Metta Fund

Hospitals, Government, Nonprofits and Funders Working Together for Lasting Change


SFHIP is a cross-sector collaboration to improve structural determinants of health in the city. In one neighborhood, TLHIP is making a difference block-by-block.

One of the founding principles of Metta Fund’s mission to improve health in San Francisco is that no one organization, agency or provider on its own can change outcomes for all the city’s residents. It will take actors from different sectors coming together to solve health issues and underlying social problems.

As Jennifer Kiss, director of the Tenderloin Health Improvement Partnership (TLHIP), puts it, “We each have resources and our own expertise, but if we’re operating in silos, we can’t create the change we all seek.”

To break out of traditional silos and commit to more structured collaboration, the city’s nonprofit hospitals, the University of California San Francisco (UCSF), and the San Francisco Department of Public Health (DPH) created the San Francisco Health Improvement Partnership (SFHIP) in 2013.

“Each organization or agency had its own responsibility, but in 2013, we decided to combine our work,” said Paula Jones, senior health planner at DPH. “We saw persistent and deep health disparities in San Francisco that were not getting better, so we committed to a citywide collaboration with all health sector players.”

Metta was one of the first private foundations to join SFHIP, demonstrating the foundation’s strong belief in the collective impact model, where a formal structure for collaboration helps actors working toward a common agenda align efforts, share data, and communicate regularly.

“The mission of SFHIP is to mobilize resources in San Francisco to eliminate health disparities and inequities, and that is directly in line with our vision,” said Shalini Iyer, Metta Fund’s director of programs. “Even more, SFHIP’s collective impact model reflects our grantmaking approach, which is focused on collaboration and systemic change.”

Beginning with Measurement

SFHIP’s collaborative work began with conducting a citywide Community Health Needs Assessment (CHNA).

Laws at the federal, state, and local level require hospitals and public health departments to regularly conduct this kind of assessment. More and more, communities around the country are collaborating to do this measurement work together.

With a citywide assessment as the first step, SFHIP helps different actors identify health needs in the population of San Francisco, and work together to address those needs.

“Alignment is a national trend. It’s a new way of working together,” said Jones. “SFHIP is trying to narrow our focus, to bring the health sector together so we can align with other groups, such as the public schools, or nonprofits serving children and families in San Francisco.”

In September 2016, SFHIP completed the most recent CHNA. That assessment informed an implementation plan adopted in early 2017, which will focus the collective work going forward.

The 2016 assessment identified seven health needs that heavily impact disease in San Francisco. These seven needs were then grouped into three priority areas; Metta aligns its grantmaking with the first two of these three areas. These priorities are:

  • Access to Care
  • Healthy Eating and Physical Activity
  • Behavioral Health

“Support from Metta Fund allows us to work with community groups on some of the indicators SFHIP is focused on, such as reducing food insecurity for pregnant mothers,” said Jones. “Those resources enable us to do more specific work.”

Demonstrating the Power of Collective Impact in the Tenderloin

After SFHIP was formed, TLHIP emerged as a demonstration project, where local actors in the Tenderloin could coordinate their work based on the citywide principles of collective impact, communication, shared measurement, and mutually reinforcing activities.

“With TLHIP, we’re taking concepts discussed at a citywide level, and seeing how they apply in a geographically-defined, place-based implementation,” said Kiss, who is the director of TLHIP at the Saint Francis Foundation.

The Saint Francis Foundation and Saint Francis Memorial Hospital led the launch of TLHIP. The community hospital and its supporting foundation have served the Tenderloin community for decades. In that time, TLHIP organizations have seen chronic diseases bring many residents to the hospital’s emergency room and psychiatric unit.

“Despite tremendous human and financial resources serving the population in the Tenderloin, the health of the community hasn’t changed over time” said Kiss. “When we launched TLHIP, we asked ourselves: ‘How can we work differently to disrupt the status quo and improve health outcomes?’”

As part of TLHIP’s emphasis on systemic change, its member organizations shifted their collective focus to address root causes. They’ve studied how societal factors, such as neighborhood safety, food access, and opportunities for physical activity, determine health outcomes. TLHIP works on community interventions that, over time, could prevent ER and psychiatric visits.

Transforming Boeddeker Park

In 2014, the advisory committee guiding TLHIP (representing public, private and nonprofit partners in the Tenderloin) identified place-based interventions that could be potentially be game changers to drive better health outcomes.

“We narrowed 40 blocks of the Tenderloin down to 10 blocks,” said Kiss. “Within those 10 blocks, we identified Action Zones where we could implement changes and have an impact on the community.”

One of the first game changing interventions was the revitalization of Boeddeker Park, at Jones and Eddy Streets. Following the San Francisco Recreation and Parks Department’s refurbishment of the park in 2014, TLHIP’s investment in programming and community engagement helped transform the newly renovated park into a health and safety hub for the entire Tenderloin. The park had long been a focus for crime and drug use, and had been closed for years.

During the planning process, TLHIP applied the collective impact model to bring neighborhood stakeholders together to address resource gaps, and to reimagine Boeddeker Park as a safe, welcoming space for healthy choices, physical activity, and community connection.

With TLHIP funding, the Boys & Girls Club became the master tenant of the renovated park, and brought in other neighborhood organizations as anchor tenants to coordinate programming and keep the park safe.

A New Funding Model

To support its strategy for systems-wide impact in the Tenderloin, TLHIP adopted an innovative pooled funding model, in which foundations like Metta Fund could collectively support strategies set by the partnership.

“We set out to launch a different kind of partnership that could shift the status quo,” said Kiss. “We challenged our funders to really think differently about how they make grants in the Tenderloin.”

As with SFHIP, Metta Fund was one of the first private foundations to contribute to TLHIP’s pooled fund.

“Pooled funding was new for us, committing to a partnership and a vision, rather than to specific organizations,” said Iyer. “But we trusted the organizations involved in the TLHIP partnership and they had many conversations with our board, helping us understand how they were working toward systemic change in the Tenderloin.”

Not only did Metta commit to a new funding model, but also to measure outcomes on a longer timeframe. “Systemic change takes longer than service delivery, and with SFHIP and TLHIP, we are measuring outcomes over 8 to 10 years, rather than 2 or 4 years,” said Iyer.

“The conversations we had with Metta Fund’s board were very helpful for us and for them,” said Kiss. “Because this work is so innovative, it’s helpful to have those deep conversations and together think through how we’ll achieve our collective goals.”

With SFHIP’s core assessments complete, the next step for the citywide partnership is to work together on more projects on the ground, like the renovation of Boeddeker Park.

“We now have a common agenda,” said Jones. “We’re taking it to the next level. We’ve seen our collective impact model in action in a couple places, but as a partnership, our potential is before us.”