Pivoting to Advocacy and Organizing: Changing Grantmaking Tactics in Service of Our Core Mission - Exponent Philanthropy
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Pivoting to Advocacy and Organizing: Changing Grantmaking Tactics in Service of Our Core Mission

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“This has been the most pivotal grant to our organization since I got here. It has enabled us to be in a space that we weren’t in before.”

I heard this recently from our first advocacy grant partner, Health Care For All Massachusetts (HCFA). It highlights how a risk the Rx Foundation took in 2019 has had impact on the ground in communities across the U.S. With our funding, HCFA added a Health Justice Organizer to the team, who spent the last several years listening to and building relationships with community-based organizations across the state.

HCFA harnessed their expertise in systems-level thinking and policy to support the CBO’s priorities and bases of support, in effect amplifying those voices. And building on that groundwork, HCFA is now actively reducing barriers to COVID-19 vaccines in some of Massachusetts’ hardest hit communities.

In each state where we support partner organizations, we hope to see growth in the collective power of the advocacy ecosystem.

Building advocacy, organizing, and citizen-engagement capacity and infrastructure

With the support of more than $2 million in Rx Foundation grants to date, 16 organizations are building advocacy, organizing, and citizen-engagement capacity and infrastructure in 12 states. While these grants began before the pandemic, each partner played a critical role in their community during it; acting as trusted sources of information, and organizing to advocate for policies to ease hardships brought on by COVID-19.

In the first 18 years, the Rx Foundation made over $20 million in grants to support innovative leaders and projects, largely based within the health care delivery system. While many of those grants were impactful, we saw the limits of programmatic changes in broadly improving health care quality and access.

The Building Capacity for Health Advocacy program was a big shift and logical next step for a foundation established in 2002 by a family in Boston who had a national vision of “a prescription for better health care.”

In 2017, the foundation began engaging with and listening to experts on advocacy, community organizing and capacity building, both within and outside of philanthropy. What emerged from that process was a stated desire to foster greater capacity and infrastructure among advocates and organizations to champion issues that promote social justice through better health and health care.

Strengthening the advocacy ecosystem

The majority of our advocacy grants are three-year, six figure commitments. Almost all of them include sub-grants to smaller partner organizations that we are unlikely to have reached directly. This was an important part of how we structured the program; rather than strengthening individual organizations, our goal was to strengthen the advocacy ecosystem.

In another first for the Rx Foundation, we brought grant partners together as a virtual learning cohort to share their expertise and connect with peers. This includes an online community, virtual meetings and additional funding for training opportunities with organizations like PowerLabs and Social Movement Technologies.

Now in our second year of the Building Capacity for Health Advocacy program, there is much to learn and share. Here are a few brief reflections and lessons learned:

  • There is value in taking a field building approach. Our advocacy partners have shared that they wish more funders would give them the flexibility to sub-grant funds. This makes it possible for them to spend more time building new partnerships, especially with underrepresented groups, and they have done amazing work to develop issue priorities and policy agendas in partnership with communities and coalitions. Rx resources help make this possible, but never dictate the agenda.
  • There is work to do to bridge the divide between grassroots organizing and “grasstops” legislative advocacy. Many of our partners are bringing those leaders and groups together to ensure they’re building power at the community level, while legislative policy agendas are built on the priorities and energies of those communities. Foundation resources can help foster the time and space for that work to happen.
  • Funders should support advocacy, organizing and citizen-engagement as key strategies for achieving more just, equitable and healthy communities. Power is a social determinant of health, and civic engagement is one of the most important elements of moving toward the systemic changes that will create conditions for real innovation and progress.

No funder is too small to impact this work. As the sole employee of the foundation at the time, I built this program with the generous advice and expertise from philanthropy colleagues, advocacy experts and our board of trustees.

When I hear advocacy leaders say this grant program was a game changer, contributing to their mission of building real power in communities, I know that both the heavy lift and risk of doing something new were more than worth it.

Jennie Riley is Executive Director of the Rx Foundation and Secretary to the Rx Foundation Board. Since 2014, she has worked with the Foundation to seek out and fund innovative projects and people to develop groundbreaking, cost-saving improvements in health care quality and access in the United States. Jennie’s previous experience includes working with Partners In Health to support health care delivery in Lesotho, contributing to the development of an innovative program to increase access to quality clinical care for pregnant women, newborns and children in remote, rural areas. She has a BA in Biology from Smith College, and a Master’s degree from The Fletcher School of Law & Diplomacy.


  1. Scott Gelzer

    Thanks for sharing your work, is interesting. Mindful of the fact that the overwhelming number of funders are much smaller than Rx I’d like to know more about how you worked with smaller funders.

  2. Joh Evans Coleman

    I am interested acquiring infomation funding specifically for advocacy, family suppport and caregivers.

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