In 2001, the national Healthy Start program emphasized the importance of sustainability, and directed grantees to develop a plan for the continuation of Healthy Start services at the end of their grant cycle. Three-quarters of Healthy Start grantees reported having a sustainability plan as of December 2003. A majority of them identified sustainability strategies that involved the pursuit of additional financial support – either through other local funding (79 percent), additional Healthy Start funding (79 percent), or other Federal funding (77 percent). However, over two-thirds of grantees with a sustainability plan indicated that they did not have agreements in place with any entities to absorb their projects’ services.

Sustainability strategies employed by State health departments differed significantly from those of other grantees. Of the 9 State health department grantees that had sustainability plans, less than half (44 percent) sought other State or local funding. In comparison, most local health departments (88 percent), non-profit organizations (84 percent), and all other remaining agencies (71 percent) sought such funding. Moreover, no State health department grantee had implemented a fund-development strategy, while a sizeable proportion of local health departments (38 percent), non-profits (48 percent), and all other agencies (29 percent) had implemented such a strategy. State health department grantees were also less likely to develop collaborative efforts with other organizations (22 percent), compared to grantees associated with local health departments (73 percent), non-profits (84 percent), and all other agencies (71 percent). However, State health department grantees were more likely to incorporate in order to apply for other funds (70 percent), compared to local health departments (13 percent), non-profits (19 percent), and all other agencies (29 percent). The State health departments that listed incorporation as a strategy planned to apply for 501(c)(3) status for their local consortia, which would eventually assume responsibility for Healthy Start fundraising and become the body that oversees programming and services at the end of the third grant cycle.