CHL 630 Week 4 Program Budget and Justification Example

What Walk and Eat Well Costs and Why: A Three-Year Program Budget With Justification, In-Kind Support and Cost per Participant

[Student Name]

University of Phoenix

CHL/630: Planning and Implementing Community Health Initiatives

Week 4 Assignment

[Instructor Name]

[Date]

The initiative's budget lines, salaries, in-kind contributions, participant counts and funders are composites written for a model paper modeled on Yakima, Washington; research findings come from the sources cited.

The regional health foundation invited a full proposal for Walk and Eat Well, with a three-year budget due in three weeks. The coordinator, a resident co-chair and the health center's finance manager built the budget together. This paper presents it, with the reasoning behind each line.

Budget Principles

The team set three rules. Every line must trace to an activity in the plan. Every rate must reflect local wages and prices, not national averages. And the budget must show the full cost, including partners' in-kind contributions, so the foundation sees the real investment.

How the Budget Was Built

The team worked from the activity calendar outward. For each month, it listed who would be working, how many hours, which sessions, walks and tastings would occur and what supplies each would use. It then priced each item using the health center's salary scale, quotes from two local suppliers and the costs of child care and food from the coalition's past events. Building from activities avoided the common mistake of setting a total first and filling lines to match it.

Personnel: Coordinator

The coordinator manages the initiative, supervises promotoras, works with stores and reports to the coalition. At a full-time salary of $64,000 plus 28% fringe benefits, the annual cost is $81,920.

Personnel: Promotoras

Six promotoras each work about 20 hours a week, 1,000 hours a year, at $24 an hour, a living wage for the region. Annual cost: $144,000, plus 10% for payroll taxes and paid time off, $158,400. Promotoras lead lifestyle groups, recruit participants and support walking groups.

Personnel: Walk Leaders and Resident Stipends

Twelve volunteer walk leaders receive a $50 monthly stipend, $7,200 a year, recognizing that they give up evenings three times a week. Resident co-chairs and advisory members receive meeting stipends totaling $4,800 a year.

Store Program

Four stores receive one-time grants of up to $3,000 for refrigerated cases and shelving, $12,000 in year one. A produce delivery subsidy of $150 a month per store for the first year, $7,200, helps stores try smaller, fresher orders. Shelf labels and display materials cost $1,600.

Participant Support

Child care during sessions costs $15,000 a year. Pedometers, kitchen scales and recipe materials for 180 participants cost $6,300. Food for cooking sessions and store tastings costs $9,000. Bus passes for participants without cars cost $3,600, since the assessment found many families share one car.

Training and Materials

Initial promotora and walk leader training costs $8,500, with refreshers of $3,000 in later years. Printing of bilingual binders, logs and signs costs $7,500 in year one.

Evaluation

The health district's evaluation, including data collection, analysis and reporting, is budgeted at $28,000 a year, about 8% of direct costs.

Indirect Costs

The health center, as fiscal agent, charges 10% indirect costs on direct costs to cover finance, human resources and insurance, the foundation's allowed maximum.

Year One Total

Year one direct costs total about $351,000 and indirect costs about $35,100, for roughly $386,100. Years two and three are lower, about $353,000 each including indirect costs, because store grants, the delivery subsidy and initial training are one-time costs, for a three-year total of about $1.09 million.

In-Kind Contributions

Partners contribute resources not in the request: church and community center space valued at $18,000 a year; the health center's clinical screening and referrals, $22,000; the parks department's path maintenance and lighting, $15,000; and the health district's epidemiologist time beyond the evaluation line, $12,000. In-kind support totals about $67,000 a year, raising the full annual cost to between about $420,000 and $453,000.

Year-by-Year Changes

The budget changes over three years. One-time costs, store equipment, the delivery subsidy and initial training and printing, fall away after year one. Recurring costs, staff, participant support and evaluation, are held level; modest wage increases will be absorbed by savings on printing and training after year one. The coalition will ask the hospital to take on part of the coordinator's salary in year three as a first step toward sustainability.

Cost per Participant

Over three years, the initiative expects to enroll about 540 lifestyle participants and reach about 900 walkers and several thousand store shoppers. Counting only lifestyle participants, the grant cost is about $2,000 per person; spreading costs across all people reached lowers it substantially.

Benchmarks From the Trial

Economic evidence helps judge these costs. In the Diabetes Prevention Program's ten-year analysis, the lifestyle intervention as delivered in the trial cost $4,601 per person in direct medical costs over ten years, but participants' other medical costs were lower than with placebo, and with costs and outcomes discounted, lifestyle cost $10,037 per quality-adjusted life-year gained (Diabetes Prevention Program Research Group, 2012). Walk and Eat Well's cost per lifestyle participant is well under half the trial's ten-year intervention cost.

Lower-Cost Delivery

Community delivery lowers costs without sacrificing much effectiveness. A meta-analysis of 28 US community programs modeled on the trial found no meaningful difference in weight loss between lay-led and clinician-led groups, supporting the use of promotoras rather than clinicians (Ali et al., 2012).

Return on Investment Evidence

Evidence from a related model supports the case to payers. Kangovi and colleagues, working from their own randomized trial, calculated that a Medicaid payer recovers about two and a half dollars within a year for every dollar invested in a standardized community health worker program (Kangovi et al., 2020). While Walk and Eat Well differs, the finding supports approaching the Medicaid plan about paying for promotora services.

Risks to the Budget

Three risks could raise costs. Food prices may rise, affecting cooking sessions and tastings; the budget includes a 5% contingency within participant support. Turnover among promotoras would add training costs; living wages and supervision aim to prevent it. And if enrollment runs below target, cost per participant rises; recruitment through the community health worker program and clinic referrals is designed to keep groups full.

Budget Justification Summary

Each line has a one-sentence justification in the proposal, written so a reviewer with no local knowledge can follow the math. For example: promotora wages are set at a living wage to reduce turnover, which disrupts groups; child care is essential because the assessment found caregiving a leading barrier; and evaluation at 8% meets the foundation's guidance.

Sustainability Outlook

After three years, the coalition plans to fund promotoras through Medicaid plan contracts and the hospital's community benefit budget, keep stores stocking produce through sales, maintain walking groups with volunteers and seek state diabetes prevention funds for group supplies.

Conclusion

The Walk and Eat Well budget of about $1.09 million over three years ties each line to an activity, prices at local rates, values $67,000 a year in partner contributions and calculates cost per participant. Economic evidence from the Diabetes Prevention Program, community delivery studies and a community health worker return-on-investment analysis supports the spending and points toward sustainable funding.

References

Ali, M. K., Echouffo-Tcheugui, J. B., & Williamson, D. F. (2012). How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Affairs, 31(1), 67-75. https://doi.org/10.1377/hlthaff.2011.1009

Diabetes Prevention Program Research Group. (2012). The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: An intent-to-treat analysis of the DPP/DPPOS. Diabetes Care, 35(4), 723-730. https://doi.org/10.2337/dc11-1468

Kangovi, S., Mitra, N., Grande, D., Long, J. A., & Asch, D. A. (2020). Evidence-based community health worker program addresses unmet social needs and generates positive return on investment. Health Affairs, 39(2), 207-213. https://doi.org/10.1377/hlthaff.2019.00981