Cutting Through Red Tape to Provide Health Care Services

    • October 16, 2015

Originally posted: February 2, 2009
Last updated: October 16, 2015

Position at the time of the award: Deputy Director, San Francisco Department of Public Health

Current position: Director of Health, San Francisco Department of Public Health

Poor, rural communities often are strapped for decent health care—sometimes because of sheer bureaucracy. How can private and public funds be leveraged to support excellent care in these communities?

Garcia’s beginnings. Barbara Garcia grew up near California’s shipyards, where her father worked to maintain naval carriers. Hard work was a virtue in her large Mexican-American family. At 14, Garcia got a summer job as a youth counselor at a neighborhood center in Long Beach. There, she was taken under the wings of college students who had big dreams for themselves and their Latino communities.

“They instilled in me the sense of responsibility to myself and to others, the need to be involved in social justice and the commitment to give back,” Garcia recalls. Her mentors also planted the seed that Garcia would someday go to college—a goal neither she nor her family had ever considered.

Garcia worked her way up the ladder at various community and nonprofit agencies until 1979 when, at age 23, she joined Food and Nutrition Services. Her first job was to help organize a summer lunch program for families living in migrant camps in Watsonville, a farming community near Santa Cruz. It was an eye-opening experience.

“There were high numbers of work injuries and illnesses from exposure to pesticides,” Garcia recalls. “And here the same people who were growing and picking our food were suffering from anemia, diabetes and other chronic conditions. That’s when health became my focus.”

In 1984, she became executive director of Salud Para La Gente, a primary care clinic serving the largely Latino population of farm workers in Watsonville. She also took college courses and in 1988 was the first in her family to get a college degree.

Garcia was struggling to raise funds for her fledgling clinic when, in 1989, a major earthquake struck the San Francisco Bay Area, with its epicenter near Watsonville. Damage was widespread, including to the local hospital. Salud Para La Gente remained open 24 hours a day to meet the community’s major medical needs—and to distribute food and clothing. Some 10,000 people were served in one way or another.

But the clinic’s efforts also stirred controversy. Salud Para La Gente was not authorized to provide disaster services, and so it had to sue the city to get reimbursement from disaster funds set aside by the state and the Federal Emergency Management Agency—simply due to that lack of “authorization.”

“This made me very aware of the relationship between government and nonprofits and the need for disaster preparedness in rural areas,” Garcia says. “After that, we did a lot of state-wide trainings on disaster preparedness.”

Receiving a Community Health Leader award. In 1993, the Robert Wood Johnson Foundation named Garcia one of its first 10 Community Health Leaders in recognition of her work to expand health care services in her predominantly Latino community, in the midst of a natural disaster and political challenges.

RWJF’s award boosted community status for Salud Para La Gente. It also helped the clinic meet the final requirement for designation as a Federal Qualified Health Center, which made it eligible to receive federal funds, by allowing it to hire a nurse manager to finalize the necessary organizational structure. “That solidified our clinic into being a very large provider in the area,” says Garcia. “We’ve built satellite clinics and were able to realize all the dreams we had in growing the program.”

Garcia’s experience impressed upon her the importance of sound public policy in meeting the health care needs of underserved groups. After earning her master’s degree in public administration from the University of San Francisco, she completed a stint in AIDS policy management with the federal government in the mid-1990s. But Garcia felt she was too far from “the action” and returned to direct homeless policy for the city of San Francisco.

One of her projects was to help launch Homeless Connect, a public/private effort to connect homeless people with needed services. Every two months, city health department staff and volunteers fan out into the streets to meet people where they live—escorting them to health facilities, fixing wheelchairs, handing out eyeglasses or helping them make phone calls to loved ones. They serve about 2,500 people in an eight-hour period.

“We ended up utilizing the same kind of structure that we did in responding to an earthquake,” says Garcia. “Now we have a lot of homeless people who are volunteers. This project was a way for people like me and others to get out from our desks and be of service.”

As deputy director of one of the country’s largest public health departments, Garcia finds her job particularly rewarding because it draws so much on her past experiences and allows her to apply them in a larger scale.

“I like dealing with people and with systems,” Garcia says. “It’s an incredible process: How do you move a large government agency to be more responsive to real needs with less bureaucracy? You do that by one person at a time.”

Postscript. After 11 years as deputy director of the health department, Garcia was appointed director of health by then-Mayor Gavin Newsom in October of 2010.

RWJF perspective. The Foundation recognized the first 10 RWJF Community Health Leaders in 1993—unsung and inspiring individuals who work in their communities, often among the most disenfranchised populations, to address some of the nation’s most intractable health care problems. The last round of leaders was chosen in the fall of 2012. The program closed at the end of 2014. For more information on the program see the Special Report.