In the early 2000’s, the Grammy Award-winning band Jars of Clay was confronted with the magnitude of the HIV/AIDS crisis that was so disproportionately affecting Eastern and Southern Africa. At a time when testing and treatment options were not affordable or widely available on the continent, palliative care, clean water, sanitation and hygiene were core strategies to improve the quality of life and slow disease progression for persons living with HIV. Established in 2004, as a philanthropic organization Blood:Water exists to see the end of the HIV/AIDS and water crises in Africa. We do this by partnering with African leaders and their community’s vision for change. Through grantmaking, we support community-based HIV and WASH initiatives that are concurrently paired with organizational strengthening. Since inception to date, Blood:Water has raised $40 million U.S., supporting work in 12 countries on the continent.

In the earlier years, Blood:Water partnered with a diverse range of organization types and sizes, which allowed for experiential learning to refine grantmaking strategies for the greatest impact. In 2015 following an extensive technical strategy review, Blood:Water adapted its model to position its flexible and sizable grant funding exclusively to grassroots African-led and community-driven civil society organizations (CSOs).

Driven by data, the strategy shift took into account the irrefutable body of evidence generated over the decades prior which attribute grassroot community movements and organizations as the most effective, innovative and sustainable drivers of social change. Our partnership posture further upholds that highly impactful development solutions are already being resourced and implemented by communities, independent of external partners. The Blood:Water partnership is therefore intended to be catalytic for communities to leverage existing strategies and resources for amplified impact and expanded reach.

The Blood:Water model is designed with relational depth as a core tenant of meaningful partnership; acknowledging that institutional health processes require time and trust. For this reason Blood:Water’s grant portfolio is designed for focused support to a maximum of 10 partners annually and for up to 8 years. Our grants are applied in two-year grant cycles, with funding ranging $50,000 to $150,000 annually. Inextricably paired with grants is an organizational strengthening (OS) process that invests additional funding and resources into partner organizations holistically across systems, people, policies, and practices. Central to this model, is the hypothesis that strengthened CSOs with improved institutional health provide communities with higher impact interventions and will be positioned to do so with longevity.

Each grant cycle is paired with $10,000 in OS funding for partners to invest in their organizations targeting strengthening priorities self-identified using the Institutional Development Framework (IDF). This process is fully driven by organizations which determine not only how to utilize the funds, but also the specific solutions and the pace at which to do so. The goal is to support partners’ along the organizational health continuum so that beyond the 8-year partnership, they experience increased operational sustainability, financial viability, and autonomy. In tandem with partner-driven OS, Blood:Water offers its partners additional resources to support peer-learning and community building. Among these efforts is a newly established community of practice called The Leader Collective at Blood:Water.

The Leader Collective exits to convene, cultivate, and amplify African leaders championing health and development change on the continent. The Collective’s diverse offering of online and in-person activities includes networking events, peer exchange visits, webinars, masterclasses and workshops, a curated library of eResources and personalized leadership coaching. In person events have been suspended due to COVID-19 and will be reinstated when gatherings are determined to be safe. One of the Collective’s goals is to showcase community expertise and thought leadership by generating publications, emerging best practices, and other learning from within the membership. To ensure the sector’s collaborative contribution and benefit, membership access will be extended to the wider philanthropic community and implementing partners on the continent by late 2022.

For Blood:Water, the question at the heart of our approach remains: Do healthier organizations result in healthier communities? We are in continuous pursuit of this answer through our ongoing monitoring and evaluation. While this is a longitudinal process, preliminary data analysis supports that there are positive changes in health metrics at both levels.

Since applying the exclusively community-focused approach seven years ago, Blood:Water has administered $2.9 million in grant funding, paired with an additional $570,000 in OS investments to eight African-led grassroots organizations. Improvements in organizational health are measured against the IDF, which stages organizations on a continuum as Beginning, Developing, Expanding and Sustaining Stages, quantified numerically from 0.00 to 4.00.

At baseline, the partner cohort averages as early Expanding Stage, 2.08 [1.78-2.48]. At last re-assessment, the partner cohort reflects an average 0.71 increase in staging, reflecting 18% improvement in institutional health. Furthermore, financial viability is demonstrated by increased community cost-sharing to their projects from 15.8% in 2015 to 41% to 2021. COVID-19 related interruptions caused delays in the IDF reassessment schedule. As a result, multiple reassessments are currently underway through the end this year. Therefore, an update to this data analysis is expected by early 2022. This will look beyond the overall institutional health changes to interrogate specific domains with the most significant improvement. This will also include thematic distribution of monetary investments and non-monetary resources leveraged through Leader Collective.

While the COVID-19 pandemic has amplified the call to action for proximate and community-led philanthropy, for years prior the centrality of communities has been actively challenging the status quo of long outdated top-down development models. Our hope is that as a community of African and African-focused philanthropists, we would commit to ensuring this moment in time be seized well to create long-lasting paradigm shifts. As a sector, we must resolve to re-examine and challenge funding models to see more direct resourcing of community change agents across the continent. We must collectively aspire to see the expertise and agency of African communities honored by defining an entirely new normal in philanthropy where equity in partnerships is the standard.Grassroots organizations are without a doubt the gatekeepers and critical champions for the health needs of their communities. Their solutions are proximate and tailored to best suit specific contextual drivers of underdevelopment. Furthermore, they evolve in real-time with emerging demands, as most recently demonstrated during the COVID-19 pandemic. Between 2015 to June 2021, the programmatic efforts of our partners has trans9,085lated into expanded access to and retention in the health care system continuum, as well as improved community coverage with safe water, adequate hygiene, and sanitation facilities. All of which are inbuilt with community management structures for long-term maintenance.

HIV and WASH Programmatic Reach

January 2015 to June 2021