Working Together for Greater Impact in the Carolinas
For more than a century, The Duke Endowment has worked to strengthen communities across North Carolina and South Carolina. Throughout our history, we have recognized that lasting progress on the issues we support, including education, child welfare, health care and the advancement of rural communities, requires more than just funding. It requires trusted relationships, a clear understanding of community problems and a willingness to learn and adapt.
Today, the Endowment is applying that principle to our partnerships with government, collaborations that have become increasingly important to our grantmaking.
The Endowment is pursuing more opportunities to work alongside local, state and federal agencies to advance shared goals for the Carolinas. That does not simply mean asking government bodies to sustain projects we developed independently of them. It means identifying common priorities, engaging public partners earlier and, when appropriate, jointly designing, funding, implementing and evaluating promising approaches.
Our motivation is straightforward. Government agencies often possess the scale, authority, infrastructure and long-term resources needed to reach large populations. Philanthropy can provide flexibility, respond more quickly and support innovation, learning and rigorous evaluation. When those complementary strengths are aligned, successful programs have a better opportunity to grow, endure and benefit more people.
A relationship shaped by changing times
During its first several decades, from 1924 through 1960, the Endowment often helped fill critical gaps in public health, education, social services and rural development. It supported retired rural United Methodist ministers and their families, assisted its beneficiary colleges during the Great Depression and provided operating support for orphanages at a time when federal child welfare funding was extremely limited.
The Endowment’s influence on the development of America’s hospitals was particularly profound. Watson S. Rankin, who served as the first director of the Endowment’s Hospital and Orphan Sections, was one of the most influential public health leaders in the Carolinas during the first half of the 20th century. His work through both the N.C. State Board of Health and The Duke Endowment had a significant impact on health policy and health care infrastructure.
The Endowment’s work to build and improve nonprofit hospitals also helped inform the federal Hill-Burton Act of 1946, which supported the construction and modernization of hospitals across the country.
The landscape changed during the 1960s as the federal government made major investments in health and human services, including the creation of Medicare and Medicaid and expanded support for foster care. Government funding became more available to states, localities and nonprofit organizations. During this era, the Endowment’s connections with government were often indirect, with grantees looking first to public programs as potential sources of support. The Endowment also took care not to use its grants in ways that might replace public funding or relieve government of its responsibilities.
Beginning around 2000, engagement with government became a more deliberate feature of the Endowment’s work. The number of Endowment grants involving government grew from one in 1996 to as many as 50 in 2025. Across most program areas, relationships progressed from information sharing, committee participation and occasional co-funding toward deeper forms of collaboration.
That evolution has taught us an important lesson. Namely, that a promising idea is not enough. Earlier efforts sometimes assumed that a public agency would eventually sustain an effective program after a philanthropic grant ended. Experience showed that even programs producing positive results might not fit an agency’s priorities, funding structures or operational realities. More durable work begins with conversation, not assumptions. It gives government partners a meaningful role in defining the need, selecting an approach and determining how success will be measured.
From presenting solutions to creating them together
The Endowment’s emerging approach can be seen in partnerships designed to expand programs such as Annual Book Fairs and the Positive Parenting Program (Triple P), both evidence-based initiatives. In these efforts, public and philanthropic partners have worked together on program design, implementation, evaluation planning and funding. By contrast, in the effort to expand and evaluate the Nurse-Family partnership program, the Endowment sought to persuade South Carolina government leaders to entertain a pay-for-success contract instead of establishing that the program was a priority for the state before starting negotiation on design, implementation and evaluation. It resulted in a less-than-optimal agreement.
Other examples of productive partnerships can be found across the Endowment’s grantmaking program areas. In North Carolina’s Catawba County, the Success Coach child welfare program was developed with Endowment support in 2007, followed by state funding for statewide expansion beginning in 2024. In South Carolina, the Endowment and the Department of Social Services worked together to expand the Strengthening Families Program, including providing shared funding, joint decision-making, common outcomes monitoring and mutual accountability. In 2005, the Duke Endowment partnered with the S.C. Department of Mental Health (SCDHM) to co-design a concept for providing tele-psychiatry services to rural hospital emergency departments. In 2007, the program launched with start-up funding from the Endowment and with evaluation support from the University of South Carolina. The telepsychiatry network was later replicated in North Carolina, where the Endowment worked with ECU Health and the N.C. Department of Health and Human Services (NCDHHS) to create the N.C. Statewide Telepsychiatry Program (NC-STeP).
These experiences also reveal the challenges inherent in public-private collaboration. For instance, changes in leadership can disrupt shared vision. Regulations and fragmented systems can slow decision-making. Elections and policy changes can reshape priorities. Building trust takes time, and meaningful collaboration may require repeated conversations, revised timelines and flexibility from everyone involved.
Why this work matters now
The stakes are high for the Carolinas. Children and families, rural communities, churches, health care providers and schools of higher learning face needs that no single institution can address alone. Even philanthropy’s most successful investments will have limited reach if they remain isolated projects.
The Endowment therefore sees an opportunity to combine philanthropy’s flexibility and capacity for innovation with government’s reach and potential for long-term sustainability. Future partnerships will continue to emphasize approaches supported by rigorous evidence, alignment with desired outcomes and evaluation. These partnerships also must distribute responsibility and risk fairly, rather than placing the burden entirely on either the public or philanthropic partner.
This is patient work. Not every partnership will produce the hoped-for result, and public resources will continue to be shaped by changing economic and policy conditions. But deeper collaboration offers a path toward something neither sector can accomplish as effectively alone: expanding proven approaches so that more Carolinians can benefit from them.
To be clear, our role is not political advocacy. Our focus remains centered on achieving measurable results that align with our mission and the guidance of the Trust Indenture, our founding document.
We are ready to listen, learn and build together. Alongside our government partners, we are committed to advancing work that improves lives and supplying philanthropic resources when shared priorities, strong evidence and mutual accountability come together.
Phillip Redmond is a special advisor to Endowment President Rhett Mabry, focusing on the development of public-private partnerships.