Orange County officials have decided not to renew an exclusive contract with Latino Health Access to provide promotores services throughout the county, opting instead to divvy up the approximately $500,000 contract among several community organizations.
The decision has taken Latino Health Access (LHA) leaders by surprise and left the organization scrambling to obtain other funding to keep its community-based health awareness program running at its current level.
"You invest in these type of things — now you have a team that is trained and doing great work — and your response is we're not going to renew this?" said America Bracho, President and CEO of LHA, of the county's decision, which was made in recent months.
Bracho said she is convinced that the decision was, at least on some level, retribution for a dust-up LHA had with the Orange County Board of Supervisors when the two-year grant was up for approval in 2011.
Then, Supervisors John Moorlach and Shawn Nelson took issue with the fact that promotora, a Spanish word, was being used to describe a county-funded program and hinted that the grant might not be approved. Nelson went so far as to take issue with the word "Latino" in Latino Health Access.
Meanwhile, Bracho said, county staff was telling her the word promotora couldn't be used and that the name of the program would have to be changed to "Community Outreach Services." Staff made this demand even though the 2010 request for proposal for the grant specifically mentioned the word promotora.
The supervisors faced a swift backlash after Voice of OC published their comments — including rebukes from state legislators Jose Solorio and Lou Correa — and quickly softened their stance. Nelson even invited LHA officials to his office to discuss the issue.
Ultimately, the board came to what county officials considered a compromise and approved the program, but under the name "Community Outreach Services/Promotora."
Now, Bracho believes, with the original grant up for renewal in June, the county is exacting a certain measure of political payback. "The only answer is they approved [the original grant] against their own will in the first place, and it is a political decision," she said.
Supervisors and other county officials said the decision was made as part of an overall effort to consolidate programs and to broaden the promotores program, not to punish LHA.
"I have not heard anything about that. It is just a non issue," Nelson said. "That is not what is going on."
Furthermore, county officials say, it was made clear from the start that LHA would not be the sole provider of promotores over the long term.
"They were told from the very beginning that this may happen," said Jenny Qian, division manager for prevention and intervention for the county Health Care Agency's behavioral health services branch.
Said Supervisor Janet Nguyen: "I completely understand where LHA is coming from, but everyone knows that a contract is a contract."
A Key Community Health Link
Promotores have long played a key role in administering health care in Latino and other minority communities, acting as liaison for people who because of economic and cultural reasons do not have ready access to the health care system. The concept first began to be widely used in the United States in the 1960s and 1970s.
Bracho, a former doctor in rural Venezuela, made the program a cornerstone of LHA when she founded the organization in 1993. Today, LHA's 42 paid promotores make contact with some 40,000 people each year.
Among other services, they administer programs that focus on diabetes prevention and management, obesity, alcoholism, mental health, domestic abuse prevention, elder care and women’s health.
By and large, promotores do not have formal medical training, but they have extensive knowledge on a variety of health and mental health issues, especially regarding preventative care. And public health experts have said that promotores play a crucial role in the overall health of communities in places like central Orange County.
"They are recruited from the communities they live in, so they have firsthand knowledge of what the community concerns are and how to best communicate across the cultural divide," said Steven P. Wallace, associate director of the UCLA Center for Health Policy Research.
A policy paper prepared in 2008 for the California Institute for Mental Health said promotores programs are "particularly well-suited" for the prevention and early intervention component of the state Mental Health Services Act. The act, passed as Prop. 63 by California voters in 2004, mandates hundreds of millions of dollars in mental health spending annually.
Spreading Money Around
Bracho acknowledged that the county never offered any specific guarantees beyond the two-year grant. However, she said, given the great feedback the organization was getting from county staff, she felt misled when word came that the exclusive grant would not be renewed.
"People working with us at the staff level are very happy with the results. They say, you guys are amazing, how can you do all this outreach," Bracho said. "They asked us to do a training for other organizations, and we did it for free. … Next thing they say is that it won't be renewed."
Most recently, LHA held a training in November that included: Multi-Ethnic Collaborative of Community Agencies; Orange County Asian Pacific Islander Community Alliance; Western Youth Services; and Orange County Child Abuse Prevention Center.
Now the plan is for $510,000 that was going exclusively to LHA to be split evenly between LHA and the four groups it recently trained. LHA receives about another $480,000 from the county for general outreach efforts, so its total funding from the county will be cut from $980,000 to $575,000, Qian said.
The decision to divide the grant came at the staff level, and Qian emphasized that it was done to cut down on duplicative programs and spread the county's limited resources as widely as possible.
Supervisor Nelson echoed Qian. "It's not so much that Latino Health Access did anything wrong. It's just that other groups are in the same business," he said.
However, there is little evidence that the other organizations even asked for the money or are expecting it. MECCA Executive Director Nancee Lee Allen said had heard some rumors but had not been made officially aware that her organization would be splitting the grant.
"This whole thing is kind of surprising to me," Allen said. "None of this has been discussed with me."
Bracho said she does not begrudge the other nonprofits for receiving county grant money and welcomes them to the overall mission of the promotores program. But what is "so frustrating," she said, is that all the talk is about spreading the money around and not about the quality of the service.
Bracho added that county officials owe the taxpayers a high-quality program according to the requirements of the Prop. 63 funding. "If you are going to take this money, is your objective to distribute the money or to have quality programs?" she asked.
"These partners do good work, but there has not been a programmatic quality conversation. … The process by which they made that decision was nonexistent."
All told, LHA has the equivalent of seven full-time positions that are at risk due to the reduction in county funding. Bracho said, however, she is confident that the organization will raise the necessary funds from other sources to keep those people working.
She also indicated that she might be done counting on Orange County for any funding. "We don't want to be dancing to the rhythm of a new instrument every year," she said.
Please contact David Washburn directly at firstname.lastname@example.org.