Icing or cake? Grant competitions as a model for funding chronic disease prevention in Tasmania, Australia

Competitive grant funding is a well-established mechanism for generating activity and interventions in the field of chronic disease prevention. Yet grant competitions may be burdensome for organizations, and money may not be enough to bring about lasting change in communities. In this study, we explore the dynamics of awarding and receiving money in the context of a state-level government grant competition to support community organizations and promote community-driven action for health and well-being in Tasmania, Australia. Drawing on reflections of successful grant recipients and real-time observation of grant decision-making, we consider the role and value of grant competitions both for individual organizations and for generating broader change processes. We found that grant competitions operated according to an 'icing-on-the-cake' approach to funding, whereby money was provided for extra activities and new initiatives. In this way, the grant competition was valuable not only for stimulating new programme activities but also to effect broader organizational change, such as developing planning capacity, igniting new directions and pushing organizations towards 'health'-focused activities. But for smaller organizations, grant funding was often stretched to support core work (i.e. cake rather than icing). Grants targeting specific focus areas could be a drain on resources if they diverted staff time away from core activities. We suggest an alternative approach to funding in which grants are able to be more responsive to the needs of community organizations and the support they require, as well as to desired outcomes. We describe the policy response to the results to date. Lay Summary When a person attends a class on buying, storing and cooking fresh vegetables, or enrols in a walking group, or joins others to learn first aid, this 'community-based health promotion' is often the product of ideas and actions taken by staff employed in health services, local government and the community sector (e.g. neighbourhood houses). Grant competitions are intended to foster new ideas by providing money for new services, equipment or expertise. We investigated what happens behind the scenes when state government grants are awarded. We found that large organizations fare well as they can use new funds to innovate or gather evidence about the value of new ventures. But many smaller organizations suffer as they do not have the person power to write grants, hire extra staff or support new activities. Restrictions on what can and can't be done with grant money can make receiving grants a burden, that is, grants fund 'icing' when what is needed is 'cake'. An inadequate mix of funding types at the community level can mean that grant schemes are pressured to fill gaps for which they were not designed. Our policy partners have responded with more community-centred grant making, better tailored to various levels of community organizational need.