CBO Marginalization: A Byproduct of Inequitable, Technology-Forward SDOH Interventions 

This piece features excerpts from an interview with two community leaders of color—Ngozi Moses, Executive Director of the Brooklyn Perinatal Network, and Lebone Moses, President and CEO of Chisara Ventures Inc.—as they articulate how social determinants of health (SDOH) technology vendors can negatively affect community- based organizations (CBOs).

The market-driven, tech-forward approach of social determinant of health (SDOH) intervention implementation is leading to increased marginalization of community-based organizations (CBOs). Tech vendors have begun to increasingly recognize the value of local, grant-funded community engagement services and compete with CBOs for community engagement services. Some SDOH technology companies have even recruited and hired community engagement teams instead of investing in the community infrastructure present on the ground. Furthermore, CBO marginalization is also the product of health care systems elevating the work of these technology vendors over the essential work of actually connecting people to resources, which is the role of the CBO. The value of CBOs, who are more responsible for SDOH intervention success, has decreased while technology vendors’ value continues to skyrocket.

The gross injustice that arises from CBO marginalization is that health systems and SDOH technology vendors often implement SDOH interventions in marginalized communities, and these institutional powers rely on CBO knowledge to understand the nuances of the community. CBOs know the community assets and community barriers, and their participation, given their expertise in a SDOH intervention, is vital to success. Yet, CBOs do not receive the same level of investment that technology vendors receive. CBOs are expected to yield to technology vendors request andare often not treated as an equal partner in SDOH interventions by institutional powers. For example, the imposition of a technology platform is often done without any investment into the CBOs and social services organizations (SSOs), whose operations often change to accommodate the technology vendors’ request.

Here is a condensed, edited version of an interview expanding on how the popularity of tech-forward solutions have led to the marginalization of CBOs and how tech companies use data to gain significant power within the healthcare sector.

Health Leads: What are other risks and problems that CBOs face in this tech-forward SDOH environment?

Nygozi: Many of these solutions are created for large companies to make money, not to serve. Although they market themselves as serving, they encroach on the business environment that the smaller traditional CBOs work in, (i.e. Medicaid-funded and grant-funded services). This makes it difficult for the CBOs to negotiate a cost for their services. As a result, these solution companies become the intervention handling that negotiation for them. A small percentage of that funding is given to CBOs that do not adequately compensate them for their work.The technology is also often presented in such a way that encourages health care organizations looking for solutions to believe that they have found one. These solutions then return to the CBOs to do the work of connecting communities to resources. This results in CBOs having difficulty in holding their own in an environment that is competing with technology.

The tech-forward solutions are not offering a system of care, and the technology is not enhancing outcomes for the system of care that the CBOs are trying to build. Most of the technology companies are not engagingCBOs in understanding what we need to serve. More importantly, these vendors are not surveying the consumers to understand their needs, too. Communities know what the problem is, and communities have solutions. If we fail to listen to communities, these solutions will inevitably perpetuate harm.

HL: In your opinion, what do CBOs need to address structural health inequities utilizing a community-led approach?

Nygozi Moses: Community -based organizations are generally non-profits that have worked from a poverty model instead of a business model. It’s important to have a business model that shows what you’re giving, what the community gets in return, what you earn and what the program is doing. Most importantly, it is essential for CBOs to be valued appropriately. The healthcare sector must realize that CBOs drive the resource connections that are so crucial for SDOH interventions’ success. In return, CBOs must recognize their power.

Questions for Tech Vendors, Funders and Other Organizations to Ask Before Engaging in CBO Partnerships

Compensating for CBO Services: 

1. How do you compensate community-based organizations for the role they play in your SDOH intervention?
2. How are you seeking to partner with CBOs to help the organization build capacity (if needed and desired)?
3. What decision rights do CBOs have in your SDOH intervention?
4. Is your compensation to CBOs equitable to the investment placed in SDOH technology?
   1. How do you receive feedback to ensure that the compensation structure is equitable?
5. Are you paying SDOH technology vendors for community engagement work?
   1. If so, what is the SDOH technology’s relationship with the community?
   2. How long has the SDOH vendor relationship been present in the community compared to CBOs?

Partnering with CBOs that Reflect the Needs of the Most Marginalized: 

1. Are you including BIPOC CBO leaders in the design, implementation, and evaluation of your SDOH interventions?
2. Are you including leaders from other historically marginalized groups in the design, implementation, and evaluation of your SDOH interventions?

Additional resources on this topic:

• Blog: The Risks And Rewards of Digital Health Technology in Racial Health Equity
• Webinar: Beyond Do No Harm: Structural Racism In Tech-Forward SDOH Solutions

To share thoughts or learn more about the impact of SDOH technology in communities, reach out to author and Health Leads Director of Programs, Stacey Thomas at sthomas@healthleadsusa.org.