Bridging the Gap: Community-Based Organizations Seek Trust, Tools and Funding to Advance Public Health

The Collective Health Equity Report Cover

Community-based organizations (CBOs) are the cornerstone of community health—yet across the country they face substantial uncertainty, according to a new national survey supported by Τhe Pfizer Multicultural Health Equity Collective (The Collective).

These on-the-ground, grassroot nonprofits play a vital role in improving health, particularly for historically underserved populations, as they build trust and meet local needs. As part of Pfizer’s long-term efforts to uplift and strengthen community health centers, The Collective sought to better understand current challenges and opportunities to support CBOs working to advance health equity.

Results from this national survey of nearly 500 health-focused CBOs in the United States, Puerto Rico, and tribal nations reveal they face persistent and systemic challenges, most notably unstable funding, limited access to capital, and underinvestment in organizational capacity.

Improving health outcomes for underserved communities requires trust and collaboration—and CBOs are at the core of those efforts. This survey helps uncover ways we can support those working on-the-ground.

By exploring organizational resilience, capacity and resources, as well as public policy influence and engagement, the survey, developed in partnership with NORC at the University of Chicago and the National Collaborative for Health Equity (NCHE), was designed to help elevate the voices of organizations serving marginalized communities.

Key Findings

Funding remains a major barrier, especially for smaller CBOs.

Bar graph of funding cut impacts by budget category and funding source

Survey results underscored the financial instability CBOs face and inequitable access to government funding.

37% of CBOs lack funding to support planned programming for the next 12 months and 36% expressed concern about financial stability over the next 3-4 years.
While larger CBOs receive a higher proportion of government funding and have been more impacted by recent budget cuts, the smallest CBOs expressed the greatest concern about their long-term financial stability.

Challenges to fundraising, such as limited access to high net-worth individuals, limited staff time, and burdensome grant application processes also disproportionately impact smaller CBOs, which often lack the infrastructure, networks, and expertise needed to navigate competitive and resource-intensive funding systems.

Community-based organizations are the lifeblood of healthy communities and these results demonstrate the urgent need for greater, more reliable and long-term funding sources to help shore up and sustain their impact into the future.

Public Policy has great influence on CBO priorities, yet a trust gap remains.

Circle graphs showing activities to influence local, state, or federal policies that CBOs participate in

The survey revealed that while CBOs are deeply impacted by and engaged in public policy, a substantial disparity in trust exists between CBOs and policymakers.

A majority (79%) said policy engagement is central to their work and 85% reported collaborating with policymakers.
CBOs reported that policy decisions at every level, state (85%), federal (81%), and local (77%), directly shape their programmatic priorities.
Only 40% of CBOs believe policymakers trust their input and expertise.

Despite their active involvement with policymakers, the results indicate CBOs perceive a lack of meaningful policy influence.

Community-based organizations are experts in fostering community trust and cultural understanding, yet too often their role is overlooked or undervalued. We need to provide CBOs with a seat at the table and a role in decision-making.

Circle graphs showing staff development resources that CBOs reported would be useful to them

Beyond funding, CBOs seek capacity building and access to tools

In addition to identifying barriers, CBOs shed light on the top tools and resources needed to strengthen their capacity and impact.

Nearly all respondents (95%) emphasized the need for improved data collection and analysis tools, with 75% seeking external support for monitoring and evaluation training.
Practical storytelling resources were also a priority, with 73% requesting tools to help capture personal testimonies from those they serve.
More than two-thirds (68%) highlighted the importance of grant writing and fundraising skill-building, as well as opportunities for deeper collaboration with other organizations (68%).

These findings demonstrate a clear call from CBOs for targeted capacity-building support to help them advance health equity.

Our hope is this research will help open the door to critical, timely discussions, providing the foundation for CBOs, donors and other stakeholders to come together around shared solutions.

Recommendations and Opportunities

In a rapidly changing healthcare environment, the findings highlight clear actions for donors, policymakers, and other collaborators:

Provide more reliable and flexible funding that invests in strengthening operations and creating more equitable funding structures to support all organizations.
Build stronger and more inclusive relationships with CBOs to engage them in every step of policymaking processes.
Support CBOs with tangible capacity-building resources, particularly data collection and analysis tools and training, storytelling support, and opportunities for new partnerships and networks.

About the Survey

Survey respondents	491 health-focused CBOs
Geography	U.S., Puerto Rico, and tribal nations
Design	Web-based survey informed by community advisory board
Focus	Challenges faced by health-focused CBOs
Outcomes	Funding instability threatens the sustainability of programming, with 37% of CBOs lacking sufficient funds for the next 12 months. Barriers to fundraising, including limited staff time and access to high net-worth donors, are widespread across organizations of all sizes. Policy engagement is a priority for most CBOs, yet only 40% feel their expertise is trusted by policymakers. Tools and training for data collection, storytelling, and grant writing identified by CBOs ability as top-needed resource.

For more details about the survey and the report, visit the NCHE website.

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