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The government is cutting funding for community health groups that were crucial in the Covid-19 pandemic

The US government is making some of the largest investments in public health ever made, but grass-roots organizations working in underserved areas complain that they are being overlooked.

These organizations claim they are particularly disappointed that the federal government relied upon them during the Covid-19 pandemic to encourage vaccinations and other mitigation measures.

The US Centers for Disease Control and Prevention will announce this week the recipients of almost $4 billion in grants for improving public health infrastructure. The program has been described by the Washington-based nonprofit Public Health Foundation as a “landmark”.

According to the CDC, the funding is part of President Joe Biden’s American Rescue Plan. It will address a “historic underinvestment” in rural communities, communities that are economically or socio-economically marginalized, and communities with people who are racial or ethnic minority groups.

According to the CDC, the money will be used to support health departments in government. These leaders from marginalized communities say that funding is necessary, even though they are aware of the need for it. They have been working in health promotion in these areas for many years and are familiar with their needs.

The federal Health Resources and Services Administration announced in September that it had awarded 83 grants to support its Community Health Worker Training Program. This grant program was separate from the HRSA grant program. It totaled more than $225 million. HRSA grants were mostly awarded to large government departments, universities, and other large organizations. The grants were not distributed to grass-roots health promotion organizations whose members are located in or work in these communities.

Denise Smith, Executive Director of the National Association of Community Health Workers, stated that funding streams often have names such as ‘community’, ‘community-based organizations’, or ‘community workers. However, funding often goes to the states and does not end up helping at the grassroots level.

Venus Gines, president and CEO of Dia de la Mujer Latina in Texas, stated that community groups are often asked to perform health promotion work for which they do not receive government funding. Many people say that they are doing unpaid work because it is important to their communities and they don’t want any negative relationships with potential funders.

“We will always be in your kitchen. We won’t be invited to the dinner table. “That’s how we feel,” Gines stated.

HRSA spokesperson said that the federal agency had supported community-based organizations over the years.

HRSA is proud of the vital role community health workers can play in improving the well-being and health of communities. HRSA has spent hundreds of millions of dollars in the past year to support community-based organizations in addressing vaccination hesitancy by hiring and deploying community workers and other trusted messengers that reflect their communities’ needs,” Richard Olague, spokesperson for HRSA, wrote in an email to CNN.

A spokesperson for the CDC stated that the agency’s almost $4 billion program was “specifically designed” to provide support to states, localities, and territorial public healthcare jurisdictions. These jurisdictions have experienced severe stress in their foundational infrastructure and workforce during the pandemic.

Kristen Nordlund, the spokesperson for the CDC, stated that the CDC “appreciates the need to support community-based organizations”. She also said that in the past, funding from the agency was sub-awarded to these organizations by state and local departments of health.

“Community workers are trusted members of their communities and are frontline health workers. Nordlund sent an email to CNN describing how this trusting relationship allows the worker to act as a link between the community and health/social services to improve service delivery and facilitate access.

A letter from President

Gines was sent a letter by President Biden on October 15.

Biden thanked Gines and Dia de la Mujer Latina for their work during the peak of the pandemic. Promotores de Salud (community health workers) encouraged vaccinations and established a hotline to provide accurate information about the virus.

“Dia de la Mujer Latina’s efforts to get shots in the arm was crucial.” Your organization will be remembered as a hero when the story of the health crisis is finished,” the President wrote. “I am grateful to have Dia de la Mujer Latina as a partner in my Administration’s efforts to address the health challenges of this time.”

Gines was denied a grant from the government to train community health workers.

Gines was intrigued to learn about HRSA’s $225 Million program. Her group, Dia de la Mujer Latina, has been training and deploying community health workers for 25 years. Their work has been recognized by the Obama White House, the National Institutes of Health, and others.

Gines challenged HRSA’s rejection of her application. An HRSA official told Gines that HRSA’s external review panel had “recommended your program to be funded which is truly something you can be proud of.” We were unable to fund every application that was suggested because we only had limited funds.

Gines stated that she expected that some of those groups that received funding, such as large corporations and universities, will ask her for assistance but that she would not share the grant money with any of them.

“These are the organizations that get the money. They come to us to do their work. She said that we care about our community.

Tonya Roberson, President of the National Community-Based Organization Network said that government agencies have asked for her help, but she has not been paid.

She said, “I learned this the hard way.” “I’ll give away my strategies and information that I have worked so hard for.

Roberson is also the chair of Far South Chicago Coalition’s health and wellness committee. Roberson said that the Far South Chicago Coalition applied to HRSA for recent grant funding, but was denied.

Maria Lemus, the executive director of Vision y Compromiso (a group representing health promoters across the country), said that community groups are often asked to perform work without being paid.

Lemus stated, “It’s an issue of equity because most promotores (promotors) are women.” They have traditionally been viewed as volunteers.

Olague, the spokesperson for HRSA, said that eight of the 83 organizations that were awarded funding had been identified as community-based. He said that many other HRSA awardees were focused on community-based services and training, including community colleges, community health centers, and community partnerships.

The CDC tells state health departments receiving funding that they should give 40% to local health departments. It also encourages local departments to get involved with community organizations.

Nordlund, a spokesperson for the CDC, stated that grantees would be able “to hire community health workers as needed and appropriate.” “CDC-funded jurisdictions subaward and contract with many community-based organizations,” Nordlund said.

The grant program encourages recipients to develop and grow relationships with key partners, including community-based organizations. She said that although the grant doesn’t specify how grant recipients will use it, she was confident grant recipients would fund and work with community-based organizations in their localities.

However, there is no requirement that grant money is distributed to grass-roots organizations.

Lemus, the head of the national organization for health promoters, suggested that the narrative should include ‘you must’ rather than ‘you can’t, ‘you will’ or you may. It is HRSA and CDC that understand the power they have. If they want to make a difference, they must change from a may’ to a ’must.

Jeffrey Levi, a professor of health policy and management at George Washington University’s Milken Institute School of Public Health said that the CDC could do more to help the grass-roots organizations that the government depends on during a crisis.

He stated that “some of us would like to see [a] stronger requirement from the CDC that would elevate the community voice and community-based organizations as partners in public health infrastructures and decision-making.”

Appeal to federal agencies

Smith, who is the leader of the association of community health workers, was informed that $4 billion had been granted by the CDC. She reached out to Karen Hacker, director at the National Center for Chronic Disease Prevention and Health Promotion.

Smith stated that she spoke to Hacker and other CDC staffers in April during a telephone call. She suggested that the expanded workforce supported by grant funds include community health workers who are closely connected to the communities they serve.

Smith stated to CNN that without this, it was “impossible” that a program could be culturally-aligned.

Although Nordlund, a spokesperson for the CDC, didn’t directly answer CNN’s questions regarding that meeting, she said that the agency had gathered input from stakeholders about the funding opportunity.

Nordlund explained in an email that the grant was created collaboratively with input from many stakeholders to best address the needs of different communities across the country. “We held 6 listening sessions outside with state, territorial, and local health departments, as well as non-governmental organizations and national public healthcare partners.”

Smith also reached out to HRSA regarding its grant program. He wrote to the agency stating that it was difficult for community organizations to apply for the funds.

First, community organizations were required to obtain a certification which can prove difficult to obtain. She said that larger organizations like universities and state and local hospitals have a lot of administrative capacity and are therefore able to compete for grants.

Smith, in a May letter to HRSA, stated that if HRSA didn’t modify its criteria, there would be a decrease in the impact of the proposed funding opportunity on health disparities.

Smith stated that the application period closed on June 14th without any changes to the requirements.

“What we were worried about actually worked out.” She said that most of the recipients were from large academic institutions. The award was not given to grass-roots organizations in health care that have been “recognized as leaders in this field for decades.” This is a worrying trend.

Karmen Blackwell, a spokesperson for HRSA, stated that Smith’s criticism was unfair and that the agency had “crafted the requirements for the program to include as wide and diverse an applicant pool as possible.” This program provides funds directly to community-based organizations for training or placements in their communities. Blackwell also stated that HRSA held training sessions for grant applicants as part of its efforts to attract a diverse applicant pool.

Smith and other community advocates believe the problem is much bigger than these grant programs.

“There are a lot of people who have been at the table with CDC/HRSA saying ‘let’s adjust these requirements so that they are more realistic, and to include community’ – else, [the funds] will continue to go to the same large groups that have been around a long while,” stated Lemus, who heads the national organization for health promotion.

She said, “What we are advocating is that these systems be reviewed to adapt them more realistically to the people and communities they serve.”

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