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Challenges:

• The provision of technical support by multiple Grantees can be limiting. The lead technical assistance provider adopted a brokering model of technical support that worked very well but limited to some extent the technical support contributions of other Initiative Grantees.
• It is difficult to balance Initiative-wide management activities with overall technical support activities. Throughout the Initiative, convenings for technical support occurred two to four times a year. While attempting to meet the technical support needs of Grantees, management issues regarding the design and implementation of the HII were raised and required time to address. In retrospect, more management meetings designed to facilitate greater coordination and joint decisionmaking regarding the overall Initiative would have been preferred.
• Efforts to produce technical support tools fell short of initial expectations. At the outset, TCWF grants were awarded to identify best practices in community collaboration and to develop a Population Health Index to assist health partnerships in measuring the health of their communities. These tools were intended to assist in the planning and implementation of systems change workplans. In both instances, self-promotion took precedence over the Grantees’ attempts to provide timely and effective technical support to the Initiative. In some circumstances, contracts and other procurement mechanisms may be preferred so as to allow the Foundation to retain ownership and control of products/services.
• It is difficult to evaluate the impact of technical support/training. How should technical support be evaluated? Should it be focused on process or outcomes? Is consumer satisfaction sufficient? If capacity, productivity or performance are the desired outcomes, how are these evaluated in such a way that technical support can be identified as a contributing factor? The HII struggled with an inadequate science base from which to assess the impact of technical support. It was not well understood how the provision of technical support services benefited members of the health partnerships and the communities. Technical support Grantees did an outstanding job of exposing various members of the partnerships to training and technical support; however, the HII had no formal strategy by which these individuals would share skills/lessons with others in the community.
• Over time, greater technical support was needed to address organizational and partnership development issues rather than issues particular to systems change. As the health partnerships entered into the second year of the Initiative they began to experience a variety of managerial/administrative challenges including employment policies, budgeting, staff supervision and interorganizational relationships. Increasingly, the technical assistance provider focused on management-related technical support rather than systems change technical support.
• Inadequate time and resources were provided for technical support activities. Further work is needed to establish a permanent system of support and services to health partnerships and other community initiatives that are responsive to the scope and scale of the assistance required. Throughout the HII, the need for technical support was often greater than the health partnerships’ demand, despite repeated offers of assistance by support Grantees and encouragement to use technical support by TCWF. This was particularly true of support for systems change, policy development and population health measurement.