Strengthening State Immunization Infrastructure Through Public Health-Community Action Partnerships

Introduction

The success of public health initiatives often hinges on the ability to build meaningful partnerships with local communities. State public health agencies can enhance their efforts by collaborating with the Community Action network, which has a long history of engaging communities and supporting health-related projects, including those directly connecting individuals to health care services like immunization. CAAs are invaluable partners themselves but can also facilitate collaboration between health agencies and other diverse networks through the wealth of their connections with local governments, social services organizations, local businesses, religious entities, and more.

This toolkit is designed to help health agencies navigate the process of building and maintaining partnerships with CAAs and other community-based organizations — empowering agencies to leverage community-driven approaches that ensure the sustainability and effectiveness of immunization infrastructure.

How to Use This Toolkit

To make the most of this toolkit, public health professionals and partners should follow these steps:

1. Familiarize Yourself with the Community Action Network: Begin by reviewing the introductory sections that explain the role and value of the Community Action network. Understanding its capacity for fostering engagement through direct community involvement and health initiative support will provide context for successful partnerships.
2. Learn from Real-World Application: Gain insights from the included examples into how other state health agencies have worked with Community Action partners.
3. Apply Partnership Guidance and Implement Collaborative Strategies: Focus on the practical steps that can help you build strong, long-lasting relationships with Community Action organizations to ensure you meet mutual goals. These strategies are designed to help you integrate community-driven approaches into state health programs for lasting impact.

Following this framework will equip state and territorial health agencies to develop and sustain partnerships that enhance immunization efforts and support overall community health.

What Is Community Action?

CAAs connect individuals and families to programs and services that help them succeed — from high-quality education programs for children to job retraining for adults, stable and affordable housing for families, utility assistance, and health care services or referrals — and promote community-wide solutions to seemingly stubborn challenges throughout cities, suburbs, and rural areas. CAAs often partner locally, statewide, and nationally to support infrastructure change and to share their expertise on how to promote greater economic opportunity for children and families. CAAs operate at the local level, serving 99% of America’s counties, and boast a network of 1,000+ agencies nationwide. CAAs are funded through the Community Services Block Grant (CSBG) and connected/supported through a multi-level network including the National Community Action Partnership (NCAP), regional and state associations.

Understanding the Community Action Approach

A core strength of CAAs lies in their ongoing, systematic approach to understanding and addressing local needs. Central to this is the Community Needs Assessment, which the Community Services Block Grant requires agencies to conduct at least every three years and informs strategic planning and program development. These assessments combine quantitative data (e.g., demographics, economic indicators, health statistics, and housing data) with community input to identify key challenges and guide responsive, targeted interventions.

With a clear understanding of community needs and resources, CAAs act through a multi-faceted approach. Their services range from emergency support to long-term solutions like housing assistance, job training, education, and financial empowerment. Individualized case management helps clients navigate systems and access tailored resources. Collaboration is key — CAAs partner with local organizations, government agencies, and businesses to build a coordinated, effective service network.

To maximize impact, CAAs use performance management frameworks like Results Oriented Management and Accountability to assess needs, determine outcomes, plan services and strategies, measure progress, and evaluate outcomes. This ongoing cycle of assessment, service delivery, and collaboration helps empower individuals and families toward economic security and community resilience.

Public Health and Community Action

CAAs are ideal and necessary public health partners given their intimate understanding of community needs and offering of programs/services that are critical to the health and well-being of their community residents. They are uniquely positioned to help overcome immunization access challenges through targeted education, navigation services, and community-based programming. Public health agencies can partner with state and local CAAs to support immunization efforts, by hosting vaccine clinics at trusted community sites, conducting outreach, and leveraging their case management frameworks to identify and connect individuals with services — ultimately strengthening immunization infrastructure and improving vaccine coverage across jurisdictions.

Between 2022 and 2024, ASTHO and NCAP partnered with five CAAs under CDC’s Partnering for Vaccine Equity Program (P4VE). The five recruited CAAs leveraged diverse partnerships with their state and local public health agencies, health care providers, and other crucial community partners to create action plans grounded in evidence-based strategies to increase acceptance and uptake of vaccines in their communities:

• In South Carolina, CAAs formed partnerships between community action, local federally qualified health care centers, emergency medical services, and state health departments to provide access to vaccines in rural areas with limited access to health care services.
• In Georgia, CAAs partnered with churches to distribute materials with evidence-based messaging and information on vaccine events to congregation members.
• In Arkansas, CAAs utilized existing CAA programming serving individuals experiencing homelessness and families participating in Head Start as bridges to vaccine services.
• In California, CAAs empowered community partners already doing vaccination work to expand the reach and impact of vaccine clinic pop-ups.
• In Alabama, CAAs engaged trusted community messengers and conducted continuous outreach to new businesses/agencies to spread the word about vaccine events.

The five recruited CAAs played an integral role in facilitating these partnerships and their ties with health departments, and other health care partners bolstered their work. For more information on how CAAs can help amplify public health immunization efforts, access ASTHO’s Championing Change toolkit.

In addition to immunization-specific initiatives, public health agencies can partner with their state or local CAAs to advance public health and infectious disease prevention broadly. As demonstrated during the COVID-19 pandemic, CAAs are well-positioned to support infectious disease prevention by sharing accurate information, facilitating access to testing, and implementing other critical interventions. During the early stages of the COVID-19 pandemic, CAAs and public health agencies partnered to identify and meet COVID-19 testing and vaccination needs as well as a variety of other essential and associated needs worsened by the pandemic (e.g., lack of access to food, water, shelter, and health care).

Partnering with Community Action

State and local health agencies can find sustainable ways to collaborate with the Community Action network in strengthening the infrastructure and resources available to implement health-related interventions. To begin, NCAP’s CAA finder can help public health agencies identify community action partners at the local, state, and regional levels. After identifying a CAA to partner with, there are a few considerations to keep in mind when starting a working relationship:

Consideration #1: Taking a Mutual Approach

It is important to keep in mind that CAAs often use a whole family approach to identify and address the needs of both the children and adults within a family unit. This approach, taken with a whole health approach, can be effective in protecting the health and well-being of community members. The following are examples of low-burden, high-impact ways health agencies can partner with a CAA for mutual benefit:

• Engaging parents and grandparents of children enrolling in Head Start programs to assess if they are up to date on their own yearly vaccinations.
• Providing immunizations during existing back-to-school or other fall events to prepare for respiratory virus season.
• Identifying community needs during health fairs via surveys and/or one-on-one conversations — as trusted organizations, CAAs may have a closer pulse on relevant health-related needs in the community.
• Providing up-to-date information on vaccines and other health interventions to allow community members to make informed choices about their health needs.

Collaborative initiatives like these allow CAAs to expand the reach and breadth of their services to the community, and health departments to provide health-related information and interventions through a trusted channel. Many CAAs already utilize integrated case management approaches that address clients’ comprehensive health needs, encompassing crucial factors like health care access, management of chronic diseases, housing, and nutrition.

Consideration #2: Funding

To consistently fund these initiatives and increase the impact of health investments, public health agencies and CAAs can consider braiding and layering funding sources, or leveraging multiple funding streams to support foundational initiatives that benefit multiple programs. While the reporting process can come with complexities, the effort allows greater flexibility and innovation to address basic needs and achieve sustainable outcomes. ASTHO maintains several resources on braiding and layering and its ability to amplify public health impact.

Consideration #3: Prioritizing Collaboration with Community Leaders

One of the benefits of partnering with CAAs is they have experience and expertise in using a community action team approach to inform and advance health-related initiatives, which leverages networks of partners and trusted leaders to extend the reach of communications and outreach programs. Under the P4VE program, ASTHO’s CAA partners worked with organizations including schools and universities, nursing students, emergency medical services, community health workers, faith-based leaders, business owners, and other influential community members to increase their outreach efforts and improve access to critical vaccination services.

Trusted community leaders can be influential public health messengers when public health partners provide timely, relevant, and accurate information. The relationship between public health agencies and community leaders is critical during outbreaks or other emergencies, but building the initial connection and sustaining it long term are essential pieces. By prioritizing input, partnership, and continual feedback from community members throughout the course of collaborating, health agencies have the potential to significantly amplify their impact.

Consideration #4: Data and Evaluation

Data collection and evaluation are critical to assessing and demonstrating the impact of public health-community action partnerships. The following examples show how CAAs and other community partners have approached data collection on immunization initiatives:

• Under ASTHO’s P4VE project, Community Action Program for Central Arkansas conducted an anonymous pre-assessment survey in its service areas to understand concerns and preferences related to vaccine access and acceptance prior to conducting outreach.
• Staff at University of Florida’s Program to Alleviate National Disparities in Ethnic and Minority Immunizations in the Community developed an anonymous questionnaire, the Survey of Perceptions, to track community perspectives on the COVID-19 pandemic. They fielded the survey throughout various stages of the pandemic, which yielded critical information on changing perceptions of risk and preferences related to vaccinations.
• Other programs developed surveys based on CDC’s Rapid Community Assessment Guide, achieving similar results.

There are a variety of ways to collect data on the success of collaborative initiatives, but it is important to consider three things:

1. Balancing Administrative Burden: Under work funded through the P4VE cooperative agreement, ASTHO, NCAP, and the five CAAs worked with Gramercy Research Group to evaluate the impact of the community outreach work on increasing access to vaccines. Gramercy developed a simple data collection form online where the CAAs could report on the reach of their efforts, using simple metrics such as number and location of events, vaccines being administered, number of staff and community members engaged, and qualitative information (e.g., unique successes or challenges they encountered). This method allowed partners to track progress without undue burden on community agency staff. A more rigorous approach involving community surveys and focus groups could yield more data on community and regional outcomes. However you choose to collect data, it is important to seek input on what is feasible for your agency and CAA partners.
2. Feedback and Outcome Sharing: Another key consideration in supporting a successful partnership with CAAs is ensuring that the impacted community receives routine data, insights, and lessons learned. To be truly sustainable, public health-community action partnerships should be mutually beneficial, with the shared goal of improving community capacity to address health needs.
3. Leveraging the Impact of Qualitative Data: Data storytelling is a method of weaving quantitative and qualitative information together in a meaningful way to share the narrative of the program and its effect on a community. In addition to reporting quantitative progress to funders under the P4VE project, ASTHO developed blogs, newscasts, and other media to share its work publicly. In addition, Gramercy developed case studies for each CAA to use in their media and communication efforts. The case studies included their own data, program examples, quotes, and photos from their work. Qualitative data, such as the perspectives, benefits, and challenges of the program in the words of community members themselves, are important to capture and help produce data of interest to all stakeholders.

Resources

• Championing Change: A Toolkit for Addressing Vaccine Equity Through Community Mobilization by ASTHO
• Partnering for Vaccine Equity: A Public Health-Community Action Model to Advance Delivery of Essential Health Services by the Journal of Public Health Management and Practice
• Community Action Academy eCourse: Lessons Learned from the Vaccine Equity Project by National Community Action Partnership (login required)