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Implementation Considerations for Community Health Programs

Each rural health program is different and there is no one-size-fits-all implementation strategy. Successful programs identify existing resources and best practices, and tailor them to address their community's needs. These resources are adapted based on program goals, model, and scope (See Considerations When Adapting a Program - Module 2). Depending on the health programs, required resources may include staff, space, and transportation.

Partnership Structure and Governance

Rural community health programs may involve formal or informal partnerships, depending on the vision, mission, and goals of the partnership. Informal rural partnerships are often ad hoc, have fluid membership, and lack formal governance structures. Formal governing bodies are often more structured, and may include a coalition, steering committee, board of directors, and elected officials.

A board of directors serves a variety of roles in a partnership, including providing oversight to accomplish the goals of the group and ensuring the work is conducted collaboratively. Members are often recruited to sit on the board of directors based on their expertise and commitment to the partnership's mission. If the partnership wants to address a specific problem or concern, it is common to develop subcommittees or task forces. Board members may volunteer or be assigned to work on subcommittees or task forces, and if the issue in question exceeds the expertise of the board members, outside experts may be invited to the table.

Formal partnerships may involve signing a Memorandum of Agreement/Understanding (MOA/MOU) to represent a member's investment and agreement to participate in the partnership. Typically, the document includes an overview of goals and activities of the partnership and provides details on the signing member's role and responsibilities. The Centers for Disease Control and Prevention (CDC) provides additional information about MOUs in their Guiding Principles for Public-Private Partnerships.

For additional information on partnerships, see Identify and Engage Partners, Community Members, and Decision-Makers in Module 1.

Recruiting and Retaining Staff

An important factor in recruiting is how program staff will fit into an organization and community. Generally, program scope and community needs should drive recruitment. For example, an organization may recruit volunteers to conduct outreach activities, or hire a certified professional to deliver screening services. The type of staff hired should align with the job expectations, time commitment, and compensation for the role. Since rural communities are typically highly connected, community health workers may be especially adept at building community capacity while delivering services.

Rural communities can also consider different strategies to retain staff over time. Staff that feel supported and appreciated tend to feel better about their work and their role in an organization. The Recruitment and Retention for Rural Health Facilities topic guide provides additional considerations for recruitment.

Training for staff

Trainings can be critical to successful program implementation. Training formats will depend on the program components and structure, and could include role-playing, case studies, and team discussions to demonstrate direct connections between training content and job tasks. Some rural programs also partner new staff with experienced staff to provide mentorship and individual instruction.


Certain rural health programs, such as those involving a range of medical providers or home visits, may consider developing a risk management plan to mitigate liability for potential issues. Risk management plans can also help programs determine the training needs of staff members. For example, programs that involve home visits or travel should provide safety training to staff members. ECRI offers a sample risk management plan for a community health center.

Additional Considerations

For implementation considerations for specific types of programs, see:

Resources to Learn More

The Community Tool Box: Chapter 5 – Section 5. Coalition Building - Starting a Coalition
Presents an overview of what a coalition is and the importance of organizing a coalition of individuals and professionals to achieve a common goal. Discusses when to develop a governing body and who should be included in the group.
Organization(s): Community Tool Box

The Community Tool Box: Chapter 9 – Section 3. Developing Multisector Task Forces or Action Committees for the Initiative
Describes steps involved in establishing multisector task forces or action committees.
Organization(s): Community Tool Box

The Community Tool Box: Chapter 9 – Section 4. Developing an Ongoing Board of Directors
Defines the role of a coalition's board of directors and offers guidance for developing a board.
Organization(s): Community Tool Box