The Process of Change: Staff Reflections

In 2021, our foundation partnered with the Kate B. Reynolds Charitable Trust on a Request for Proposals (RFP) entitled Supporting Grassroots Efforts to Promote Equitable Early Childhood Systems. And even though we are more than two decades into our work as a grantmaking organization, this initiative brought with it many firsts.

This was the first time in several years that we had released an open funding opportunity and the first time ever we had designed an opportunity specifically for Black, Latino, American Indian, and people of color-led organizations. This funding opportunity also reflected an enhanced focus on centering equity and being intentional about making decisions in its design and implementation to reflect principles of equity including a focus on clarity, transparency, accessibility, and learning.

This focus on ensuring our applicant experience was as inclusive and accessible as it could be, was not a one-time undertaking, rather this was intended to be foundational to how we facilitate grantmaking moving forward.

With this long-term significance in mind, we knew it was essential we learn as much from the experience as possible. To do so we partnered with ETR Services, LLC (ETR) on an external evaluation. I welcome you to check out the full report here.

In addition, I wanted to take this opportunity to highlight the perspectives of two members from our team who were heavily involved in the design, implementation, and evaluation of this Request for Proposal process. And so recently, I sat down with Teresita Maz, Vice President, Operations and Rob Thompson, Director, Early Childhood to reflect on their experiences.

Q: The motivation to take a critical look at our Request for Proposal process really started with the newly formed cross-functional workgroup focused on operational excellence. How did operational excellence at the Foundation start? What does operational excellence entail?

Teresita: During our last team retreat in-person, before COVID, there were a lot of questions coming from the team about what it means for us to be an equitable funder. We had been doing this work for 20 years, and we have never asked ourselves “Are we doing it right?” “Are we being fair?” Those questions came later with our equity work. We started looking into how the private sector uses continuous improvement and customer experience and how we could incorporate these at the Foundation while integrating equity into our practices.

Right now, operational excellence contains the concepts of continuous improvement and exceptional experience. Focusing on those two areas requires us to constantly evaluate what we are doing and ask ourselves – who is missing and how are we creating barriers for organizations to access funding? What are the biases that we are putting in our way of working that we need to continually reflect on and change to build that muscle of equity?

Operational excellence started as an idea, a concept of changing to have more of a continuous improvement mindset, testing out ideas, being ok with failure, and bringing learning into that process. This has been key for developing operational excellence for what it is today.

Q: Operational excellence is at the juncture between programs and operations. What does a focus on operational excellence make possible for our programmatic work?

Rob: Operational excellence helps us ensure that we have processes in place to implement work in a way that is true to our vision and values as an organization. More specifically, when we talk about being equitable grantmakers, it is more than who and what we fund, it’s also about our process for supporting different organizations and projects. To me, that is where operational excellence really fits in.


“Due to structural racism, philanthropy tends to fund large, white-led organizations, leaving people of color-led organizations with less capacity to pursue their missions and to serve their communities. Our goal was to interrupt this cycle.”

Rob Thompson

Q: Why is it important to have a focus on an equitable and exceptional experience?

Rob: We were early in the development of our early childhood focus area, and we recognized there was a need to diversify the organizations we were funding, particularly in terms of the race and ethnicity of the organizational leadership and the communities they served. Due to structural racism, philanthropy tends to fund large, white-led organizations, leaving people of color-led organizations with less capacity to pursue their missions and to serve their communities. Our goal was to interrupt this cycle.

To do that, we created a funding opportunity specifically aimed at supporting organizations led by and serving Black, Latino, American Indian, and other people of color. Since this involved reaching new organizations that we didn’t have previous relationships with, it was critical to ensure that we centered the grantmaking process around what was most helpful for them.

Teresita: As a philanthropic organization, we have historically sat in a place of power. We need to remind ourselves that this is a partnership between us as funders and the nonprofits we work with. In any healthy business model, you want to make sure that the customer is getting what they need and expect. That is how business succeeds. Because we don’t depend on a customer model, we must be even more mindful of how we are approaching communities in a way that we are respecting people’s time, commitment, knowledge, and experience. That requires us to bring them into the conversation to better understand how they are experiencing the full life cycle of their relationship with us.

Further, philanthropy has historically disinvested in certain communities and certain groups. We know there is an uneven field for the nonprofit sector to access resources. We must go to the basics – who are we trying to serve? We’re trying to serve communities and in order to do that we must see our non-profit partners as our customers. If they don’t exist, we don’t have a way to do what we do. Each partner deserves the best from us. If we want to achieve our racial equity goals by increasing the number of investments to organizations led by people of color, we need to understand how we are entering into the relationship, what level of service we aim to provide, and what changes in our organizational structure and practices are needed to intentionally put our “partner experience” at the heart of our cross-functional operations.

Q: Why was it important to do an evaluation of this RFP process?

Teresita: For this specific funding opportunity, there was a focus on equity throughout the entire process. Because we had not done that before with such intentionality, we needed to assess and understand if what we thought we were doing, was actually working for our partners. We are testing new practices, making adjustments, and learning what other organizations are doing. How do we know if this is effective or not? How do we know if this is meaningful to our “customers” if we don’t ask? It was important to have an external firm collect this data and provide us with insights on what our partners really experience. This evaluation is not just for us and our own understanding of what’s working and what’s not. It is a demonstration of that commitment and respect to our communities.

Q: What was your experience like during this RFP process? What was your experience like with the evaluation?

Rob: On the design-side, my own involvement in RFPs had always been applying for them. My professional background was in nonprofit work. I definitely didn’t have an appreciation for the level of planning that needed to go into it, but the most important takeaway for me is about language.  It seems obvious looking back, but different people have different definitions of the same words and phrases. We caused a lot of confusion with the term “systems change.” We had our own understanding, but that wasn’t necessarily shared by many of those applying for the grant.  It was a big learning experience.

With regard to the evaluation, the conversations that I had with the team at ETR Services were good opportunities for reflection. When you get into the day-to-day of implementing the funding opportunity, there is not always that space. Answering their questions helped realize some key lessons from the project.

Overall, the evaluation was a really good experience. It was affirming to see the feedback from applicants and grantees. It wasn’t 100 percent perfect, but there was a lot of positive feedback about the strategies we used to lighten the burden on applicants and ensure that the process was equitable.

The most gratifying feedback were the comments expressing appreciation of the Foundation’s willingness to evaluate its own processes. I am grateful to work somewhere that can take the magnifying glass to look at its own work, and that is willing to ask our partners what we can do better to serve the community.

Teresita: It was a new experience to lean into being a thought partner to Rob. From an operations standpoint, it provided me with a better idea of what our program staff were trying to accomplish and their strategies. Our partnership between operational excellence, program, and learning functions created the container for testing different approaches, sometimes asking thought-provoking questions, and getting the team to pause and understand if our goals and values were aligning with implementation plans. This elevates operational excellence to not just being a process manager or operational support but allows us to bring the lens of customer experience – what kind of experience we want to create for the applicants. Putting ourselves in the applicant’s shoes or thinking about the process as though we are the ones applying. Being involved in the process created a richer experience for all of us.

One of the things that I was excited about with the evaluation was using a journey map, a visual tool that helps us define our customers’ needs, problems, and engagement with our organization. Creating it allowed us to see and better understand the different interactions that we have with our applicants, the different touchpoints throughout the application phase, and whether that specific touchpoint created a good experience or a barrier. It was developed in two phases – the first phase was internally asking questions about how we think a specific persona experiences our grantmaking process. The second part was actually testing it out and asking about the different touchpoints and how applicants experienced it. The journey map that we created for this evaluation focused on the experience of a Black Executive Director of a grassroots organization outside of the Triad with a close, direct connection to community and early childhood issues. We know that the way that American Indian-led organizations or the way Latino organizations experience our process, won’t be exactly the same. The process of going through this journey map exercise helped us to understand how we could use a tool like a journey map to understand various perspectives. When we saw the results, we were excited to see where there was alignment between what we thought and what applicants shared. There were also places that were eye openers for us.

“We needed to assess and understand if what we thought we were doing, was actually working for our partners. We are testing new practices, making adjustments, and learning what other organizations are doing. How do we know if this is effective or not? How do we know if this is meaningful to our “customers” if we don’t ask?”

Teresita Maz

Q: What did you learn through this process and through the evaluation?

Rob: One thing I learned, which I mentioned earlier, is to interrogate the words we are using. Different groups of people may have different meanings for the same words and phrases, so there are  consequences for how we describe the work. One of the most valuable things that we can do at the Foundation, and one of the things we did with this funding opportunity, is to get external feedback before we finalized the RFP. In this case, we asked five leaders of community-based organizations with experiences in the field of early childhood education to review the funding opportunity and provide feedback on what could be improved and clarified. We wanted to make sure the language we were using resonated with the people who the funding opportunity was designed for.

Related to that, another thing we did was to have preliminary conversations with any potential applicant that wanted to have one. Two of us – myself and our grants manager – had more than 20 calls with people who expressed interest in applying. This part of the process took a substantial amount of time on our end. However, we found it to be one of the most important steps in the process for a couple reasons. First, it helped applicants tailor their application for the specific funding opportunity, and in some cases, it helped them decide not to apply if the work wasn’t a fit. Second, it was a great opportunity to have a back-and-forth conversation, so we got to know organizations in a way that wasn’t dependent on a written application.  It was also just a lot of fun. There are so many great people and organizations in our state doing incredible work and it was inspiring to hear them talk about it. Recognizing the amount of time it takes, we are now intentional in our timelines to allocate sufficient staff time and resources to this step.

Also, at the onset, we made the decision to make the process bilingual in English and Spanish with the understanding that there is a large and increasing population of native Spanish-speakers. If we want to promote an early child care system that serves all families and young children well, we need to prioritize language access.  We had live interpretation and translation services for webinars and any interviews, and we ended up supporting two organizations that are primarily Spanish speaking.

Teresita: One thing I learned throughout the process was that there is no right way to do it. It is more an art than science. When we don’t have an instruction manual that tells us “This is how you do it,” it requires us, as a team, to be more open to change. With continuous improvement, we need to remind ourselves that this is not the end, we are going to change this, as communities change, and as the environment changes. It will never be one-size-fits-all or one specific way, we must think strategically on how to function internally due to the effort that this requires.

We are customizing a lot of the work. The more customized we want to be to meet the needs of the community, the more time and effort we need to invest internally. We have big strategies, and we want to move the money fast into communities. However, if we want to be intentional about how we are doing it and who we are giving resources to, we need to pause and do it right. It takes time to get to know people, build trust, and understand what they need. There is a lot of work that our Program Officers do that isn’t captured anywhere. By the time we brought the funding opportunity to implement it, Rob had been thinking about and working on it for a long time. This might not be reflected in the whole process but reflects the ultimate outcomes. The time invested is worth it.

Q: What are you taking with you?

Teresita: From an operational excellence perspective, there are many ways that we can do the work and it’s up to us to figure out what is really “required” and what is a “nice to have.” We do want our partnerships to be meaningful to help us achieve our organizational goals and we are the ones that create the barriers for investments and resources to flow into communities. We have to recognize that and act on it.

We can’t have rigid processes. There are pieces that we can use as a general practice. But we really need to be nimble in how we approach the work and be ok with the unknown and if something doesn’t work, let’s try again.

Rob:  The number one thing that I am taking away is that it’s a good thing when philanthropy and foundations try to be more humble about their work, and operational excellence is a way to put humility into action by asking grantees, our partners, and communities what we can do better and making responsive changes based on that.



About Featured Staff

Sarah Smith is the Director of Learning and Evaluation for the Blue Cross and Blue Shield of North Carolina Foundation.  Learn more about Sarah.




Rob Thompson is the Director of Early Childhood for the Blue Cross and Blue Shield of North Carolina Foundation.  Learn more about Rob.




Teresita Maz is the Vice President of Operations for the Blue Cross and Blue Shield of North Carolina Foundation.  Learn more about Teresita.




At the Blue Cross NC Foundation, we work every day to improve the health and well-being of everyone in North Carolina and aspire to help make North Carolina one of the healthiest states in the nation, in a generation. We are fortunate to collaborate with communities and partners across the state who are leading efforts to create the conditions where everyone has the opportunity to be as healthy as possible. And together, we believe we can make a significant impact on the structural, social, and economic conditions that produce inequities by race, income, geography, education, and more.

We recognize that our pursuits are bold and there are a number of interrelated issues that need to be addressed to achieve them. While our resources as a foundation are significant, the challenges are vast and therefore we can’t attain measurable impact without an intentional focus. And for us, this encompasses directing our attention and resources in the following areas:

  • Access to Care: Every community in North Carolina’s primary and behavioral health needs are served by a talented, engaged, diverse, and robust workforce.
  • Early Childhood: Every young child (ages 0-5) in North Carolina has the opportunity and resources to be healthy and well-prepared for success in school, work, and life.
  • Healthy Communities: Every community in North Carolina has the conditions for good health.
  • Healthy Food: Everyone in North Carolina has access to healthy food.
  • Oral Health: Everyone in North Carolina has access to quality, affordable oral health services.

Our strategies under each focus area are generated and informed by engagement with communities, subject matter experts, and other stakeholders and adapted based on what we are learning and how the environment is shifting. I describe this collaborative and emergent approach to strategy as engaged strategic philanthropy.

Key to practicing engaged strategic philanthropy are vehicles to promote information flows, transparency, conversation, feedback, and accountability. With that in mind, over the past couple of years, we have implemented a variety of learning-oriented tools and practices to help us make our thinking visible, test our assumptions, engage in continuous improvement, and better understand progress toward our goals.

One of these tools is focus area-specific dashboards. These dashboards provide a visual summary of key components in each of our five focus areas – centered around each areas’ core strategies – and serve as a tool to map how work is progressing. We update these on a regular cadence to reflect changes in the environment, developments in our grantmaking, and updates within each of our strategies. One purpose for making these tools available is to provide a vehicle for supporting more ongoing conversations with communities and partners.

“We are choosing to share these dashboards publicly, because we believe we are most likely to achieve our goals if our partners know what we are thinking and how we are approaching our work. This transparency can facilitate opportunities for more engagement and listening and a deeper understanding of the systems we are working to change."

We are choosing to share these dashboards publicly, because we believe we are most likely to achieve our goals if our partners know what we are thinking and how we are approaching our work. This transparency can facilitate opportunities for more engagement and listening and a deeper understanding of the systems we are working to change.

We anticipate that, like our strategies themselves, the dashboard will evolve over time as we develop our understanding of what is useful to track and what to share. As of now, each features the following components:

Goal: These are generational goals. We believe that these goals, if accomplished, will contribute to North Carolina becoming one of the healthiest states in the nation.

Signals in the Field: This section highlights trends, challenges, and opportunities in the external environment, ensuring we are mindful of the current, and ever-evolving, context within which we work.

Current Focus: In addition to the generational goal, the dashboard elevates our current focus. While our generational goal will remain constant, our current focus is expected to evolve as we respond to shifts in the environment, learn, and make progress.

Strategies and Updates: Based on the context, current focus, and work planned for the coming year, each area has specific strategies that guide our work. While there are many more strategies we could employ, the goal is to prioritize those that present the most opportunity and ensure we don’t dilute our work by spreading too thin. The updates elevate some examples of progress within each strategy.

Grantmaking Data: Providing additional insight into our grantmaking, the  dashboard includes grantmaking data such as the number and dollar amounts of active grants, counties impacted by our grantmaking, and new grants approved by fiscal year.

What to Expect in the Next Fiscal Year: This component takes each of the strategies and details specific work that will be accomplished in the current or upcoming fiscal year.

How We are Measuring Success: It is important to understand what success looks like for each of our strategies. Understanding what success looks like allows us to track progress in the implementation of our strategies and toward our goals. This section also contains a timeframe for when we expect to update our understanding of success based on what we have learned.

We appreciate your partnership in this work and welcome your input as we continue to work together toward helping make North Carolina a place where everyone has the opportunity to be as healthy as possible. Input we receive will be integrated into our regular learning practices in support of our emergent approach to strategy.

To share your thoughts and feedback to inform our learning practice, please reach out to our Director of Learning and Evaluation, Sarah Smith, at Is there something we are not thinking of? Is there an avenue of exploration we need to consider? What have you learned that can inform our approach? Let us know. We welcome your insights and look forward to hearing from you.

As we move forward, we commit to continuing to being transparent about where we think we are, what we are hearing from you, where we are going, and what we see needs to be done.



About the Author

John Lumpkin is the President of the Blue Cross and Blue Shield of North Carolina Foundation.  Learn more about John.



For many of us, gratitude, along with reflecting on the things that we’re thankful for, is the norm during this week and throughout the holiday season.

However, this year I was fortunate to bring in the season a little early as I was able to attend the 2022 Community-Centered Health Fall Convening, which was held in Rocky Mount. While there were many things I took away from this experience, the biggest was an overwhelming sense of gratitude.

The Fall convening is an annual event where our foundation’s Community-Centered Health grantees come together to learn and share experiences about the ongoing efforts, successes, and challenges they face in solving important issues in the communities where they live. This convening was significant for me personally as it was my first time attending the event since joining the Blue Cross NC Foundation team in 2021. The pandemic essentially halted in-person gatherings for most of us, so when the opportunity to attend this event came up, I knew I couldn’t miss it.

The Experience

“It’s a vibe.”  While the official theme of the gathering was “Coming Back Together,” I would say the unofficial theme of the convening for myself, along with most others in attendance, would probably be those three words. From the time I arrived, there was a feeling of togetherness, camaraderie, and excitement. I also have to point out that upon walking into the event center and hearing those nostalgic, cultural tunes I grew up on playing in the background throughout, was instrumental (no pun intended) in fostering a great atmosphere and making it easy for everyone to relax.

That is unless you just couldn’t resist that urge of busting a move before quickly remembering that it’s important to appear professional during business hours – or that you aren’t in your 20’s anymore, and no amount of BC Powder is going to help you with that hip or knee pain.

Brian (right) with members of his Blue Cross NC Foundation family

To be honest, I’d describe the experience much like homecoming or a family reunion, which is interesting considering the fact I’d never met many of those in attendance. But I was fortunate to engage in some great conversations, and what stood out to me right away was how easy going and down to earth everyone was. I also quickly realized that these people were making an extraordinary difference for so many individuals and families in their communities. Whether it was listening to the featured speakers or seeing the engagement in breakout group sessions, real people were talking about real problems in full transparency, and it was refreshing to hear the amazing stories of meaningful change that’s happening in places where just a few years ago, there was little hope.

“Being able to properly and authentically engage community members with lived experiences who are closest to whatever issues the communities have chosen to address in this work has been a game changer for us.”

-Donyel Barber

Making a Difference

One of those inspiring people I had the pleasure of meeting was Donyel Barber of Kintegra Health. Donyel is the lead coordinator for Healthier Highland, one of the Foundation’s first Community-Centered Health grantees.

Donyel Barber 

“Being able to properly and authentically engage community members with lived experiences who are closest to whatever issues the communities have chosen to address in this work has been a game changer for us,” said Donyel.

“For me personally, that means so much because that’s what makes this sustainable. They are at the forefront and their input is not only adhered to, but it’s valued, taken into consideration, and put into action. They’ve been equipped with many tools, not only in the health care realm but also in local government. As a result of (this initiative), they’ve become elected officials, decision makers, and committee leaders. They’re able to speak something and see it come into fruition, and it means so much to them.“

She also talked about the value in bringing everyone together, which for her, is a learning opportunity to gain knowledge and information from others. “It’s like a shot in the arm for me because you realize you’re not alone in the work you’re doing. It’s encouraging and gives the strength you need to keep going.”

As I mentioned earlier, we were in Rocky Mount, home of OIC of Rocky Mount, who would be there to support the convening. Their organization is part of the Foundation’s second cohort of grantees, which is building upon the lessons learned from the first. I was able to connect with the charismatic Reuben Blackwell, CEO, OIC Rocky Mount, who shared his thoughts about the impact of what this group of community coalitions means to their organization and also North Carolina.

“The collaborations that we have been able to build, not just locally, but a network of like-minded people across the state that Blue Cross NC Foundation has opened us up to has been extremely valuable. The benefit of having peer collaborators has been incredible as far as keeping us encouraged, helping us to remain focused on our work, and creating metrics beyond our individual organizations or even our collective affiliations,” said Reuben.

“We’ve been able to spread this out throughout the community so that they can be able to benchmark the success that it has achieved by working together with us.  I don’t feel we would have been able to design that without having intentional, thoughtful, skillful support, along with consulting teams, and ‘heart’ partners.”

Reuben Blackwell

Anyone who’s familiar with Reuben will confirm that he exudes enthusiasm and optimism that makes you smile, and it’s clear that the impact of his drive and positive outlook has been integral to OIC Rocky Mount as they continue to make amazing strides in the community.

“Community-Centered Health strengthened the work that the community had been leading in Rocky Mount.  We’ve had voices that have been able to be strengthened and encouraged. It has really amplified their voices so that their power could manifest. The very real, tangible results that occurred were policy shifts because the community took these issues to the city council and brought data driven recommendations that refocused attention on affordable housing, community wealth building, and bringing intergenerational support in places that been devastated because of lack of investment and attention. It’s resulted in programs that have redirected public funding in the tune of tens of millions of dollars into neighborhoods that have been disinvested for 50-70 years. We have a whole movement in our city that looks at livability and quality of life for the people who are already here, not raising taxes and moving people out so other people can come in. It’s been incredible. ”

“Shared prosperity is not anti-American. Shared prosperity should be the point of America.”

Reuben Blackwell

Reuben said something that really stood out to me, “Shared prosperity is not anti-American. Shared prosperity should be the point of America.” It was a powerful statement and a sentiment I share wholeheartedly. I resisted the urge to shout out, “PREACH!”

Josie Williams, Executive Director, Greensboro Housing Coalition, whose sharp humor was responsible for my sides hurting throughout the two days, talked about the return of the convening and the impact of Community-Centered Health on their organization and community. Greensboro Housing Coalition was one of the first three grantees funded as part of this work.

Josie Williams

“The value in Community-Centered Health has been a critical foundation to all things related to our equitable community changes. It laid the framework for us to understand how to work on policy, systems, and environmental changes. The value of us coming together at our annual convening gives us an opportunity to come together after being away from each other for two years due to the pandemic.  And although we’ve come together virtually, there’s nothing like the power collective energy when we come together like this. It gives us the opportunity to collaborate and have thought partners across different sectors,” said Josie.

“We all have similar challenges, and we all desire to see equitable change within our communities, so when we all come together to work within a system that allows us to address the changes that are most needed, I think that not only makes our neighborhoods and communities better, but it also makes North Carolina, the state, better.”

You see what I mean? So much to be thankful for…amazing work being done by amazing people, and the opportunity to experience it all first hand – if only for a couple of days.

Donyel, Reuben, and Josie were just three of the inspiring individuals I was able to connect with during my time in Rocky Mount. There were so many others, those doing life-changing work in communities across the state.

It’s one thing to say what needs to be done and hope for the best. It’s another thing to actually create the change you hope to see. The work isn’t easy by any means, and they don’t receive much fanfare, but they are the everyday heroes who roll up their sleeves so that you and I can live in communities that are better, healthier, and ultimately a place we can all be proud of and thankful for.

I’m already looking forward to seeing them again at next year’s Convening.


About the Author

Brian Edmonds is the Communications Officer for the Blue Cross and Blue Shield of North Carolina Foundation.  Learn more about Brian.



For the first time in nearly three years, many North Carolina families find themselves in back-to-school and back-to-office routines that don’t center around navigating the latest public health guidance. That’s good news, particularly for school-aged children who are, for the most part, back in classrooms full-time, learning and growing with their peers. Yet this return to a new version of normalcy hasn’t come without challenges. One of these challenges is the ongoing shortage of affordable, accessible, high-quality child care options for many North Carolina families with infants and young children. The shortage is well-documented and business leaders have pointed to it as holding back our economic growth.

More and more, families are turning to home-based child care (HBCC) providers who deliver care from their home to small groups of children. These providers appeal to families for the affordability, proximity to home, and ability to account for cultural norms and values in the care they provide. However, a new report released this week by the early care and education experts at Stoney Associates points to the state’s home-based child care sector as a potential missed opportunity in the struggle to expand child care options. It also highlights unique challenges that HBCC providers face in growing their child care practices.

The report notes that North Carolina currently has far fewer licensed home-based care centers than neighboring states like Virginia. As state and community leaders explore initiatives to innovate child care delivery while growing the number of available child care options, it is increasingly important for all of us to determine how to better support home-based care and the networks that represent them.

Our Foundation recently released a funding initiative to do just that; however, large scale structural changes and support systems must be considered.

The analysis identifies HBCC networks as a viable approach for increasing the supply of home-based child care in North Carolina. These networks identify common needs among providers and link them with system supports to improve child care quality and sustainability.

In compiling the report, Stoney Associates reviewed licensing processes and available funding streams, and conducted interviews with leaders from three HBCC networks. These networks reported that their members face significant challenges opening new sites, navigating complex systems designed for larger center-based care providers, and accessing critical public funding for start-up costs and program improvements.

The report also spells out steps that North Carolina can take to build stronger connections among home-based child care providers and networks including:


  • Acknowledge homes that serve as few as two children as legally exempt from licensure. Providers can therefore start their businesses with only two full-time children, be included in quality improvement supports, and grow to serve a larger number of children when they meet regulatory requirements.
  • Link HBCC start-ups to state-of-the art technology to support operations as well as child assessment tools. There are many new, innovative tools on the market that can help providers run their businesses – even from a cell phone.
  • Explore new business models for providers that seek to grow their business in a non-residential setting, such as a church or community-based organization.
  • Enable expansion of legally exempt part-day programs, potentially in partnership with community-based organizations.
  • Provide regulatory ‘amnesty’ for existing HBCC providers so they don’t remain hidden and isolated from available support and improvement efforts.
  • Utilize networks to improve HBCC quality.
  • Build connections among existing HBCC networks:
    • Identifying and connecting HBCC networks in North Carolina that face similar challenges to strengthen awareness and provider voice.
    • Linking networks to national organizations like Home Grown, which can help identify additional funding and support.
    • Leveraging state and national organizations that have experience working with cultural communities and providers for whom English is a second language and can offer unique expertise.
    • Exploring potential links to faith-based entities with early childhood expertise, including national, statewide, or local organizations.

These are intriguing suggestions, some of which may be provocative, but all of which deserve serious discussion. Read the full analysis and recommendations.

About the Author

Rob Thompson
Director, Early Childhood

Rob leads the Foundation’s focus on early childhood,  working to ensure that every young child in North Carolina has the opportunity and resources to be healthy and well-prepared for success in school, work, and life. Learn more about Rob.





If the GPS commute time seems too good to be true, it probably is – a lesson I learned the hard way a few months back as I traveled to Bertie County Middle School to spend time observing their school-based dental clinic, operated by the ECU School of Dental Medicine and grant-funded by the Duke Endowment. I plugged the address into Google Maps and received an estimate of two hours from the Raleigh-Durham area. Just to compare, I decided to plug the address into another common maps system (that will not be named) – it said an hour and forty-five minutes. “Great!” I thought, “There must be a quicker route.” Spoiler alert: there was no other route. As the computerized voice proclaimed, “you’ve arrived!” I was in front of a wooded area, with no school in sight. Confused, I pulled over and quickly discovered the route I was following was missing the last 10 minutes of the drive.

When I finally arrived, a little flustered from running late and apologizing profusely, a school staff member reassured me that I was not the first, nor would I be the last person to get turned around by my GPS out in rural Bertie County. She led me to a cozy room filled with portable dental equipment where I was greeted by dental hygienists, Jennifer Buck and Rachel Stewart. The positivity in the room immediately eased my frustration.

Rachel was leaning over a dental chair, working in the mouth of a little girl in sunglasses who cheerfully served as a “helper” during the process of setting her sealants and holding the light used for curing. Jennifer sat at the well-worn teacher’s desk that had been placed in the room, serving as a second set of hands, meticulously documenting information that Rachel called out. As it turns out, the positive energy on display during this patient interaction was not unique. In fact, Rachel and Jennifer shared that the typical response from children who participate in the program is largely positive and explained, “They come to us when they have oral concerns or pain and ask for a consent form so they can become enrolled in the program.” Rachel continued, “Occasionally, there is some hesitancy from very young children, those that have never seen a dentist, or the ones that have had poor dental experiences in the past,” but they love having the opportunity to give children a positive first experience or a fresh start with a better one.

Bertie County has 19,000 residents, yet only has one dentist - who primarily sees adults.

Unfortunately, too many school-age children in our state haven’t had regular, or even any experience with oral health care. 90% of the children enrolled in the Bertie County School-based dental program have Medicaid or North Carolina Health Choice insurance. Only 66% of children enrolled in NC Health Choice and 60% enrolled in Medicaid, used at least one oral health or dental service in 2019. A big reason is access. Bertie County has 19,000 residents yet has only one dentist - who primarily sees adults. To put this into perspective, the threshold to be defined as a dental provider shortage area – a federal designation used to identify populations that are experiencing a shortage of care providers – is a population to provider ratio of 5,000 to one. Bertie County is experiencing a shortage almost four times over this threshold.

The Bertie County School-based oral health program helps to alleviate some of the pressure coming from this provider shortage by serving 25% of students in kindergarten through 12th grade. Additionally, a significant number of pre-k and private school students receive care via the outreach program, which periodically operates out of the local health department. Recent legislative rule changes now allow public health dental hygienists (practicing in community settings like schools and clinics of dental provider shortage areas) to provide preventive care – such as cleanings, sealants, and fluoride varnish – under a standing order of a dentist, rather than requiring a prior exam from a dentist. With a dentist not required on-site for every patient seen, the efficiency of many school-based programs, including the Bertie County School-based clinic, has increased and more children are able to be served.

My experience in Bertie County prompted a moment of reflection for me on just how invaluable these programs can be. As a busy, working parent, I’m not sure how I could manage making a 45-minute trip to another county for a dental visit for my child. I’d likely need to take time off work given typical dental office hours, combined with the commute time. That trip would address my child’s dental needs, but what about my own? I’d need to repeat this whole process, while also ensuring that childcare is available to go and be seen myself.

School-based oral health services are a convenient way for children to access oral health care services.  When children maintain optimal oral health, they have a better opportunity to learn, grow, and thrive without the distraction of oral pain

I am fortunate enough to have paid leave time, so although it would be incredibly inconvenient, this would not be impossible. But what about those who don’t? Less than 20% of working people in the United States have access to paid parental and caregiver leave. School-based dental clinics are a source of care for children, but they also act as a system of support for parents, making it a bit easier on them to ensure their children receive the essential preventive care they need. It also supports a continuity of care that is disrupted in many provider shortage areas. Parents of students in the Bertie County program often reach out with questions or concerns about their child’s oral health and refer friends and family to the program.  Parents want the best for their kids. This authentic engagement and trust in the program providers highlight the value and quality that they see in it.

How do school leaders feel about this program? Rachel said, “The majority of school leaders and teachers are very supportive of the program.” While there are some who have concerns about the interruption of class time, she explained, “Jennifer and I take care to be cognizant of interruptions and minimize any impact on student learning.” Data shows that it is worth the investment. On average, children with poor oral health status are about three times more likely to miss school because of dental pain, and those absences are also associated with poorer school performance. The services that the clinic is providing for students helps ensure they are receiving preventive care and referral for intervention on minor issues before they become more serious ones that will distract from learning for far longer than 30 minutes.

After spending just a few hours visiting at the Bertie Middle School dental clinic, I found myself deeply inspired. To build such strong rapport and provide services at such a high quality that children request them, and parents also recommend them, all without prompting – is incredible. It is what we should strive for – the gold standard of community care.

“School-based oral health services are a convenient way for children to access oral health care services.  When children maintain optimal oral health, they have a better opportunity to learn, grow, and thrive without the distraction of oral pain,” said Rachel.

The Blue Cross NC Foundation, The Duke Endowment, and the BlueCross BlueShield of South Carolina Foundation have an on-going partnership to support the development of school-based oral health programs in the Carolinas. With financial and technical support from this partnership, 27 dental clinics have established dental programs like the one described above and serving 35 counties in North Carolina.  Applications for the next cohort of grantees will begin in Fall 2022.

About the Author

Daijah Davis
Program Officer, Oral Health

Daijah leads the Foundation’s focus on oral health, working to ensure that everyone in North Carolina has access to quality, affordable oral health services. Learn more about Daijah.






Today is the White House Conference on Hunger, Nutrition, and Health. As believers that everyone deserves access to the nourishment the right food provides, it is heartening to see these issues elevated on such a platform.

The only other such conference, in 1969, helped lead to landmark programs such as school lunches, SNAP and WIC, and changes to how food is labeled. And so, there is optimism among many of us who work on issues breaking down barriers to healthy food that equally significant approaches will result this time around, and that these efforts will include a specific focus on overcoming the inequities that persist by race, age, income, and geography.

This hope is buoyed by the pillars on which this gathering is built. One in particular outlines the further integration of nutrition, food security, and health by elevating the role that the nation’s health care system can play in addressing the nutritional needs of all people.

North Carolina is fertile ground for an approach doing just that, bolstering health care’s role in addressing food security and opening doors to healthy food, all while leveraging the expertise and leadership of two of the state’s great resources - its people and the work of our community-based organizations.

This promising approach - Healthy Food Prescription Programs - features partnerships between community-based organizations and the health care sector that leverage the inextricable links between food, nutrition, and health. In these programs, health care providers assess patients for diet-related conditions and/or food insecurity. They then prescribe a food-based intervention, delivered by local organizations with long-standing ties within their community.

Like many medications, Healthy Food Prescriptions are not a cure all. However, they are many great things, including most significantly a pathway to achieving greater equity in food security, nutrition, and health.

Like many medications, Healthy Food Prescriptions are not a cure all. However, they are many great things, including most significantly a pathway to achieving greater equity in food security, nutrition, and health. They are community driven and customized rather than a one size fits all approach. They meet people where they are. And they leverage, and marry, the expertise and trust of health care providers with the capabilities and wrap-around services of community organizations to serve the unique needs of residents.

Understanding the potential that lies within this approach, about a year ago our foundation funded a statewide scan of Healthy Food Prescription interventions to learn more. This opened our eyes even further to what was happening on the ground. We saw solutions for urban and rural communities. We saw an array of food and nutrition interventions from vouchers to medically tailored meals to food boxes from local farms. We saw diverse health care partners, including health plans, health systems, and community health centers – all referring patients. And we saw local, community-based organizations playing an emerging role as essential partners to health care providers in caring for the food and nutrition needs for the patients being sent their way.

We also saw opportunity, the opportunity to strengthen the Food is Medicine work happening in our state. This has resulted in a $3.5 million investment to support, and learn from, 10 Healthy Food Prescription Programs throughout North Carolina that were identified as part of this scan. This is being highlighted as part of the convening today and representatives of three of the grantees have been invited to attend, a fitting acknowledgement of the work they are doing.

We encourage you to learn more about this initiative and each of  the 10 organizations we’re supporting. They range from small operations serving historically under-resourced neighborhoods to the largest produce prescription program in the country, whose footprint spans the entire state.  Among the goals is to identify factors for success and elevating these programs as models from whom others can learn.

In an era of deepening focus on health equity, shifts to value-based care, and increased attention on non-medical drivers of health, growing Healthy Food Prescription Programs could not be timelier, both in North Carolina and throughout the country. With them, the health care sector and others have an emerging opportunity to meaningfully move the dial on addressing food security and reducing diet-related conditions.

Ensuring that everyone has access to healthy food and increasing food security requires big changes at all levels, new and different partnerships, and – most of all – a variety of approaches. For us, growing the Food is Medicine movement is just one. Our focus also includes strengthening  food hubs, food councils, and others working to create a more equitable food system as well as increasing access to no-cost healthy school meals for all, for which we have recently made a $4 million commitment.

Our belief is simple, everyone in North Carolina deserves the opportunity to be as healthy as possible. However, that opportunity cannot be realized without the nourishment that available, accessible, and healthy food provides.


About the Authors

Merry Davis, Director, Healthy Food and Valerie Stewart, Director, Healthy Communities, are partnering together to lead Blue Cross NC Foundation's multi-year effort to strengthen and spread Healthy Food Prescription efforts across North Carolina.


Merry Davis
Director, Healthy Food
Learn more about Merry




Valerie Stewart
Director, Healthy Communities
Learn more about Valerie




A Yearning for Learning

In my free time, you can find me immersed in YouTube videos of evaluation consultant, Michael Quinn Patton, or using Emergent Learning tools to plot my reality game show win. Safe to say, I am a learning and evaluation super fan, but I didn’t become a superfan overnight.

Ten years ago, if you said evaluation, I would have conjured up images of straight-lined logic models and sharp-edged boxes made for compliance. Uninspiring to say the least. However, having been part of the development of learning and evaluation within two foundations, the images that come to mind today are much more abstract with curvy lines and interconnected shapes and elicit a stronger emotional response.

I am energized by the continued momentum to reimagine evaluative practices in philanthropy, in particular to center equity and think more broadly about what it takes to create social change. 

I am energized by the continued momentum to reimagine evaluative practices in philanthropy, in particular to center equity and think more broadly about what it takes to create social change. I am also challenged by the continued work we need to do as individuals, as a sector, and as a society to create the conditions necessary for evaluation to be in service of these ambitions. This momentum and energy, as well as all of the challenges, keeps me coming back for more.

The role of learning and evaluation at foundations is dynamic (read more on this topic here). The day-to-day of learning and evaluation at the Blue Cross NC Foundation involves a variety of work – from facilitating relationships with external evaluations to leading internal strategic learning efforts to clarify goals, assumptions, and generate insights. While this requires close attention to methods and data, I have found it is just as important to focus on change management, relationship building, and dialogue.

A key aspect of our learning and evaluation function involves facilitating collaboration between our program team, grantees, and external partners to design, implement, and disseminate evaluations of our work. This allows us to identify and explore questions to help move strategies forward and generate insights and lessons learned. And while this provides us the opportunity to take a good look at ourselves in the mirror, it also provides an opportunity to shine a light for others to see. For us, sharing what we are learning is just as important to what it is we are discovering. Which brings us to why we are here today.

Learning and Evaluation at Work. Lessons from a Placed Based Approach.

Nearly a decade ago, we launched Community-Centered Health to increase the capacity of community-based organizations and health care entities to act on the root causes of health and health inequities. It is a multi-dimensional approach including investments in diverse multi-sector partnerships that amplify community voice in setting local health priorities. Community-Centered Health has helped the Foundation focus more explicitly on racial equity, understand the value of power shifts, elevate the perspectives of residents and community-organizations, and become a more thoughtful, community-centric investor in supporting health equity. While a formal evaluation was not built in at the start of the initiative, we saw a valuable opportunity to pause and to gain a deeper understanding of how it was working and, ultimately, utilize the insights gained to be more flexible and effective in our strategy moving forward.

To accomplish this, our Foundation, with grant support from the Robert Wood Johnson Foundation, partnered with Engage R+D to conduct a retrospective evaluation of the Foundation’s three initial Community-Centered Health partnerships. While we leverage different types of evaluation, we have found retrospective evaluations valuable to unearth more nuanced insights and lessons learned that emerge when you look at something over a longer period. The evaluation examined early progress and enduring outcomes through interviews with each community’s grantees, partners, and technical assistance providers; perspectives from Blue Cross NC Foundation staff, other funders, and researchers involved in similar community-driven initiatives; and a review of initiative-related documents, as well as secondary population-level data.

I won’t summarize all the findings here. For that, I will gladly point you to the full evaluation report. Instead, I wanted to take this opportunity to elevate some important insights and correlations related to our overarching approach to learning and evaluation that resulted from this undertaking.

The social change we are hoping to influence is long-term, and the pathways to get there are complex and messy. Recognizing this, the evaluation of Community-Centered Health explores many interim factors related to its partnerships’ structure, values and practices, and progress such as increasing community residents’ engagement.

  • Social change takes time and is nonlinear- evaluation must reflect this
    Community-Centered Health is focused on social change – or changing the ways people and organizations interact to transform cultural and social institutions over time. The social change we are hoping to influence is long-term, and the pathways to get there are complex and messy. Recognizing this, the evaluation of Community-Centered Health explores many interim factors related to its partnerships’ structure, values and practices, and progress such as increasing community residents’ engagement. While there seems to be growing acceptance in the fields of philanthropy and health concerning how interim factors are critical to understand progress toward long-term outcomes, there is an opportunity to consider how these factors can better inform learning and decision making over the long run. As this retrospective evaluation demonstrates, our learning and evaluation function can help our organization and its partners better understand progress by focusing both on the long-term outcomes we are aiming to see as well as more interim factors along the pathways to change.


  • Context, context, and more context- evaluation needs more of it
    The work of the Community-Centered Health partnerships does not take place in a bubble. As with all collaboratives, there are histories and power dynamics between partners. Additionally, the partnerships are all operating within a greater political and social context. This information is elevated as part of the evaluation to not only situate the work in a broader ecosystem, but to also intentionally explore how partnership dynamics, structural and systemic barriers, local and state policy context, and community strengths impact the work over time. All of our organization’s learning and evaluation work is grounded in the increased understanding of the conditions we are working in and how those conditions impact our work and that of our grantees and partners. This provides us with a more nuanced understanding of success and challenges as well as deeper insights into what it takes to affect change.


  • Allow for emergence - evaluation needs space for this
    Each Community-Centered Health partnership identified pressing health needs within their specific community and developed the strategy to address them early on. However, as anyone who has planned anything from a relaxing vacation to a complex program knows, a plan represents someone’s best guess of how something will turn out. While the evaluation looked at the progress the partnerships made toward goals and outcomes related to specific health needs, there was also space within the evaluation to focus on what emerged over the course of nearly a decade. For instance, while not an explicit or intentional focus of ours at the onset of the work, acknowledging and addressing structural racism emerged as a critical factor to success. This became clear well before the heightened national focus on this issue the past two years; however, in 2020 many Community- Centered Health partner organizations leveraged windows of opportunities to more vocally address racism as a public health issue. Since the inception of Community Centered Health, the Foundation has also become more intentional about prioritizing racial equity as a critical dimension of supporting health equity. The evaluation elevates this story. Moving forward, it will be important for us to pay attention to how we think change will unfold and how that thinking changes over time based on unanticipated challenges, opportunities, and lessons learned . This outlook aligns with our approach to emergent strategy.


  • The process is important – evaluation must embrace this
    Often, all anyone outside of an organization can see is the final outcome or product from an evaluation. The reports are beautifully designed, and lessons learned are nicely summarized. However, much of the value of evaluative work is in the process to get there. From the outset, it was important to acknowledge the time and expertise required of our grantee partners and work toward a goal that would be additive and not duplicative of other work taking place in their communities. As we began planning, we realized we had not included participation in a formal evaluation as an expectation of the funded work. With this understanding, we moved to increase the size of the grant to compensate the communities for their participation in the evaluation activities. We also recognized that the partnerships were involved in several other evaluation efforts supported by various entities, and therefore Engage R+D spent considerable time conducting literature reviews, web searches, and speaking with other researchers, evaluators, and funders in the space to ensure participant time was well spent. We will continue to be mindful of these types of impacts as we grow our evaluation work.

Ultimately, our hope is that this approach to self-interrogation will benefit others in the field of philanthropy as well.


Looking Ahead

While we aspire for our learning and evaluation work to lift up the successes and challenges of our partners in the field, as we have discussed here, learning is bi-directional. What we have learned from this retrospective evaluation about ourselves will inform our overall approach, helping us to strengthen our practices to more effectively position learning and evaluation as a tool for social change.  And as we continue to explore different types of evaluation and learning practices, we will prioritize sharing what it is we are learning – this includes what we are discovering about the issues we are working on as well as how we are functioning as an organization. Ultimately, our hope is that this approach to self-interrogation will benefit others in the field of philanthropy as well.


I am grateful to our grantees and partners at Collaborative Cottage Grove, Healthier Highland, Mothering Asheville, evaluation partners at Engage R+D, Oktawia P. Wójcik, Director of Learning at the Robert Wood Johnson Foundation, and my colleague, Shelia Reich, Director of Racial Equity and Healthy Communities, for their time, engagement, and contributions to this evaluation.

Support for this evaluation was provided in part by the Robert Wood Johnson Foundation (grant number 77128). The views expressed here do not necessarily reflect the views of their foundation.

About Learning and Evaluation at the Blue Cross NC Foundation              

Our Learning and Evaluation team develops and implements practices and projects to help clarify programmatic and organizational goals and assumptions, assess progress, evolve and adapt strategies based on what we are learning, and share insights with the broader field. We are committed to the practice and principles of the Equitable Evaluation Framework  (believing evaluation and evaluative work should be in service to equity) and center our learning and evaluation work on three core tenets: how we work, what we are working on, and our values and principles. Our organization believes evaluative work should inform learning, decision-making, and action and recognizes that a variety of qualitative and quantitative methods are necessary due to the complexity of the issues and the dynamic environment in which our work takes place.

We just turned the page on another Black History Month when, as a nation, we recognize the meaningful contributions and sacrifices of Black leaders, pioneers, and every day Americans in shaping our country. One of the ways we can continue to honor the considerable legacy of Black Americans is by working to create a society where being Black in America does not limit one’s ability to be healthy.

To achieve good health, a person must first have a fair and just opportunity to be as healthy as possible, also known as health equity. But for many people living in North Carolina, this opportunity has been limited.

Geography, gender, veteran status, and socio-economic status – these all create health inequities that exist in our state. When you factor in race and racism – the result of generations of public policies, institutional practices, and social norms reinforcing inequities among people of color – poor health outcomes are compounded.

“The American health care system is beset with inequalities that have a disproportionate impact on people of color and other marginalized groups. These inequalities contribute to gaps in health insurance coverage, uneven access to services, and poorer health outcomes among certain populations. African Americans bear the brunt of these health care challenges… They still experience illness and infirmity at extremely high rates and have lower life expectancy than other racial and ethnic groups while also being one of the most economically disadvantaged demographics in this country.”

The Century Foundation

Beginning in 2020, we worked to develop a greater understanding of the ways in which racism drives inequities in the areas of our work and determined the best ways to address the issues. This resulted in a formal commitment to prioritize racial equity as a critical dimension of supporting health equity. In short, racial equity is achieved when racial identity no longer predicts, in a statistical sense, how one fares in life.

While this commitment takes many forms, a core tenet will be achieving equity through our grantmaking – or to put it more bluntly, putting our money where our mouth is. As a foundation, our grantmaking is one of the most significant means by which we can impact racial equity, both in who and in what we fund - from racial equity-focused grants and initiatives to grants specifically supporting leaders of color and people of color-led organizations.

As we approached our goal of achieving equity in grantmaking it was essential that we be intentional about a high level of self-interrogation; using data to assess where we are with our funding, where we are making progress, and where we can grow and improve.

A key component of this was a Grantee Demographics Survey which was designed to help us better understand grantee and partner demographics at the board, head(s) of organization, leadership, and staff levels, as well as gather baseline data on their diversity, equity, and inclusion (DEI) work. If we were going to advance racial equity through our grantmaking, we first must know from where we were starting.

Ultimately, though, good intentions must be grounded in deliberate actions and mechanisms for transparency and accountability. Setting targets, and being accountable to those targets, is essential in reaching broader objectives.

To that end, the goals we established are as follows:

By 2024, at least 60 percent of our grant funding will prioritize racial equity.

By 2026, at least 60 percent of our grant funding will support people of color-led entities.

To achieve these goals we intend to increase both the number of grants and the dollar amount of grants in these categories. The dollar amount is equally as important as organizations receiving more grant opportunities in order for them to have more substantial means of accomplishing the goals they hope to achieve for their communities.

In addition, in establishing our racial equity goals, we are striving for equitable funding, which is substantively different than equal funding. Recognizing that people of color are disproportionately impacted by poor health outcomes, we are setting targets that reflect the need for intentional, equitable investments that address the size and scale of the issues that impact those communities.

Connected to our goals for increasing investments in people of color-led organizations, there is great value in supporting organizations and leaders who are most proximate to the issues, who reflect the lived experience, and who can lift and center community voice in addressing the social problems we are all aiming to solve. We want to do more than a set a numerical target; embedded in our goal is a commitment to help build the capacity of organizations that may not have been able to get grants in the past.

These goals will have a substantial impact on our grantmaking strategy and programmatic approach going forward. We are now tracking demographics for all applicants and monitoring data in real time. Transparency is also key, and we plan to share data so that it might help others to improve racial equity in their own practices and processes.

We understand there are risks involved with being so transparent; however, we think showing both our progress and our shortcomings is an important part of the process. We hope this will spark important conversations and encourage other philanthropic organizations to examine their approaches to supporting racial equity, how they award grants, and who receives them going forward.

It is paramount that grantees across all spectrums are represented and supported as they work to build better communities. For North Carolina to be a healthier state, all communities need to be healthier, and for those communities that have been marginalized and disinvested in, health is much harder to attain. That is why this work is so important to us.

Our belief is simple, everyone in North Carolina deserves the opportunity to be as healthy as possible. Realizing this will take many things. For us, that includes striving to achieve equity through our grantmaking and fulfilling our broader commitment to supporting racial equity.



About the Authors

John Lumpkin, MD, MPH

John is the President of the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about John.








Shelia Reich

Shelia is the Director of Racial Equity and Healthy Communities for the Blue Cross and Blue Shield of North Carolina Foundation. Learn more about Shelia.






For some, the last couple of months has been full of over-indulging, food comas, and even meat sweats. Many of us celebrated by getting together with friends and family where we enjoyed abundant holiday meals. Yet for many others, it wasn’t that simple.

The lack of access to affordable, healthy, local food is an urgent issue for communities in North Carolina. It’s a frustrating one given the fact that our state is ranked in the top 10 nationally as it pertains to agriculture and in the bottom 10 when it comes to food security.   How can a state that produces so much food be a place where certain communities cannot consistently enjoy the benefits of healthy food options? This has been an issue for years, and the ongoing pandemic has pulled the curtain back more to reveal just how prevalent it is.

However, while attending a recent grantee site visit, my eyes were opened to the work of an organization that is providing real hope for their county and making great strides in ensuring that fresh food is getting into the hands of more residents in the community.

Working Landscapes is a rural development organization founded in 2010 by Carla Norwood, PhD and her husband Gabriel Cumming, PhD.  Its headquarters is located in the community where Carla grew up, and it’s clear how much she cares about Warren County.

The overarching mission of Working Landscapes focuses on building a better quality of life in rural communities by leveraging the value of community assets. At its core, Working Landscapes is a food hub, which is defined as a business or organization that actively manages the aggregation, distribution, and marketing of food products primarily from local and regional producers to strengthen their ability to satisfy wholesale, retail, and institutional demand. They are also involved with education, research and engagement, climate crisis and mobilization, and building reuse.

They are the only North Carolina food hub, out of the nine nonprofit hubs in the state, that, in addition to aggregating produce from small local farmers, wash and chop the produce for easy use by institutional purchasers like schools. As a result, they are the first food hub to become part of the North Carolina Department of Agriculture’s Farm to School Program, which sells a variety of locally grown fresh produce to schools.

Food hubs are an important, and unique, component of the food system in North Carolina. In addition to helping feed their communities healthy fresh food, food hubs support local farmers, contribute to a more equitable food system, and enhance overall community development.

“Food hubs play an important role because they disrupt the current mainstream method that we have for transacting food which tends to be very corporate, consolidated, and driven by profit,” says Carla. “Food hubs tend to be mission-driven organizations and have a broader sense of our obligations to the people that we’re working with. We’re really playing a role that hasn’t been played—at least in this country in terms of food distribution.”

The oldest food hubs in North Carolina have been around for about 10 years, but in the last couple of years, there’s been a maturation of efforts and networks.

“Organizations are starting to do more collaborative work, which is good in building an effective system throughout the state in a pretty intentional way,” continued Carla.

This expansion and collaboration were well-timed assets as the state, and the resiliency of the food system, came face-to-face with the impacts of COVID-19.

“Within one year in the pandemic, seven North Carolina food hubs worked with approximately 270 farmers and moved 700,000 pounds of food in addition to working with more than 75 community organizations.”

Carla Norwood, PhD

Within one year during the pandemic, seven North Carolina food hubs worked with approximately 270 farmers and moved 700,000 pounds of food while also working with more than 75 community organizations,” says Carla. “The impact that food hubs are having now is significant, but it’s not nearly as large as it can be.”

Working Landscapes also expanded their services during the height of the pandemic to become a senior meals provider preparing and providing fresh frozen meals utilizing “local products first” through a partnership with the Warren County Senior Center.

Despite the positive impact they are having throughout their community, there are challenges. Food hubs are trying to do something different than the way things are typically done. They’re working in ways that run counter to the mainstream narratives about efficiency, cost, and price.

Simply put, they provide quality food that can often cost more, due in large part to their commitment to paying farmers a fair price and workers a living wage, in addition to the added costs in serving rural areas.

Another challenge Working Landscapes deals with is their focus on value- added processing which is beneficial but also complex and takes additional resources and focus. Cutting, peeling, washing, packaging, and freezing food are examples of the additional value. According to the Rural Health Information Hub, this level of processing increases the value of the food for both the producer and the purchaser.

“There’s a lot of regulation around value-added processing, but we’re very committed to producing a very safe product,” says Carla.

Preparing meals for a greater purpose

While visiting Working Landscapes I was fortunate to meet Cyril Murphy, a chef now leading their Healthy Meals Program that provides fresh frozen meals to local seniors. Chef Cyril lost his job in May 2020, just a few months after he and his wife received their first foster child placement. By the time Thanksgiving arrived that year, they were reliant on boxes of food they had been receiving from the government for five months.

Being a talented chef, Cyril certainly knows his food, so one can only imagine his reaction when opening up one box that included two and half pounds of processed American cheese, a questionable chicken substance, and other food with no redeeming nutritional value. Fast forward a bit, and Cyril was contacted by the Department of Social Services who informed him that his family would be getting a special food delivery for Thanksgiving. He assumed he’d be receiving the same type of food he’d been getting regularly. He was pleasantly surprised.

As Cyril tells it, one of the DSS workers showed up with bags of organic vegetables, an organic turkey, and other healthy foods.

“I literally sat down and cried,” says Cyril. “Because I hadn’t been able to be creative, and I also knew this food was much better for me and my family’s bodies.”

He came to the realization that once he was able to go back to doing what he loved—what he thinks he’s meant to be doing—it needed to have a bigger purpose. Working Landscapes is a perfect fit.

A year later, Cyril was back at the place where he could shop at grocery stores like Whole Foods and buy the food he wants while also understanding that not everyone has that opportunity or privilege.

“I’m now in a position where I can design menus and recipes that fit different people’s life stories,” says Cyril. “I’m from the North, and over the years of working in kitchens, I’ve taken the time to learn from people here in the South on how to cook collards, chicken, and the important ingredients they feel should go into that pot because I’m actually listening.”

Vision for the future

Working Landscapes is already doing important work, but Carla’s vision for the organization is to process food on a full-time basis, provide reliable markets for the farmers they work with and good jobs for the people they employ while creating high quality, convenient, and exceptionally good products. They recently finished up construction on a new food processing facility and cold storage space and processed their first batch of kale which was then served to students in Halifax County Schools. The kale was grown on two farms – Green Leaf Farm, which is a farm and outdoor learning lab run by Halifax County Schools and Davis Family Farms, a growing farm in Warren County run by Larry Davis whose ancestors were once enslaved on the same land. Carla also wants the organization to be a viable business that’s an example of how well our local North Carolina food system can work.

It seems that vision for the future is well on its way to becoming a reality.

Working Landscapes is a current Blue Cross and Blue Shield of North Carolina Foundation grantee. We are proud to support their continued efforts to increase access to healthy foods, strengthen the local economy, and build a more equitable food system.  


About the Author

Brian Edmonds is the Communications Officer for the Blue Cross and Blue Shield of North Carolina Foundation.  Learn more about Brian.



For many, the end of the year is a time to get plans in place for what lies ahead. While we value this pursuit, it is also important to pause and take stock of the year that’s passed. And because our work is greatly influenced by, and has bearing on, our partners, grantees, and friends, we are taking this opportunity to share these reflections with you.

As hard as it is for us to believe, this year marked the start of our third decade as a foundation. While this was a chapter in our history that we looked forward to turning the page toward, like most, we had just as much eagerness to turn the page away from the difficulties of the prior year.

Of course, this was more symbolic than anything. The realities of 2020 continued even as the calendar marked January 1. As such, remaining responsive to the challenges brought forth by COVID-19 was essential; however, so too was advancing our commitments to confront racism and support racial equity, as well as progressing a greater body of work in service to the health and well-being of everyone in North Carolina.

We can’t overstate the admiration we hold for the tireless work of our grantees, and the thousands of other nonprofits across the state, that have spent what will soon be two years addressing the impacts of COVID-19 while simultaneously carrying forth their missions every day despite the pandemic.

While our initial COVID-related response supported our full portfolio of grantees to do just this, in 2021 we narrowed our focus to where we thought support was most needed. This included investing $5 million in support of emergency food assistance as well as in Black, Latino, and American Indian-led organizations and communities to help stem COVID's negative short- and long-term health and social impacts on people of color. You are welcome to learn more about our full response.


We knew we must do more to center racial equity in our work and to invest more in breaking down barriers to good health for those who have historically been denied this opportunity.

Last year not only further opened the world’s eyes to the realities of a global pandemic, but it also continued to shine a long-overdue and much needed sustained light on the pervasive, systemic racial injustices in our society. Like many, we knew we could, and must, do more. We knew we must do more to center racial equity in our work and to invest more in breaking down the barriers to good health for those who have historically been denied this full opportunity.

We spent much of 2020 listening and learning – seeking perspectives from those most impacted as to how we would do this. This past year, we continued to build out our approach based on these findings and initiated concrete steps to advance this commitment across all aspects of our organization. We invite you to learn more about our approach to support racial equity.

Finally, complementing this all was an expansive approach to advance work across our four areas of focus and organization as a whole. While this took many forms, a few examples include:

Deepening and expanding our approach in early childhood, including:
  • Supporting efforts to assess the impacts of COVID-19 and spotlight the current workforce crisis in child care.
  • Implementing an open opportunity to fund community-based organizations led by and serving people of color.
  • Initiating what will be a sustained effort to address the racial bias that exists in pre-school suspensions and expulsions.

Investing in improving access to healthy food by breaking down barriers
, including:
Partnering in support of strong, healthy communities, including:

Realizing progress in pursuit of more accessible and affordable oral health
, including:
  • The continued expansion of school-based oral health programs working in partnership with The Duke Endowment.
  • The passing of Senate Bill B146 this summer, which was due in large part to the continued efforts of our grantees and partners and formalizes the practice of teledentistry and streamlines rules for public health hygienists.

Continuing to strengthen our organization
, including:
  • Establishing an Operational Excellence functional area to foster a culture of continuous improvement.
  • Engaging in formal evaluations of grant programs and our grantmaking processes.
  • Welcoming two new team members, Program Officer Marquita Mbonu and Communications Officer Brian Edmonds.

Looking back, we all had high hopes that this year would be better than 2020, and despite continued challenges and disruptions, the spirit, determination, and hard work of people and organizations across North Carolina moved us further down the road of meeting the needs of the state.

Of course, the pandemic is not yet behind us and that is a reality we all must continue to face. So too is the reality that everyone in North Carolina is yet to have the same opportunity for good health. We will continue to center this truth in our approach as we welcome the new year, and as we work alongside and in support of many partners, new and old, that are committed to righting this.

As we move further into our third decade, we remain humbled and inspired by those willing to share their commitment, insights, and experience to advance our shared goals; the collaborations we are fortunate to be a part of; the organizations we have the opportunity to support; and the many people who work tirelessly within their own communities to make life better for everyone.