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What Does It Mean to Make Grantmaking More Equitable?

Why It Matters

" . . . looking at things through an equity lens (versus an equality point-of-view) means reviewing systems, practices, and policies with the intention of creating fair, equitable, and just outcomes for all, including marginalized groups."
What Does It Mean to Make Grantmaking More Equitable?

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As the Institute for Healthcare Improvement (IHI) works to improve health outcomes on a global scale, we have invested in improving health equity in many ways. Recently, IHI has developed a grantmaking process to ensure that we give resources equitably to those trying to advance health equity by leveling the playing field for marginalized groups. 

The US Centers for Disease Control and Prevention (CDC) explains the difference between equality and equity in this way: “Equality is achieved when each person or group is given the same resources or opportunities. Equity is achieved when it is recognized that each person or group of people has different circumstances, and resources are allocated accordingly to reach an equal outcome.” Consequently, looking at things through an equity lens (versus an equality point-of-view) means reviewing systems, practices, and policies with the intention of creating fair, equitable, and just outcomes for all, including marginalized groups. 

An equitable grantmaking process offers multiple potential benefits. It can, for example:

  • Challenge disparities and gaps in the traditional grantmaking process by shifting power dynamics and uplifting the voices most affected by these dynamics. 
  • Provide sustainable improvements in the grantmaking process and make a lasting impact. This allows a continual look into where the gaps are and how to support those typically excluded from the grantmaking process. 
  • Offer an opportunity to build relationships with communities who will directly benefit from the funding. These relationships provide substantive feedback about the grantmaking process and eliminate waste that could potentially be harmful to the community. 
  • Help contribute to the progression of equity work across the globe. Without using an equitable lens, gaps continue to widen, leading to additional harm to the communities we aim to support. 

Recently, IHI engaged in an equitable grantmaking process to support health care organizations looking to close equity gaps in their organization’s infrastructure, data, and clinical outcomes. The application review committee consisted of six people who had extensive backgrounds in health equity improvement. Committee members used an equitable lens during each stage of the grantmaking process, including developing the application requirements, creating review and scoring methods, and awarding of funds. 

In addition to considering the review and award processes, the committee also assessed the potential impact the grant award could have on the community. Applications scored more favorably if the organization could demonstrate how their projects would impact the communities in which they served. The committee also considered the history and equity journeys of the health care organizations applying for funding. 

After developing an equitable application process, IHI convened a diverse grants review panel that had a strong background in health equity. Panel members included people who worked and lived in the communities the grant-funded projects would serve.

The panel reviewed applications independently and collaboratively, utilizing shared knowledge and experience in equity work to identify each project’s potential successes and challenges. Each application had two different sets of eyes to help ensure input from different perspectives. We also allowed reviewers to ask applicants to make suggestions to improve their project scopes. Instead of penalizing those whose initial applications did not meet the goals of the project, the panel permitted teams to submit their application as many times as needed to ensure equity was central to the work.

The most heavily weighted portion of the application asked organizations to demonstrate the community’s need for a project and how it intended to improve equity. To show their commitment to the work and attention to long-term sustainability, the application also asked teams to describe the organizational supports they had in place to provide project oversight. The applications were not lengthy to ensure emphasis on how these teams planned to equitably serve patients. 

For the award process, there was no limit to the amount of dollars teams could request. Amounts varied based on the size of the organization and the needs described in the application. Allowing teams to request what they needed freed them to focus on how best to achieve their equity goals without often arbitrary funding restrictions. Ultimately, IHI awarded all organizations funding to carry out the work to which they committed in their applications. Projects are currently underway. We have seen impressive progress thus far and are excited to see more in the coming months.

Victoria Terry, MPH, is an Institute for Healthcare Improvement Senior Project Manager.

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