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addition to funding for capacity-building, a menu of training and technical assistance around chronic conditions management enabled clinics and their networks to improve their systems of care. . In 2004, KFH provided approximately $48.3 million in charity care in California. This amount does not include any contractual shortfalls resulting from participation in public programs such as Medi-Cal. KFH defines and measures charity care in a manner consistent with the recommendations of the Office of Statewide Health Planning and Development. . Operation Access, co-founded by a Permanente physician, provides free surgical care for the uninsured in several Bay Area counties. KFH - San Francisco was the pilot site for the program and, as of 2004, seven Northern California Region facilities participate. KFH's participation was instrumental in recruiting other community hospitals and clinics, and expanding the network of medical volunteers. In 2004, one hundred twenty-two Operation Access surgeries were performed at Northern California KFH facilities. A nonprofit corporation, Operation Access is the only organization of its kind to offer low-risk elective surgeries to the uninsured in the United States. The most common type of surgery performed is for inguinal hernia, which represents about 34% of the surgeries performed by Operation Access. A hernia often keeps men from obtaining a job. Because it is a pre-existing condition, it prevents the person from obtaining coverage. These surgeries significantly improve the quality of the patient's life. . KFH's emerging Community Health Initiatives (CHI) strategy is based on a growing evidence-base and Kaiser Permanente's experience with community health partnerships. The CHI strategy seeks to create a demonstrable impact on population-level health outcomes through intensive, place-based interventions and multi-sector partnerships that promote environmental and policy change. KFH's CHI strategy holds that major improvements in community health can be brought about by sustained, targeted and comprehensive efforts, featuring the following characteristics: A defined geographic focus, somewhere between the size of a neighborhood and a county, which allows for improved targeting of resources and deeper reach to those in need of health services. A broad definition of health and a focus on issues resonant with both assessed and expressed community needs. Multi-level interventions, including those addressing the environmental and community conditions that have a powerful influence on health behavior. Partnerships with organizations from multiple sectors - a reflection of the complexity and interconnectedness of effective health improvement strategies. A commitment to evidence-based care, community-level health interventions, and measurable outcomes and accountabilities.