In February 2016, South Carolina Governor Nikki Haley, Nurse-Family Partnership, and Social Finance announced the launch of the nation’s first Pay for Success initiative aimed at improving health outcomes for mothers and children living in poverty. The initiative expands Nurse-Family Partnership’s evidence-based program to an additional 3,200 first-time, low-income mothers and their babies across South Carolina. The program will support these mothers in having healthy pregnancies, becoming knowledgeable and responsible parents, and giving their babies the best possible start in life. By strengthening families and improving early childhood development, this project will spark multigenerational change and help break cycles of poverty.

“This innovative program is going to allow us to improve the health of our children and families, and it’s a perfect example of what we can do when leaders from the private sector and public service work together.”

– Governor Nikki Haley

The initiative mobilizes $30 million to expand Nurse-Family Partnership’s services. Philanthropic funders have committed $17 million to the project and Medicaid will fund approximately $13 million via a 1915(b) Medicaid Waiver, awarded to the South Carolina Department of Health and Human Services by the federal Centers for Medicare and Medicaid services. South Carolina will make up to $7.5 million in success payments if the evaluators find positive results, 100 percent of which will be reinvested in the program.

Goals of the Project

  • Create long-term and lasting results for families statewide by supporting first-time mothers to have healthy pregnancies and become great parents, setting up children for successful early childhood development in rural and urban areas across the state.
  • Build a pathway for sustaining these effective services through reinvesting state success payments into the program and partnering with Medicaid.
  • Use a rigorous evaluation to understand the efficacy of the Nurse-Family Partnership model after implementing strategies to improve delivery and lower costs, providing important insight on how to best scale this program.
  • Bring an added level of government accountability for results for the families served.

How It Works

South Carolina DHHS

Makes success payments if outcomes are achieved

1 Partner

Social Finance

Develop project, mobilize capital, manage for results

2 Develop & Finance

Nurse-Family Partnership

Provide home visitation services

3 Deliver Services

First-time, low-income mothers

Participate in NFP’s services

4 Achieve Outcomes

J-PAL North America

Conducts evaluation (RCT)

5 Trigger outcome payments

Philanthropic donors

Provide upfront capital, reinvest payments in additional services

Key Resources


South Carolina Department of Health and Human Services (SCDHHS) leads the project and will make up to $7.5 million in success payments.

Nurse-Family Partnership will receive funding to expand its evidence-based home visitation program to serve an additional 3,200 low income first time mothers.

Social Finance supported the design, negotiation and financial structuring of the project. Social Finance also managed the capital raise, and will coordinate performance management services for the duration of the project alongside SCDHHS, NFP and the Harvard Kennedy School Government Performance Lab.

The Government Performance Lab at the Harvard Kennedy School advised the SCDHHS throughout the phases of project development—including project design, data analysis and contract negotiations.

J-PAL North America, a research center at the Massachusetts Institute of Technology, will lead the evaluation of the project.


The philanthropic funders include:


WilmerHale provided pro-bono legal support, helping to structure and develop the PFS agreement.

Nelson Mullins Riley & Scarborough LLP provided low-bono legal support, assisting with the development of the PFS agreement.

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