Sustainability in Public Health

In the non-business sector, success is more difficult to calculate. You are mission-driven organizations, and you aren’t seeking to make a profit.

Profit, remember, is revenue that exceeds cost. In the non-profit and government sectors, it isn’t always appropriate to have revenues that exceed cost (it depends partly on the amount), and it is never appropriate for any excess revenue to “accrue to the benefit of an individual.”

Why? Because your goal isn’t to generate returns (profit) for investors, it is to generate value for a community. Your equation is not money in, money out; it’s money in, mission out. You have to measure output not as a dollar value, but as a “health” value. Measuring outcomes is clearly much more difficult than calculating profit.

Dare County had to figure out whether the program would break even, balancing revenues and costs, but also figure out whether the program would produce enough health. In addition to tracking cost and revenue, they also tracked how many uninsured children were seen in the mobile clinic and how many children were given sealants to prevent tooth decay. Only then were they able to decide whether the program was successful.

A good business plan makes it easier to get money and turn it into outcomes. Funders increasingly are asking grantees for “sustainability plans.” They want to know what plans you have for sustaining a program (i.e., generating revenue to cover your costs) after the funder stops funding you. That’s what a business plan is all about: figuring out whether or not an idea is sustainable and describing the necessary steps to get there. Because Dare County could show that the dental van program would be completely sustainable after five years, it easily received funding.