Health Care & the Isolated Poor in the Lower Rio Grande Valley: The Quest to Make a Lasting Change

John F. Kennedy School of Government (Harvard)



Case Study Sector


The spring of 2005 marked a tricky juncture for the leaders of a program designed to improve health care access for thousands of residents living in impoverished, isolated settlements just north of the Mexican border in the Lower Rio Grande Valley and also for the Robert Wood Johnson Foundation, which had provided the program with a four-year startup grant, due to expire in a few months time.
The project leaders wanted to keep the Integrated Health Outreach System (IHOS) alive, but were not sure how to fund it. In addition, frustrated by aspects of the project’s design, they wanted to reorganize and refocus the program. The Robert Wood Johnson Foundation, meanwhile, had gone through an internal organizational change that had significantly changed RWJF’s approach to charitable giving. In general, the Foundation was no longer funding "safety net" programs like IHOS, but had moved toward broader, systemic, collaborative efforts to address the root causes of poor health in vulnerable populations. But the RWJF administrators recognized that the plight of the IHOS clients was extreme. In addition, they knew that resources on the border were scarce. In practical terms, that meant the Foundation was reluctant to cut off the IHOS fundingat least not until IHOS could stand on its own feet.
This case tells the story of IHOShow it was conceived, how it was funded, how it evolved in the context of conditions that defined and complicated life in the Lower Rio Grande Valley: extreme poverty, complex social dynamics, and competitive relationships in the nonprofit sector. It describes how the project leaders wanted to change IHOS, on the one hand, and how the Robert Wood Johnson Foundation wanted to make the project more sustainable, on the other. The "A" case ends with IHOS’ future up in the air, offering students the chance to analyze the problems and propose their own solutions. A sequel describes how the project leaders and the Foundation ultimately agreed to alter the program.



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