As Vineyard nonprofits large and small confront the realities of competing for a shrinking pool of donor dollars, The Foundation for Island Health (FIH) announced this week that it will eliminate the bulk of its paid staff and convert to an organization that is run almost entirely by volunteers.

Foundation executive director Bob Tonti will lose his job next week, and administrator Kerry Binder will go to part-time status.

"This is an issue of resource allocation - we are a startup and now we're at a place where we need to think about where best to put our resources," said Dr. Charles Silberstein, the chairman and founder of FIH.

Launched three years ago with the lofty goal of using the Vineyard as a laboratory to test a patient-centered, state-of-the-art, self-funded community health care system, the foundation has led several ambitious projects including the recent Health Report of Martha's Vineyard.

In an interview with the Gazette and also in a letter to the editor this week (see Page Twelve), Dr. Silberstein said the work of the foundation will continue without letup.

"When we started NASDAQ was at 5,000, and now we are in a completely different climate," Dr. Silberstein said. "This is the kind of thing lots of nonprofits face - where do you spend limited resources and where do you best invest your donor dollars? Do we invest it in our projects or do we invest it in an executive director?" he added.

In the letter Dr. Silberstein wrote in part: "An outstanding board of directors has been learning from our startup experience about the best way to apply scarce resources to our mission. Because we are a small organization trying to do innovative things, we are still evolving. Now the board has decided to target our resources toward health initiatives that are driven by volunteer energy." The letter is published on the commentary page in this morning's Gazette.

Dr. Silberstein praised the work of Mr. Tonti, who came on board as executive director early this year. Among other things Mr. Tonti presided over the health report, a comprehensive survey done on the Vineyard this year using a team of researchers from Johns Hopkins University. Diane Becker, a professor of medicine and director of the Center for Health Promotion at Johns Hopkins, was the point person in the survey. Ms. Becker is a seasonal resident of the Vineyard and a member of the FIH board.

The results of the survey were released at a public forum this summer; Dr. Silberstein said the foundation plans to release a 250-page summary of the health survey sometime in the next few weeks.

He said the elimination of the executive director position has had the effect of making board members more active.

"With this transition, people are really getting much more involved - one donor came forward and and said, ‘I want to give you a donation and it's generous, but I want to see the money going to promote volunteer efforts and not staff at this point,' " Dr. Silberstein said.

He said Mr. Tonti will continue to do some work for the foundation on a volunteer basis, and Ms. Binder will continue to do administrative work on a part-time basis.

"This will never be an all-volunteer organization because there are things we need staff support for - and I expect the time will come again when we will need a full-time executive director," Dr. Silberstein said.

The foundation got its legs in June of 2001 with the help of a $50,000 grant from the Robert Wood Johnson Foundation. "Ultimately all health care is local," declared the mission statement for the foundation. Fund-raising goals at the time included an ambitious plan to raise $1.2 million by September of 2002.

Although he declined to use actual numbers this week, Dr. Silberstein admitted that the foundation has fallen far short of its goals. But he also said the entire climate for raising money has changed.

"It's been more difficult than we thought, and we have had to raise money more slowly than we had hoped, but times have changed - there was a sense that anything was doable in those days. That's okay, we're learning, and the question now is how best to move it forward because the mission for FIH is really crucial for the Island," he said.

When it comes to health care organizations, on the Vineyard the field has grown crowded in recent years. Martha's Vineyard Hospital, Martha's Vineyard Community Services, the Dukes County Health Council, the Island Health Plan - is there too much duplication and who, if anyone, will take the lead in developing a utopian community health system on the Vineyard?

Dr. Silberstein said each health care group is important in its own way.

"I don't think there is any duplication - it is true that the Dukes County Health Council and the foundation have a lot of crossover - we both share the vision of improving health care on Martha's Vineyard. But I think the two work hand in hand," he said, adding: "We are only going to get this done with enormous energy and commitment by lots of community members and community groups.

"The fact that there are so many people interested in health care on Martha's Vineyard to me is only a sign that we can reach the dream. And I feel really enthusiastic about moving ahead."