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Coalition in Rural Public Health

Types of coalitions in rural public health

Rural communities face different types of healthcare challenges. Coalitions are some of the approaches, which may help them to alleviate such challenges. There are different types of coalitions based on patterns of formation, structures, or functions (Kegler and Butterfoss, 2012). In most cases, geographical locations and membership define types of coalitions. Therefore, major types of coalitions in rural communities include the following.

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Grassroots coalitions emanate from the works of advocates during crises, particularly when they need an immediate action by policymakers on an issue. These coalitions may be “controversial and short-lived, but they are effective in achieving their goals” (Kegler and Butterfoss, 2012).

Professional organizations or agencies are responsible for the formation of professional coalitions. Such bodies aim to enhance their power and influence on issues through coalitions. For instance, health professionals may form a coalition to pressurize a government to increase the number of healthcare facilities in a locality. Local residents are passive stakeholders in these types of coalitions because professionals are responsible for funding and addressing of community issues.

Finally, there are also community-based coalitions. Professionals and grassroots members form coalitions to “promote long-term health and welfare objectives for a community” (Kegler and Butterfoss, 2012). Community members are major stakeholders in community-based coalitions, but funding may come from external sources.

Other types of coalitions may assume geographical positions based on community, state, regional, national, or international levels (Kegler and Butterfoss, 2012). Coalitions draw their members from neighborhoods, cities, towns, or counties, but they serve specific groups of individuals who identify with them. Members of a coalition have deep understanding and show diversity and knowledge of their coalition.

The reasons for building coalitions in rural public health

Coalitions offer several benefits to a community either directly or indirectly. They have acted as efficient and effective means of exchanging knowledge and ideas about healthcare services and issues. In addition, coalitions help communities to express their concerns about health issues, develop credibility, trust, and communicate with other stakeholders. Coalitions also help in finding talents, mobilizing resources and people, and formulating strategies to address healthcare concerns. At the same, they eliminate possible duplication of efforts and services and avoid any wastage. Coalitions eliminate cases of power struggle and risky health behaviors among community members. They are also responsible for advocating for policy initiation or changes when there is strong leadership to promote healthcare outcomes. Overall, coalitions provide synergy that is necessary for a group to adopt new ideas without individual responsibilities.

When a coalition can provide real leadership for a community, then it can effectively address health concerns, mobilize resources, and develop capacity at the grassroots level among its members. Coalitions are responsible for driving community participation in healthcare activities, developing skills, knowledge, leadership, and related networks that serve a community. At the same time, members of a community can get reliable information from their coalition networks.

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Barriers that must be overcome in coalition building

Although rural communities can build functional coalitions for healthcare purposes and other roles, they face several barriers. First, the rural aspect has a critical influence on what a community can prioritize as a major concern. In addition, there are also barriers, which relate to isolation, lack of adequate resources, and geographical barriers that cause fragmentation. These factors affect choices of priorities among coalition members, particularly in diverse rural locations. In most cases, coalitions tend to prioritize development of community-gathering centers, learning centers for youths and adults, and economic empowerment activities. These are the major priorities because of the rural nature of coalitions.

Other barriers identified among coalitions were the level of autonomy, privacy, and distrust of government. These barriers were strong among rural coalitions, and they could limit the extent of engagement with other stakeholders. Some members of a coalition may have negative views about government supports, which can limit the level of their participation in some programs.

Some studies have noted that there are critical factors in building coalitions, which ensure their effectiveness. These included leadership style; formal procedures or rules; collaboration; diversity; member cohesion; member participation; communication; technical assistance and training; and conflict containment (Zakocs and Edwards, 2006; Parker et al., 1998). However, Zakocs and Edwards (2006) noted that these factors had wide variations with regard to coalition building and effectiveness. In addition, they could have been discrepancies in measuring these factors. Thus, members of coalitions should adopt them with caution.

Coalitions should work on sustainability by focusing on long-term projects, multiple sources of funds, and embracing change processes. However, sustainability requires leadership, efforts, collaboration, and resources.


There are different types of coalitions based on membership and geography. Coalitions offer several benefits to a community in rural areas. Members could build consensus, exchange ideas and develop trust, communication, and policies that promote the provision of services among others. Overall, coalitions offer a means of achieving community goals and favorable policies through advocacy and education. Coalitions require collaboration, maintenance, and sustainability to be effective and efficient.

However, there are inherent challenges that many rural coalitions face, which include scarce resources, knowledge gap, and lack of trust among others. Coalitions can improve on these shortcomings to make them effective.


Kegler, M., and Butterfoss, F. (2012). Strategies for Building Coalitions in Rural Communities. In R. Crosby, M. Wendel, R. Vanderpool & B. Casey (Eds.), Rural Populations and Health: Determinants, Disparities, and Solutions (pp. 191-209). San Francisco, CA: Jossey-Bass.

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Parker, A., Eng, E., Laraia, B., Ammerman, A., Dodds, J., Margolis, L., and Cross, A. (1998). Coalition building for prevention: lessons learned from the North Carolina Community-Based Public Health Initiative. Journal of Public Health Management & Practice, 4(2), 25-36.

Zakocs, C., and Edwards, M. (2006). What explains community coalition effectiveness?: a review of the literature. American Journal of Preventive Medicine, 30(4), 351- 61.

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