There is tremendous stress on California's community-based health organizations right now. As they face fewer public funds, deeper welfare cuts and increasing caseloads in a funding world that has changed significantly, community programs are finding they must operate under drastically different rules. And very little has prepared them for this change. Until recently, innovation was the key to success. The lion's share of care and creativity went into program design, and the pilot programs that proved successful were often picked up by the state or federal government and expanded. The operative assumption was that projects put forth by competent, talented and hard-working organizations needed only sufficient program dollars to yield beneficial results. Today, it's not that simple. As the federal government shifts responsibility for the health and wellness of needy families to the local level, community organizations are facing not only the loss of dollars, but also the loss of a social contract that promised indefinite aid to the needy. At the same time, the Balanced Budget Amendment cuts will stimulate an escalating need for public health services for the working poor, the uninsured and the indigent. Money Alone Is Not Enough Philanthropy simply cannot replace all of those lost dollars. In light of this trend -- which shows no signs of reversal -- money alone is not enough. Community-based health programs are challenged now to become self-sustaining. To accomplish this, they will need to expand their health focus from the treatment of illness to prevention, and to draw on community resources to pursue strategies that will allow people to take better control of their health and to achieve and maintain wellness. From its inception, prevention has been the spirit underlying all of the programs of The California Wellness Foundation. Substantial grant funds have been dedicated to preventive health services and to efforts at state and local levels to encourage investment of public resources to promote wellness. But as the federal commitment to health care diminishes and the strain on safety-net providers increases, it becomes more important than ever to invest in prevention with the anticipation that better community health will eventually result in less demand for care. Communities need support to build their capacity to care for the disadvantaged, initiate wellness programs and take control of their own destinies. The Foundation has been learning from its grantmaking initiatives about the importance of this assistance. This past year, the Foundation broadened and deepened technical support, funding one or more grants for capacity building in each of its priority areas. What Does "Capacity Building" Mean? Capacity building means enhancing and expanding the leadership skills needed to forge creative ideas, good intentions and disparate energies into effective action. It means helping individuals and community-based organizations build on their assets and strengths to realize their potential and maximize their effectiveness for long-term survival. Such support is broadly defined, ranging from pro bono legal assistance to help in developing a multi-organizational collaboration. Peer-to-peer counseling and regular convenings to share resources and information have been an essential component of this support, as has hands-on assistance to build skills in marketing, multicultural competency, information technology and public leadership. It means building personal capacity as well, working within a community to discover and enhance its assets and to have people honing their strengths. Early Results While many of these support grants are still in their early stages, the impact has already been dramatic in some areas. Community clinics, facing unprecedented challenges from for-profit organizations, have successfully used organizational and marketing assistance to gain a share of the managed-care market. Collaborations, conferences and electronic networks are connecting programs, projects and individuals across the state -- and across class and racial boundaries. Leadership training is building confidence in young people, and providing the support for those who have been hurt by public policies to speak out and be heard. The concept of capacity building is certainly not new, but it has a new urgency and applicability today as changes cut away resources for those who depended on public assistance. Community organizations are eager to strengthen their own health, as well as the health of their constituents. By investing in capacity building, The California Wellness Foundation is providing opportunities for community organizations to enhance their skills to survive and thrive in uncertain times, and to keep the doors open to California's most needy.