Have you heard of “pay-for-success” funding? It’s a model intended to provide capital to programs and interventions that yield positive, measurable social good. Around the world, it has channeled hundreds of millions of dollars to support health, affordable housing, and early childhood education outcomes, to name a few.

This kind of outcomes-based investing sounds like a clear win-win.

But when three Culture of Health Leaders looked at this model from an equity perspective, their findings changed the course of their careers and launched a ground-breaking cooperative venture.

Jen Lewis-Walden, Bobby Cochran, and Matt Tinsley met as members of our first cohort of leaders. They quickly identified a shared concern: that funding based on predefined success measures can inadvertently reinforce, and even add to, inequities that prevent smaller grassroots organizations from accessing the funding necessary to advance their work. Though funders want to have the greatest possible impact, pay-for-success rarely supports the kinds of local, community-led, cross-sector work necessary to disrupt the systems that stand in the way of lasting health equity.

Shifting attitudes, behaviors, and beliefs takes time, so organizations leading this kind of change need long-term investments that enable them to innovate and respond nimbly.

(From left to right: Nova Ren Kai-Ananda (Cohort 1), Lisa Richardson (Cohort 1), Leigh Caswell (Cohort 1), Bobby Cochran (Cohort 1), Grace Kyung (Cohort 2), Eugene Cooke (Cohort 2), Felipe Tendick-Matesanz (Cohort 1), Matt Tinsley (Cohort 1), Naya Jones (Cohort 2), Jen Lewis-Walden (Cohort 1), Sonia Sarkar (Cohort 2), and Jennifer Godzeno (Cohort 1).

Advancing equity

To address this challenge, Lewis-Walden, Cochran, and Tinsley launched Shift Health Accelerator (Shift). Driven by their mission—to advocate and support a more equitable funding approach in government, health care, and philanthropy—Shift and its partners prioritize outcomes defined and achieved by communities. For example:

• In central Oregon, Shift is helping a cross-sector partnership of hundreds of stakeholders from six school districts market and leverage funding for its approach to improving education and social outcomes for all youth in the region.

• In Washington, they helped community groups negotiate with the Port of Seattle, leading to the December 2019 adoption of the Duwamish Valley Community Benefits Commitment, a first-of-its-kind agreement to address decades of inequitable health impacts in south Seattle.

• In Hawaii, they are helping fellow Culture of Health Leaders and the Hawaii Good Food Alliance attract health care investments to rebuild a local food system rooted in culture and caring.

Shift’s core team works closely with five equity advisers, practicing and modeling the kind of equitable decision-making they want to see in the world. This model also helps Shift’s partners access a wide range of expertise and perspectives.

Last summer, Shift helped convene a meeting of more than 50 participants from philanthropy, health care, government, social ventures, impact investing, and community-based organizations, including nine other Culture of Health Leaders. Hosted at the Federal Reserve Bank of San Francisco, which is deeply invested in advancing equitable community development, this convening resulted in a set of newly released principles that guide Shift’s work.

Principles of Equitable Outcomes Funding

• Local communities decide priorities, goals, and outcomes.

• Outcomes are defined by community needs and valued to reflect societal benefits.

• Benefits and risks are shared equitably.

• Pathways of community leadership are supported, cultivated, and sustained.

• Institutional and systemic barriers to health equity are explicitly acknowledged.

In addition to developing the principles above, attendees committed to two additional goals: 1) to co-lead and test funding prototypes that prioritize equity; and 2) to curate, develop, and test tools for community-led decision-making.

Looking ahead

Going forward, Shift will continue its work at a community level, aiming to simplify access to resources and expertise for community leaders making changes that advance health equity. Shift will also continue working to transform the fields of philanthropy and outcomes-based investing by building partnerships, sharing its vision, and communicating the change its founders believe is needed to achieve an equitable future.

Shift is actively seeking input from community organizations and funders to better understand their needs and perspectives when it comes to social impact investing. To share your ideas, or to learn more about the group, please visit their website.