Catalyzing Alignment and Systems Transformation Through Cross-Sector Partnerships: Findings from the California Accountable Communities for Health Initiative

Lisa Angus
Alaina Dall
Ritu Ghosal
Peer-Reviewed Article
September 2023


A multi-sector collaboration in California that included community members improved organizational partnerships and create systems change.


From 2017 to 2022, the California Accountable Communities for Health Initiative (CACHI) invested $17 million in 13 Accountable Communities for Health (ACHs) across the state. The ACHs were designed to promote health equity and community needs through structured collaboration among multi-sector organizational partners and community residents. The 13 CACHI ACHs varied in size and geographic coverage, focusing initially on specific health issues or community conditions, and later expanding their scope. Structurally, each ACH included a backbone organization, a steering committee or leadership body, and various workgroups or subcommittees. This article describes the results of an evaluation of the ACH programs using data from surveys, key informant interviews, small group conversations, meeting observations, and document reviews.


ACHs demonstrated the ability to contribute to systems change, including strengthened partnerships, enhanced knowledge, improved capacity, greater attention to health and racial equity, and increased awareness of other agencies’ work. There were areas for improvement in meaningful community engagement. The authors emphasized the context-dependent nature of place-based collaboratives, like ACHs, and underscore the need for diverse evidence to guide participants in cross-sector collaboratives toward effective systems change.


The ACH model has demonstrated effectiveness in creating systems change, particularly strengthening organizational partnerships, increasing organizational capacity to provide services, reaching new clients or decision-makers, and paying greater attention to health and racial equity. As the CACHI initiative expands, the authors highlight the importance of financial resources and operational flexibility for these entities, along with the necessary competencies to ensure ACH program effectiveness.

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