The Future of Public Health Funding: Why Flexibility Matters More Than Ever

by Jon Scaccia February 24, 2025

Public health crises are unpredictable. And right now, public health governance is unpredictable.

A flu outbreak can suddenly overwhelm a community, opioid overdoses can spike in unexpected places, and emerging health threats—like Avian flu—can demand an immediate response. Yet, despite the dynamic nature of public health, funding models remain rigid.

Traditional government grants often come with strict guidelines, dictating exactly how funds must be spent, leaving little room for adaptation. While accountability is essential, this inflexibility can prevent organizations from responding to real-world challenges in a timely and effective manner. That’s why there’s growing interest in flexible grant schemes, which allow organizations to adjust their spending, project timelines, and objectives as needs evolve.

A recent systematic scoping review explored the evidence on flexible grant schemes, their effectiveness, and the factors that contribute to their success. The findings provide valuable insights for policymakers, funders, and public health practitioners seeking better ways to allocate resources.

What Are Flexible Grant Schemes?

Unlike traditional funding models, flexible grants provide more autonomy to grantees. They allow public health agencies and community organizations to shift their priorities, reallocate resources, and adjust their strategies based on emerging challenges. Instead of being locked into a one-size-fits-all approach, these grants encourage innovation and responsiveness.

However, the review found no universally accepted definition of “flexibility.” The research identified three main themes that describe how flexibility is interpreted:

• Adaptation: The ability to modify services and activities based on local needs.
• Autonomy: Reduced restrictions from funders, giving organizations more control over how they use the funds.
• Coordination: The ability to pool funds from multiple sources for more cohesive and comprehensive public health responses.

What the Research Found

The review analyzed 38 publications, spanning multiple sectors, with a focus on public health. Interest in flexible grants has grown significantly since 2010, yet the research revealed some key gaps:

1. Lack of Consistent Definitions: Many studies failed to clearly define what made a grant “flexible,” making it difficult to compare findings across different programs.
2. Limited Evaluations: Only five of the 38 publications included actual evaluations of grant effectiveness. These evaluations were mostly self-reported by grantees, which raises concerns about bias and accuracy.
3. Few Client-Level Outcomes: Most evaluations focused on administrative and infrastructure improvements rather than assessing whether flexible grants led to better health outcomes for individuals and communities.
4. Success Factors Identified: Despite these limitations, researchers pinpointed seven key factors that contributed to successful flexible grant programs:
   • Collaboration and partnership building
   • Staff capacity (knowledge, skills, and time)
   • Clear and effective communication
   • Alignment among stakeholders
   • Managing uncertainty (e.g., ongoing funding concerns)
   • Strong accountability mechanisms
   • Reducing administrative burdens

Why This Matters

Imagine you’re a director at a local public health agency. Your organization receives a grant to address childhood obesity, with strict guidelines requiring funds to be used only for nutrition education. Halfway through the project, new data reveals that lack of safe outdoor spaces is a bigger barrier to kids getting exercise. Under a traditional grant, you’d be stuck with the original plan. But with a flexible grant, you could shift funds toward building community parks, increasing physical activity opportunities, and achieving better public health outcomes.

That’s the power of flexibility. It allows funding to follow the problem instead of trying to force the problem into a rigid funding structure.

What’s Next?

While flexible grant models show promise, much work remains. The research underscores the need for better evaluations (music to our ears) to measure their impact. Policymakers must define flexibility more clearly and ensure funding structures support—not hinder—public health goals.

And for the short term, we may need to turn our advocacy efforts to foundations like RWJF or deBeaumont.

To improve flexible grant schemes, researchers recommend:

1. Developing a Clear Framework: Standardizing how flexibility is defined and measured can help organizations design better grant programs.
2. Investing in Capacity Building: Both grantees and funders need training and resources to navigate flexible funding models effectively.
3. Conducting Robust Evaluations: Future research should use more rigorous methods—such as pre- and post-funding data collection—to assess whether flexible grants truly improve health outcomes.

Join the Conversation

How do you think public health funding can be improved? Have you worked with flexible grant models in your organization? What challenges or successes have you experienced? Share your thoughts in the comments or join the discussion on social media.

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