The purpose of the Healthy Start Initiative, a national demonstration program, is to reduce infant mortality by 50 percent in 15 communities. At the heart of the initiative is the belief that the community, guided by a consortium of individuals and organizations from many sectors, can best design and implement the services needed by the women and children in that community. This report examines the challenges the Healthy Start projects have faced in developing consortia. Five consortia--Baltimore, Maryland; Chicago, Illinois; New Orleans, Louisiana; northwest Indiana; and Pee Dee, South Carolina--were chosen as a representative cross section. Information was gathered from as many participants as possible through site visits, consortia and committee meetings, and interviews with project directors, staff, consortium members and consumers. These five Healthy Start projects exemplify how five critical factors--climate, people, resources, processes, and policies--shape the development of collaboratives. Also noted are several common challenges that quickly emerged: determining the structure of management and governance, increasing consumer involvement, handling race and class issues, and boosting economic development. By examining the approaches used by the five projects to deal with these challenges, this report presents an understanding of how consortia can develop effective strategies. The report includes brief descriptions of the project sites and contains 13 references. (TJQ)