Nothing For Us Without Us: How Connecticut is Rethinking Their Funding Systems

Connecticut, like many states across our country, has varied demographics with urban and rural areas and different priorities for health across their 20 health districts. All the state’s communities have one overarching challenge, though: public health funding.

To address public health funding challenges head on, Connecticut explored new ways of bringing funders and the community together. The Connecticut Office of Health Strategy created Health Enhancement Communities to bring cross-sector partners together to engage and align current activities across the state with a focus on preventive care and community leadership. Importantly, the Office of Health Strategy is working on the development of a Health Equity Trust to braid and blend funds from a variety of funders who have the same goal: health equity.

Brent Miller, a consultant with the Office of Health Strategy, said the idea behind the Health Enhancement Communities, is to “change the health care paradigm from sick care to health care, focusing interventions on the root causes of poor heath through changes to policy, system, programmatic or cultural norms. In addition, a Health Equity Trust allows us to work with various funders with the same goals, and we can holistically align the funding to break down funding silos.”

The Health Enhancement Communities are primarily funded through grants from the U.S. Department of Health and Human Services Office of Minority Health and the Centers for Disease Control and Prevention with previous funding from Connecticut’s Office of Health Strategy and Centers for Medicare and Medicaid Services Innovation Center.

Under the Office of Minority Health’s grant, two programs focusing on maternal health and food insecurity have risen out of conversations on community health priorities, including the Ministerial Health Fellowship’s Pregnant with Possibilities Program. This program came from an original grant explored as part of one of the Health Enhancement Communities.

Pregnant with Possibilities acts to meet the vast needs of people throughout their pregnancy journey by working with doulas—who are trained to provide physical and emotional support for pregnant people—and community health workers. These professionals support mothers, in partnership with a local hospital and obstetricians (OB-GYNs) group, during pregnancy and first year postpartum. As community members themselves, and sometimes as friends of participants, the doulas and community health workers have an inherent trust. As trusted resources and support, the doulas and community health workers partner with the OB-GYNs and the hospitals to be integrated into the pregnant person’s care team to help build trust between the expectant mothers and the entire team.

A family attends a community baby shower event hosted by Pregnant with Possibilities. The community baby shower provides needed resources, such as diapers and wipes, and social support for families.

Mother feeds her newborn at a community baby shower event hosted by Pregnant with Possibilities. The event is one way Pregnant with Possibilities helps support new families.

Beyond attending prenatal appointments with expectant individuals, the doulas and community health workers of Pregnant with Possibilities provide connections and supports for all facets of health. The program’s philosophy offers a dual-sided approach—the pregnant person themselves has more possibilities to improve outcomes during their pregnancy journey and support for all aspects of their life while also building possibilities for the new child. The doulas and community health workers address the varying needs of the pregnant individuals and their families by offering support such as cooking classes, fresh vegetables and fruits at school drives, fun exercise education, vaccine education, postpartum care, housing discussions, medical debt assistance, childcare options and more depending on the needs of the parents.

Outside of the direct impact on the community as well as on maternal health in Connecticut, the Pregnant with Possibilities program opened the door for systems change and sustainability conversations.

As Reverend Robyn Anderson, executive director of the Ministerial Health Fellowship, which sponsors the Pregnant with Possibilities program, stated, “many times when these projects start going well, funding is cut off.” This issue is not uncommon in public health as community initiatives having a positive impact lose funding to other areas or challenges. With the decrease of support systems, the original challenges reemerge within the community.

Connecticut’s Health Equity Trust is one way this community is looking to ensure long-term systems change and different solutions to build sustainable funding opportunities.

As Reverend Anderson explains, “[We have started to] talk about health equity, and it becomes a trend. True health equity requires major systems change and relinquishing power we may ordinarily have… Equity means having to address underlying issues. If you don’t address those underlining systems challenges, and we set up projects within the same structure, that continues to feed racism.”

Connecticut’s Health Enhancement Communities engage the whole community in helping people be healthier and obtain resources and services. Within the Health Enhancement Communities, different organizations, partners and agencies work as one team with community members to understand the root causes of poor health in their community as well as the best way to address those issues.

True health equity requires major systems change and relinquishing power we may ordinarily have… Equity means having to address underlying issues.

Even with the success of the Pregnant with Possibilities program, sustained funding is challenging, which is an issue faced by many community programs. One reason is based on the difficulty of smaller-scale programs, like Pregnant with Possibilities, to generate programmatic data that can be made statistically relevant to the population at large—notably, though, the program has hundreds of people on the waiting list. Another reason is the difficulty justifying the needs for an expanded and continued program within the context of all the other community funding priorities. Which leaves the question, how can different grants be explored or unrestricted funds be allocated to programs such as this one once the original funding phase is complete?

The Health Equity Trust is one innovative solution Connecticut is exploring to continue having the community at the forefront of project development and implementation and to continue doing what the community needs. As the Connecticut community says, “nothing for us, without us.”


The Connecticut Office of Health Strategy and community partners are participating in the Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative working towards developing more equitable public health systems through a sustainable plan for a health equity trust. The STRETCH Initiative is a partnership between the CDC Foundation, Association of State and Territorial Health Officials (ASTHO) and Michigan Public Health Institute (MPHI) with support from Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Robert Wood Johnson Foundation.Learn more about the STRETCH Initiative.

To learn more about the Ministerial Health Fellowship Pregnant with Possibilities Program, please contact Rev. Robyn M. Anderson at For questions about the Connecticut Office of Health Strategy’s work please contact Tina Hyde at

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