hand dcvelopmcnt requires a broad cullaboratlve
partnersll~yamong several key First. state and
1 Clear v~siunand mlssmn Initiatives with a clear community partnerships doing the wurk uF ~ o m m u n l i y
COCUS (fur example, increasing chlldhoud vacci- and systrr~is charlge link people and organizations In
natlull rales or ilnpruvlilg ernployrnen~ou~corlies) cornlnon yuryostl. For example, a cummunlty partnerslll~
bring abuul rn;irkedly hlKher rates of cvmrnunity tu reduce rac~alinequal~tiesIn hcaI111 o u t c o n ~ r smlght
(and systcr~is)cll;zrlgt: than broad "healthy corn- engage members oC ethnrc lrunorlty groups and organita-
munit iesV elforts lnckhng largeled m:sslons and dona1 representatives In trar-tsfurming local cummuni~y-
objcc t ivcs Focus on specific change bascd, health, and religious organl~ations, businesses,
sct tools, government, and financial insriru~ions.
2 Action p l a n n ~ ~1dc.r~ti~i:ig
~g sPcclT!ccon~rnui-t~~y or Second, ~ ~ I p p oand
r t lntermedlary organizations, s u c h
syste~nsC ~ ~ I I : R ~([ha[
S 15, new ur modifled pro- as unlverslty-based research centers and community-
grilnks. l ~ o l m~d ~P P ~ ~ ~ L~C I,I Cto
~ S )bc sought bclscd argan~zations,help build t h c cepacrLy of cornnlu-
nrly pdrtners b y enhancing core cotnpetencles (for exam-
ple, community assessmen[, slrateg~cy lann~ng,commu-
nlty actlon and advocacy, cornrn~~mty evaluat~on.securing
resuurcrs to si~stairlthe effort)
'Third, grantmakers and government agenclcs help
crcare conditions €or success by using requests fur pr.0-
posals to convene people in common purpose. In add]-
tion, they broker connections a m m g those working in the
same community, or un the same concern (for example.,
among grassroots community orgamzatrons and financial
institutions) and can 1rvr:rage funding and resources
through relationships with other grantmakets, Crantmak-
ers can also help make outcomes matter (for example,
through grant renewal or bonus grants contingent on evi-
dence of accomplishment).
How can these parties collaborate? What nsks,
resources, and responsibilities can they share when
engaged in the process of c o n ~ r n u n i(and
~ systems)
change and improvement? How might research-based
information be used to guide broad collaborative partner-
ships for community health? What follows is a model
memorandum of collahoration o~~tlining complementary
roles and responsibilities.
In this complex work, any model rnll be adapled to ht the
local context and adjusted to reflect emerging needs, bar-
riers, and opportunities. Based on ongoing dialogue, the
particiyahng yartles-the community partnership, sup-
port organizations, and grantmaker(s)-agree to work
together for comrnu ni ty change and improvement in the
f o l l o w ~ nways.~
Refining and targeting the vision, mission, and
objectives for community health a n d develop-
ment (€our monchs)
a. Comrnun~typartncrshrp Cons~stentw ~ t h[he com-
mun~ty'svlsion and gnals, the curnrnunlty partner-
s hip, including lucal people arld cor~~~nunity-based
organlzatlons, will select a modest number of
broad goals (ror e ~ a r n ~ l Iniprovlng e,
preventing vlolencc, reducing d ~ s ~ a r ~ Iln~ out-
comes dssociatcd with "race" a n d poverty) (Note
'The v~siorland misslor rnay retlect a cantlnuum of
outcomes, l n c l i r d ~ n ~[ d l cdteg~1ri~.11
u\,~rnpte, adole3cenl pregnancy) [I,] 1,rrjader intcr-
rrl:~ted c o n c e r n s [ h r ex:lmlilc, yo~~tlhdevelop-
n l c n t ] , and/or [ c ] i7iorc t t l r ~ r l e ~ ~ l c~-O~ C~ tL~Ld~IrIlt ~ r -
nllnants OF
health and development [for example,
children I~vingIn povr~tyj.)T h ~ s~ 1 l help
1 det'ine
and focus their common work to Inlprove the lives
of local people.
b. S~rpportorganizations. Support organlzatlons wrlI
asslst the community partnership in establ~shinga
broad-based vision and mission f w community
health and development, focusing on speclflc
locally detcrrn~nedissues or concerns and framing
objectives as cl~allengin~ (but putentially achiev-
able) community-determined goals. (An example
for education- by 2010, increase by 40% the hlgh
schvol graduation rate).
c. GrantmakerIs): Grantmakers wiII lay the ground-
work for multi-year grant appIication(s) to be sub-
mitted to relevant funders. The grant(s) will outline
coordinated investments in a long-term, comprr-
hensive, and community-determined development
process.
2. Developing an action pIan fur bringing about
community and systems change related to com-
munity-determirlcd goaIs for health a n d devel-
opment {approximately right months and ongoing).
a. Comrnu~~ity partnership: Building on earlier efforts,
culIaborating partners, including people of influ-
ence (for example, appointed officials) and those
most affected [for example, youth, low-income resi-
dents), will identify specific community and sys-
tems changes to bc effected to improve population-
level outcomes for people in this community.
Changes in programs, policies, and practices will
be sought in all relevant sectors of the community
(that is, schools, government, business, health and
human service organizations, the f a ~ t hcommunity).
Detailed and interrelated action plans will be devel-
oped for cach Focal objccdve (for example, sub-
stance abuse, cducattul-r, vlolence or neighborhood
safety), Working comrnlttees ~ v t l l be organized
around each [ocal oblective, such as a Task Force
on Substance Abuse, to coordinate and focus coln-
mun~tychange efforrs €or maximum impact.
b. Support organizations Support organlzat~onswill
education. assist wlth actron ~lanning,i n c l u d ~ nidenlJylng
~
es community changes and best practices Tor each
broad ob1ectlve (for example, employmrnr, l ~ h y s ~ c a l
actlvlly) In each relevant srcror (for example,
I S ~ L I C S (for schools, business, the Fa~thcolwnunity) They wrll
support the early stage3 OC ~ o n i ~ r r h e t ~ sd ~~ tv~cr j n
planr1i1-r~(for example, by org~inizinga n d h ~ c i l ~ ~ ~ t -
lrlg plannrng relrrats)
 c ~ r a i ~ t ~ n a k z r Cran
( s ) tmakcrs wrli brolccr cor-rnec- n~~y-lcvel rncllcators rclatud tn t h e (I bjec tmtis. Part-
trons to other organlzatlons wl t h special c\j,ertlse ners WII I I eview ciata o n I I I ~ C ~ I ~ ~uutconles
C ~ I ~ L C (for
in specific goal areas (for example, hnusinp. ~ n d e - exan$e, co~nil-tunityand systems change) at least
pendent Irving fur elders] relevanb to the j w r k In quarierl~;lnd d a on ~ more distant outcomes (that
lucaI c o r n ~ ~ l u n l t ~Ge srantmakers w ~ l also
l ; ~ s s ~ 1x1
si 1 5 , cornrnun~ty-levelindicators), at Ieast annr~allyto
f a c ~ l i t a t l nbroader
~ systems changes {lor esarnple, help g u ~ d eirnl>rovm~eet~ts and promole the celcbra-
grant-mahng practices, regional planning polic~es tion of a ~ c n t n ~ l ~ s l i r n e n t s
that concentrate poverty in a tew urban ne~ghbor- b. Support organlzatlons Supporl organizations will
hoods) to improve the coilditluns under whlch local help facil~tate a cunvt.rsatron about what the
efforts For cummun~tychange and improvement important markers or ~nd~calors of success are for
occur. the community. They mill establish, adapt (as
needed), and maintam a system for documenting
3 . Developing a n d supporting leadership within intermediate outcomes ([or example, community
cumrnunities (ongoing). and systems change). They will also help the com-
a. Community partncrship: The cummunity part- munity partnership identify comrnunity+level indi-
n e r s h p will enhance and support existing leadcr- cators thar offer the best potential lur an accurate
ship through mechanisms such as partnership and sensltlve plcture from he community's per-
~neetingsand retreats. The partnership will also spective. They will support the work of Local docu-
seek to develop ncw generations of leadership by mentars in obtaining, clarifying, interpreting, and
creating nichcs of opportunity for leadership, communicatitrg evaluation information tv the cum-
seeking n a t u r a l leaders among those most munity, and to current and prospective funders.
affeccttd, mentoring newer leaders, and support- c. Grantmakcr(s): G r a n t m a k ~ r s will request a n d
ing local youth and other underrvpresented accept fanctional informauon on the process of
groups in leadership roles. cunlmuillty charlgtl and improvement and related
b. Support organizations Support organizations will naxrative information as evidence of progress for its
use courses, technical assistance, networks of sup- grant status reports and grant applicat~ons.To max-
port, and Internet-based resourccsg to cunnect pco- imize efhciency, they will work with other grant-
ple, ideas, and resourccs. They will help convene makers and organizations to encourage the acccp-
formal and informal (for exampIe, support net- tance of common datasets for rePoits. If needed,
works among the parties) learning communiti~s. they will hetp secure access to data on community-
c. Grantmaker(s) : Grantmakers w~llsupport partners level indicators sensitive to community-defined
in securing suppIc.maniaI resources fur leadership goals. Grantrnakcrs will also asslst in d o c u r n e n t ~ n ~
development in local commun~ties. Using tradl- their own contributions to local cfforts (For exam-
tional face-to-face gatherings and new communica- ple, facllltat~ngsysrcms change, brokenng access to
tions techndogies (lor example, teleconferenc~ng. resources}.
forums on the Internet), grarlt~nakers ~ 1 1 1help
community cunncct local leadership 5 . Securing and providing technical assistance
and restdents to each other and to broader local r e l a t e d to the work i n local communities
and global resources and expertise (ongoing)
a. C o r n m u n ~ tpartnttrsh~p.
~ ' - h e community partner-
4, Documenting the process of cornmunily change s h ~ p will seek assls tarre frotn reIevant support
and improvement, and using ctngoing feedback organizations with gt.neral~zt.de~pt.rllseIn bulld[ng
for improverneni ancl celebration [monthly and rapacity (for c x a n ~ ~ lFor c , planning, evaluation) and
ongoing) w~th syeclalued knnwl~rlge about relevan1 categorid
a U o m l n u n ~ tpcirttler\Iiiil
~ Uslt~ga C ~ J I I l l I I L l I ~ IrEl ~r > ~ u - ci,l I S S U L . ~(tar cx;hrnpte, I-tlV/AIDS, child d ~ v r l o y -
rnentat~ondntl evatu;~tlunsy,ctc.l-n,local I~t.opte w~ll 111crit) I n i ~ r l r l lbun, t the local part t~ershipwill
gather ~ntormat~on OII cornr~~un~tv-ru[cv;li~t ~ncl~ca- Jevclol~ thc cdpaclty t r ~ 1,rovide tecl~nrcal a s s l s -
t ~ j ~ ~ i C: U, C I ~ L ) \ 1 1 1 dctrun p1dr-tnillg or documen~d-
tors of auccrss ']'hey wrll ;11stl A \ ~ I \ I 111 u b t L i ~ l ~ ~ n g
uther rclutr~l 117 ~ ' O ~ I ~ I ; ~ ~ 10 I I I [ ~I L>. I ~ p,~rtjr~l)allts t101i. tor otlhv~~ ) r p , a i ~ ~ ~ . ~ hcoinlllunit1e5
;UIC\ ~~~n\
ilnder31, ~ n d ,111tl I)c ;~cc.ri~~l-t~;lblc I r)r t h y r v o r k , 1 Sit[q){~rt [ ) I K;IIII/~I~ toil\ Su 13 nrganixations wdl
~nc.ludltip I I : l~ ~ l r \ ~" *c, ~ ~ c c c c\ \~ r , r l c \ " .IIILI crjmlnu- IIVI(IC ICCII~I~C';LI d ~ l \ ~ > t i l ~IICI
l ~ I C [ ~ >LCI~ l d
\e C~lpilC-
 it) in community partnerships, as requested, In s others to help do the on-
mul-rity o r ~ ~ n r z e rand
lmplsment~ngand documenting thtl prucess of going work
community change and Improvement. Thts will c Grantmaker (5). Grantmakers wilt facilitate the
include brokerlng linkages to othrrs and prowding development of grant praposals to support a long-
t r a ~ n t n gmatznals and/or workshops 111 skills term, comprehensive community change and
related to this work (for example, comrnunlty ~mprovementeffort. Grantmakers w111 ~ I S Obroker
assessment. action planning, leadership dcvclop- connections .to othcr f~rndersto help generate the
ment, evaluation) resources estimated as needed for the ef1ort.
c. Grantmakcr(5). Grantmakers will help fund and
broker connections to support organizations that 7. Making outcomes matter in the work in local
can provide needed technical assistance, They will cornmr~nj ties {ongomg).
aIso help build capar:iry, for example, by improving a Community partnershi1 The community partner-
com~nunitypartnershipsMaccess to communica- shlp agrees to submit annual status reports that
tiuns ttlchnuIogy. include information on evidence of progress @rh
intermediate (for examplt., communiq and s F t e m s
6 . Securing and providing financial resources for change) and more distant outcomes (for example,
those doing the work in Iocal communities (mi- community-level indicators). Consisteni with
tial 1 0 - y e a r c o m m i t m e n t , enhanced accountabiIity, the
potentially renewable, includ- partnership will also share evi-
ing m ulti-ycar grants with dence of accomplishments and
annual renewal contingent on needed adjustments with the
evidence of progress). We recommend specific local community and uith out-
a. Community partnership: As side funders.
appropriate, partners will interrelated roles and b. Support organizations: Suppon
seek and invest significant organizations will assist the com-
resources in d e v e l o p l n y responsibilities among munity partnership in collecting,
capacity for the work. In par- analyzing, and communicating
titular, this may involve hir- community partnerships, data o n the process of comrnu-
ing and supporting commu- nity change and improvement
nity Drganlrers responsible SUPpOrt CI~ganiZati~ns, for grant status reports. They
for helping bring about the will also help all parties use
community and systems and grantmakers. ongoing fcedback (for example,
changes, and implementing rates of c o m r n ~ n i i ychangc, sat-
the best practices, identified isfaction w t h support organiza-
in the action plan. In appli- tions and funders) for continu-
cations For grant funding, ous improvemcnr
the partners will provide evidence o f the need for c. Grantmaker(5): Grantmakers wlll rtlqulre annuaI grant
and value of con~rnunity investment, includtng status reports that include evidence of progress (far
quantitative information on cornrnunlty and sys- exampk, high rates OF cotnrnun~ty change, improve-
tems change and Improvement In comniun~ty-lcvei ment in community-level ind~cators) To maximize
~ndicators, and qur~litative informatton such as accountablllty to the cornrnunity and LO grantmakers,
success stories. three Forrns of "malung outcomes matter" wijl be used
b. Support organlzatlons Support organizi~tlonswill F I C S annual
~, renewal of multi-year awards will be
help identify ava~lable resources and support cont~ngent on evtdence of progress, I n i l ~ a l I ~progrctss
.
locaI leadership in cornmunlcatlng data (for will be judged largely by evidence of Full rrn~lernenta-
example, comrnun~tyand systems chsl-tge, coin- IIOIT of the proces5 (for example, cornniun~rytnvolve-

municy-level indtcarors) For use 111 gl~lnt s t a i ~ l s m e n t in plnnnrng) and i n t e r r n e d ~ a ~outcoines e

reports and pr~gr~sr;-to-<liltc scctionc of' grilnt (lor example, the mte and kind of community s11d S ~ S -
al~pllcatlons.T h ~ sa n d r c l t ~ ~ ecI~r;~ir~atlvc
d inl'or- terns change f=~cllttuted Iy the community pi~rtner-
lnatlon (for tlxa~l-t~le, nilrnlilve success srorics) 5 1 1 1 ~ ) In Iatcr years, aftcr sufl'lcle~~t c.nvttonmcntal
v a n be used to hell> lcvorilge rcso~ircc., for C O I J J - changes have occurred, ~ m p r o v e l ~ ~ eonn tc o n ~ r ~ l~t yu- n

level indicators will serve as additional e v ~ d e n c e
of success Second, bonus grants (that i s , u p to ane-
t h ~ r dof the grant award) may be earned annually for
outstanding accamplrshmrtnts (For t.xamplc,
~mylcmentatlon of core conlponerrts, hlgh rates of
change of importance to community members and
experts in relatcd areas s u c h as adolescent pregnancy
or education). Third. outcome divldtlnds wlll be avail-
able to enhance accountability and provide incentives
fur irnprovlng mure distant community-level out-
comes (for example, reduced adoIescent pregnancy,
improvcd academic outcomesj. The uutcornc dlvl-
dend will consist of a dollar bonus calculated based
a n cost-benefit estjmates associated with improve-
ments (for example, reduced adolescent pregnancy).
?'he outcume dihidend will be deposited in a Iocal
"community trust account" and rernv~sted by the
~ work 1~1thcornmunity-
community ~ a r t n e r s h ifor
determined goals.
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FAWCE'I'T E T AL.
Community health-ihe well-bemg of the people w he
share a common place or experirnce-rcqu1rc.s cammu-
n ~ t yengagement in changing the behawors of large nutn-
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rvsearch base, we recommend specific in terrclated rolt:s
and r e ~ ~ u n s i b i l i ~among
i e s community partnrrships, sup-
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build capacity for local people to address what matters to
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. -.
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