1 Grantwriting and Budgeting for Public Health Programs Jennifer Horney, MPH Assistant Project Director NC Center for Public Health Preparedness The following module will provide an introduction to funding for public health in America since September 11, 2001 and give an overview of grantwriting as a way to secure funding for public health programs. 1 2 Learning Objectives Describe the history of and the current environment for public health funding Define federal, state, and local government funding priorities and mechanisms, as well as private foundations and other potential funders Recognize the major content areas of a grant proposal and describe how they are developed, including budgets, workplans, technical approaches, and evaluation plans 2 The learning objectives for this module are Describe the history and current environment for public health funding Define federal, state, and local government funding priorities and mechanisms, as well as the priorities of private foundations and other potential funders Recognize the major content areas of a grant proposal and describe how they are developed, including budgets, workplans, technical approaches, and evaluation plans
3 Spending for Public Health 1960-2000 ($millions) from Frist (2002) 18000 16000 14000 12000 10000 8000 6000 4000 2000 0 1960 1970 1980 1990 2000 Federal Public Health Spending State / Local Public Health Spending Total Public Health Spending 3 All of you are probably familiar with the increases in overall health care spending that have occurred over the last 30-40 years in the US. According to the Centers for Medicare and Medicaid Services, total health spending in 2003 reached nearly $1.7 trillion dollars. Total public health expenditures have also grown, increasing from $192 million in 1960 to $17 billion in 2000. Looking at this graph, you will see that until 1980, Federal and state and local spending were nearly the same, but by 2000, state and local spending was 2.5 times federal spending. Local and state governments account for 70% of the public health spending that is accounted for in the National Health Accounts, which is indicative of the evolving responsibility of public health to the states. So, when considering a source for funds, many people probably first think of federal funds. In fact, still around 70% of all public health funds are state and local. So they may be a better source of funds for your organization. On the other hand, consider the impact of the budget crisis that so many state are facing. Will this have an impact on their funding of public health? How would you make decisions about what cuts to make?
4 Proportional Spending of Health Funding for Public Health 1960-2003 3.5 3 2.5 2 1.5 1 0.5 0 1960 1970 1980 1990 2000 2003 Public Health Spending as a % of Total Health Spending 4 It is difficult to calculate the portion of total health spending that is characterized as public health versus total health expenditures. The National Health Expenditure or NHE is part of the National Health Account, which attempts to measure spending for health care in the U.S. by type of service delivered (hospital care, physician services, nursing home care, etc.) and source of funding for those services (private health insurance, Medicare, Medicaid, out-of-pocket spending, etc.). The proportion of total health spending dedicated to public health rose from.72% in 1960 to 1.32% in 2000. By 2003, the National Health Expenditure (NHE) was 3.45% of the NHE. Ref: Heffler, S., Smith, S., Keehan, S., Borger, C., Clemens, M.K., Truffer, (2005). U. S. health spending projections for 2004-2014. Health Affairs (Millwood). 2005 Feb. 23.) Much of this reflects recent increases in federal spending for national, state and local public health activities intended to address the threat of bioterrorism and other public health emergencies. These funds totaled approximately $1.1 billion in FY 2002 and $1.2 billion in FY 2003. This is an increase of 25% in the federal contribution to public health spending.
5 6 National Health Accounts Government public health activity includes funds spent to organize and deliver services or prevent or control health problems Federal (primarily CDC and FDA) State Local http://cms.hhs.gov/statistics/nhe/default.asp Private Funding Robert Wood Johnson Foundation http://www.rwjf.org Henry J. Kaiser Family Foundation Health policy focus Susan G. Komen Breast Cancer Foundation Race for the Cure Bill and Melinda Gates Foundation International Health, including vaccines, HIV, malaria and other diseases For a fairly complete list of foundations and other public health funders, visit Pubilc Health InfoLinks at Emory University Rollins School of Public Health: http://www.sph.emory.edu/phil/philgrants.php 6 5 Not all programs that many would consider public health are included within the National Health Accounts data. Nutritional programs such as Women, Infants and Children (WIC) Food supplemental program, sanitation and water programs, other environmental programs, and federal research support are not included. You can find out for about the National Health Accounts by visiting the Center for Medicaid and Medicare Services website shown here on the slide. Another possible source for public health funding is private or nongovernmental. The first step in seeking private funding is doing your homework. There are many online and printed references that will tell you the funding priorities of private foundations. Foundation generally DO NOT make grants to organizations or activities that are outside of their focus areas. Since writing a grant can take substantial organizational resources, it is much more effective to complete your research and perhaps to have a cultivation meeting with a grants officer at the foundation. This will help you determine if your proposal has a chance of being funded. Several well known foundations are listed here the Robert Wood Johnson foundation offers funding in a variety of areas, including obesity, health insurance coverage, tobacco use and others. For a full list, visit their website at
www.rwjf.org. The Henry J. Kaiser Family Foundation supports policy areas, including health insurance coverage and the uninsured, state health policy, Medicare, as well as HIV. Many of you will have heard of the Susan Komen Foundation, which sponsors the Race for the Cure races across the US that raise money to support breast cancer research. Finally, the Bill and Melinda Gates Foundation has almost single-handedly re-written the future of public health funding, particularly in developing countries, making over $1.2 BILLION in grants in 2003. 7 November 2000: Public Health Threats and Emergencies Act Established reasonable capacities for national, state and local public health systems and their work forces Allocated funding to improve capacity of public health agencies to detect and respond to significant public health threats i.e. epidemiologic capacity, lab capacity, emergency communication capacity $4 million for FY 2001 7 (Jen, I created a tool to help folks think more broadly about sources of funding for expanding PH services. I will send it to you via email and we may want to add it as a reference/tool for folks to use in addition to what you have on this slide.) Based on the area in which I work, public health preparedness, I will give you an example of the recent increase in funding for public health preparedness related activities. In November 2000, Congress passed the Public Health Threats and Emergencies Act which established reasonable capacities for national, state and local public health systems and their work forces. This act obligated about $4million to build local public health capacity.
8 9 June 2002: Public Health Security and Bioterrorism Preparedness and Response Act Established a comprehensive framework for improving our public health system and reducing vulnerabilities $3 billion in total funding $1 billion for state and local capacity building 600% increase in funding Why? Before 2001: More than 9 out of 10 public health department lacked staff trained in bioterrorism preparedness Only 1 in 5 hospitals had a response plan in place to deal with biological attacks Nearly 20% of all health departments had no access to the Internet or e-mail 8 9 Following the September 11, 2001 attacks and the Anthrax attacks in October of 2001, Congress passed the Public Health Security and Bioterrorism Preparedness and Response Act in June of 2002. This act increased public health preparedness funding by 600% over the November 2000 Public Health Threats and Emergencies Act presented on the previous slide, providing $1 billion to the states for increasing public health preparedness capabilities. This funding has remained somewhat steady since 2002, with funding levels of over $1billion in 2003 because of an additional appropriation for smallpox vaccination and planning. State funding for 2005-06 is approximately $809 million. Although many in public health question the rapid funding increases tied to public health preparedness, when public health infrastructure has been underfunded for decades, the need for funding for preparedness was clear. Before 2001, more than 9 out of 10 public health department lacked staff trained in bioterrorism preparedness. Only 1 in 5 hospitals had a response plan in place to deal with biological attacks. Finally, nearly 20% of all health departments had no access to the Internet or e-mail
10 Grantwriting Now, lets take a look at the way that public health agencies and nonprofit organizations often access federal, state and private funds for program development and operating expenses - grantwriting. 10 11 Grants v. Contracts Grants are money given to an organization to address a problem in a community Use grants to accomplish organization s objectives within their own policies and guidelines Contracts are legally binding Contracting agency buys services from organizations in order to fulfill agency's responsibilities 11 Grant funds are generally awarded by the private sector, corporations, foundations and individuals who award grant funds based on their special interests or priorities. Grants may also be issued as cooperative agreements, where there is greater leeway for the recipient organization to make changes to the proposed plan during the grant year. Contracts are more formal and legally binding agreements between funders and agencies to perform some work, provide a service or undertake research. Contracts are for a set period of time, and generally may be renewed or extended. Many times, federal or state public health departments contract out services for which they do not have the technical expertise or capacity to provide services. A request for proposals may be distributed by the contracting entity outlining the budget and scope of work and organizations may choose to submit a proposal if they have the ability to complete the work in the given time period for the given amount of money. For example, the
state of North Carolina contracts with the University of North Carolina at Chapel Hill to perform a number of projects, including evaluation of surveillance data, workforce assessments, data collection and analysis, and other projects. Another example that may be more familiar to you is the contracting of food services by a university, where the university hires an outside company to fulfill its responsibility for feeding all students on campus. 12 Why Apply? Start a new project to meet an identified need Expand an existing project Your organization meets the requirements of the funding organization You have been invited to apply 12 There are a number of reasons why you might apply for a grant, or submit a proposal or application in response to a request for proposals. Based on data, you may have identified a need in your community that your organization could address with additional funds. Perhaps you have a successful pilot project that you would like to expand. Funding may be program or project based, or may be available for general operating support for your organization. General operating support is more difficult to secure, and if you are a manager or leader of your organization, you will want to be cautious about spreading your staff too thin working on too many different projects or programs for which funding is available. In some cases, your organization may be invited to apply, although this is fairly rare.
13 Where can I get information? DHS, DHHS, CDC, NIH, NSF Generally issue Requests for Application (RFA) or Requests for Proposal (RFP) http://www.fedbizopps.gov/ Letters of Intent Investigator Initiated Awards CAREFULLY READ THE APPLICATION! 13 This alphabet soup of federal agencies are just some of the larger federal funders in the area of public health. DHS: Department of Homeland Security DHHS: Department of Health and Human Services CDC: Centers for Disease Control and Prevention NIH: National Institutes of Health NSF: National Science Foundation NIH and NSF grants are generally more research grants, with applications undergoing a peerreview process by others working in the field Often new opportunities require that organizations planning to apply submit a letter of intent prior to the submission of a full proposal. With foundations, you may be required to wait for approval of a letter of intent prior to submitting a full proposal. Investigator initiated awards may be unsolicited proposals or may be open opportunities for applications in a certain broad subject area. REMEMBER: Carefully read all application materials. These should provide you with all the guidance you need to make a successful request.
14 What s included? Cover letter, title page, abstract Statement of the problem Project description Evaluation plan Budget request and justification Application qualifications Plans for sustainability Appendices 14 This list is a general one and may not apply to every proposal. However, most grants will have each of these components. Often times there is a page limit for your submission. Be sure to look carefully to determine whether or not items like the budget justification are included in the page limit. Applications which do not follow guidelines exactly may be excluded from any consideration which can be very disappointing considering the time you invested in developing the proposal. Remember, organizations like hospitals and universities have clearinghouses to ensure that they do not compete against themselves on proposals. The approval process for this system can add about 1 week to your deadline. Also, many application guidelines will give you a points breakdown of what each section is worth in the scoring of the proposal the personnel section is generally worth a relatively large portion of the scoring you will receive. Another thing to remember is that your grant may score high but not be funded due to a limited pool of available funds. However, if this is the case, you will often have an opportunity to receive funds at a later time without re-submitting a new proposal.
15 Statement of Problem Only 10% of sexually active adolescents in County X report using a condom in the past three months, while the rate is 15% at the state level and 25% at the national level. Interview experts if your data doesn t exist yet Perhaps you may be proposing to complete an assessment as part of the grant funding to define the problem 15 When developing your grant narrative, document the problem you want to address, using text, statistics, and charts. For example: Only 10% of sexually active adolescents in County X report using a condom in the past three months, while the rate is 15% at the state level and 25% at the national level. If data doesn t already exist, you may be able to interview experts or propose to complete an assessment as part of the grant funding to define the problem 16 Project Description Goals and Objectives Specific Measurable Challenging but achievable Methods and activities for addressing the identified problem Time line Once you have effectively documented the need, then explain step-by-step all the activities you will undertake to accomplish your goal. Give a timeline to ensure that the work will be completed by the end of the grant period. 16 17 Objectives Survey Medicaid enrollees and privately insured patients about why they do or do not access prenatal care services early in their pregnancy What s wrong with this objective? 17 Here is an example of an objective that wouldn t be very good as part of a grant proposal. What do you think is wrong with this objective? PAUSE It is not measurable, not specific, not timed A better objective would be: By June 2004, survey 100 postpartum Medicaid enrollees and privately insured clients prior to discharge from the hospital regarding why they did or did not access prenatal care services in the first trimester of pregnancy. You can see this written out on the next slide.
18 Objectives By June 2004, survey 100 postpartum Medicaid enrollees and privately insures clients prior to discharge from the hospital regarding why they did or did not access prenatal care services in the first trimester of pregnancy. Specific: 100 postpartum clients surveyed prior to discharge Measurable: Achievable: 100 women is a reasonable amount of women to interview Relevant to mission Timed: All will be completed by June 2004 18 19 Process v. Outcome Objectives Process: Measures the accomplishment of tasks completed as part of the implementation of your proposed program Outcome: Measures long term results or impact of programs 19 Many times, different people use different terminology when writing objectives. Try to follow the language in the grant guidance carefully. Two types of objectives that you might be asked to develop are process and outcome. Process objectives measure the accomplishment of tasks completed as part of the implementation of your proposed program. Outcome objectives measure the long term results or impact of your program. The following are examples of process and outcome objectives: By June 2004, distribute 500 copies of the patient education pamphlet to men between the ages of 30 and 50 in X county By June 2006, decrease the number of men between the ages of 30 and 50 with high blood pressure in County X by 5% from the 2003 rate of 40%
20 Evaluation Shows how you will measure project completion or successful accomplishment of your objectives Helps you develop an application Helps funder determine whether funds were used effectively 20 Evaluation is a key component to most applications for funding. Evaluation is your accountability to the funder and you will need to clearly define how and what you will measure to show success. In addition, your evaluation strategy (although evaluation typically comes near the end of a project) may help you develop your activities and methods for your proposal, since the evaluation will guide what and how you measure your progress. 21 Budgets Budget Categories Salaries and benefits Consultants Equipment Supplies Travel Other 21 Budgets are generally made up of several components, including Salaries and benefits: Salaries and benefits of both permanent and temporary employees, including full and part-time. Benefits are generally about 20% of salary, plus the cost of health insurance. Consultants: Consultants or contractors are staff who do not work for your organization. A number of rules generally apply to the hiring of contractors, so you will want to understand those before hiring a consultant. Equipment: generally any supply over $5000, such as a computer server Supplies: copying printing etc Other: communications, scholarships, facilities and amenities, such as meeting rooms and food for trainings or conferences These rules will depend on the organization in which you work. Much of this information generally represents the policies and procedures of the University of North Carolina. Your agency may have different requirements of
templates. Again, you can save yourself a lot of time by familiarizing yourself with these requirements well in advance of the proposal due date. 22 Direct v. Indirect Costs Direct Costs Costs of program implementation (personnel, supplies, travel, etc) Indirect Costs Also called overhead May include rent, utilities, existing equipment usage fees or laboratory space The previous slides included the components which make up your direct costs. Indirect costs are costs that enable the project to be completed, but that are not directly related to the project activities. These may include rent, utilities, etc. 22 Most organizations add overhead or indirect costs to the total cost of a project. The funder may set the overhead rate for example, most training grants have a maximum overhead of 8% while many research grants may have an overhead of up to 40-50%, or it may be up to the organization applying for funding to determine the appropriate rate. If the grant you are seeking is competitive, then an applicant with a lower overhead rate may be viewed as more competitive. Larger organizations, as well as state agencies or universities will have established overhead rates
23 Sample Budget in PHS 398 Format Here is an example program budget in a common format used for federal grants. A detailed budget is listed for personnel, consultants, equipment, supplies, travel, and other expenses. You can use formulas in a spreadsheet program like Excel to create a budget like this one. 23 24 Budgets All funders have different requirements for budgets, but here are some common items you will need to include: Fringe benefits: Include the cost of employee health insurance, Social Security and Medicare payments generally about 30% of salary Budget justification: A narrative presentation of your budget, with written details for each item 24 Budget requirements will differ among funders, but here are some common items that you will need to include. Fringe benefits include the cost of employee health insurance, Social Security and Medicare payments generally about 30% of salary A budget justification, which is a narrative presentation of your budget which describes the role that each staff person will fill on the program is almost always required. 25 Other common budget?s Need to calculate a daily or hourly rate? The typical full-time employee works 2,080 hours or 260 days per year What about cost of living increases? What are certifications and representations? These are statements that your organization must agree to in order to be eligible for funding, some common ones include a smoke-free workplace, lobbying, and veteran s employment reporting requirements 25 Budgets can seem complicated, but once you have done a few, you will find that they are generally fairly simple. A few common things that seem complex are first are: Calculating an hourly rate: When hiring a consultant, you may want to calculate an hourly rate that is comparable to a full-time employee. You can calculate an hourly rate by dividing an annual salary by 2080, the approximate number of hours a full time employee works in 1 year. For a multi-year grant, you will need to consider cost of living
26 Application Qualifications Organization s history, mission, and experience Organization and individual contributions in the field Highlight links to collaborator s and other resources letters of support 26 increases (at a minimum) for your staff, generally about 3%. You will also need to consider inflation in other areas, such as rent. Certifications and representations are part of nearly every government funded grant program. Certifications and representations are statements that your organization must agree to in order to be eligible for funding, some common ones include a smoke-free workplace, lobbying, and veteran s employment reporting requirements. Again, if you are part of a university or a larger organization, they will have this paperwork on file and you will only need to report the dates of the agreements to the funder. A few other final items that you may need as part of your qualifications to apply for funding include your organization s mission, history, and vision; the accomplishments of your organization and your staff (remember, their experience is key to a positive review of your proposal); and letters of support. Many funders want to see evidence that you program is needed by those you will serve. Letters of support indicate partners willingness to work with you if funded, or document community need.
27 Summary Funding for public health is provided by federal, state and local governments, as well as foundations, corporations and other funders Public health preparedness funding has fueled a rapid expansion in public health funding over the last 5 years Successful grantwriting provided opportunities to begin and expand progams, however, it also requires strict adherence to funders guidelines 27 In conclusion: Funding for public health is provided by federal, state and local governments, as well as foundations, corporations and other funders Public health preparedness funding has fueled a rapid expansion in public health funding over the last 5 years Successful grantwriting provided opportunities to begin and expand progams, however, it also 28 References Frist B. Public Health and National Security: The Critical Role of Increased Federal Support. Health Affairs 2002:117-130. Heffler, S., Smith, S., Keehan, S., Borger, C., Clemens, M.K., Truffer. U. S. health spending projections for 2004-2014. Health Affairs 2005; 24 (2) p.570. Moulton, A, Halverson, P, Honore, P, and Berkowitz, B. Public Health Finance: A Conceptual Framwork. J Public Health Management Practice 2004: 377-382. 28 29 Questions? If you have any questions, please feel free to contact me by email, telephone or campus mail. Thank you. jen.horney@unc.edu 919-843-5566 Campus Box 8165 Chapel Hill, NC 27599 29