Rural Health Initiative

From 2012-2016, the foundation invested in a community change effort aimed at improving health access and eliminating health barriers in three rural counties in the REACH service area.


In 2012, the REACH Foundation created the Rural Health Initiative (RHI) with a goal of breaking through persistent barriers to health care access for rural residents who are low income and medically underserved. The initiative focused on three rural counties that are part of the REACH service area. The RHI was organized to encourage and develop leadership capacity to implement solutions that can remove barriers to health care in rural areas. The goal was to develop a systematic and coordinated approach to community change that would increase the potential for substantial improvement in health.

At the time of the launch of the initiative, the County Health Rankings for Allen County, KS, and Cass and Lafayette counties in Missouri – the three rural Kansas and Missouri counties in the foundation’s service area – documented high rates of uninsurance, a serious shortage of primary care physicians, and higher rates of preventable hospital stays and lower rates of preventive services, such as diabetic screenings and mammography. Across nearly all indicators of quality of health, residents of these rural counties were suffering from lack of high-quality, affordable health care and poorer health outcomes than people in more urban communities. Against this backdrop, and given the foundation’s mandate to improve health care access and quality, and health outcomes in our service area, the foundation created the RHI to serve as a vehicle for solutions.

The RHI was organized to develop leadership capacity to implement solutions that can remove barriers to health care in rural areas.

The initiative began with a planning year, during which foundation staff worked with grantees in the three counties to develop collaborative processes for carrying out community health improvement efforts. The foundation provided planning grants and access to rural health innovation and technical assistance in network building and community change. The foundation asked the county leadership teams to engage a cross-section of county stakeholders, discuss health needs with diverse groups throughout their counties via learning communities and other networks, and to develop a framework for identifying and implementing solutions for their particular health challenges.

After the initial year, the foundation provided project grants to each county and began to define a structure for helping county leaders establish and strengthen core leadership and networks that could undertake community change processes and sustain them. As local planning and projects unfolded, foundation staff and technical assistance providers recognized the necessity of expanding collaboration and community engagement. Over time, the predominant strategy for change in the RHI moved to a network approach, which involved creating new relationships and collaborations to leverage individual and collective strengths and interests.

The foundation’s own experience, insights from technical assistance providers, and evaluations of rural community efforts to date have led to a promising framework for growing sustainable innovation capacity called the Rural Community Capacity Framework. The framework is based on four key conditions and capacities of community change and innovation and how these capacities lay a foundation for rural health improvement. Over the course of the initiative, the foundation and technical assistance team learned from the rural county partners and from their experiences, producing strong outcomes and building the foundation’s understanding of how to invest in community change.

In October 2016, The foundation convened rural health partners, technical assistance providers, foundation leaders and others engaged in rural health to reflect on the experiences and results of the initiative. The materials provided offer tools and insights for others interested in this approach to community change.


RHI Initiative Overview

For more initiative information , contact William Moore, Ph.D., Vice President of Program and Evaluation, at

Resources and Reports

RHI Network Guides

  1. RHI Evaluation
  2. RHI Network Communications
  3. RHI Network Leadership
  4. RHI Network Strategy and Structure
  5. RHI Sustainability
  6. RHI Technical Assistance

RHI Presentations

RHI Evaluation Reports

  1. Stretching, Influencing, Managing and Surviving: A Rural Health Initiative Learning Experiment, Gwen Martin, 2013
  2. REACH Foundation’s Rural Health Initiative: Year Three Report (CY2014), Adena Klem and June Holley, 2014
  3. Rural Health Initiative Theory of Change
  4. Rural Culture Competency in Health Care White Paper, Cheryl Holmes and Michelle Levy, 2015
  5. Rural Culture Competency in Health Care White Paper: Executive Summary, Cheryl Holmes and Michelle Levy, 2015