In February 2016, former South Carolina Gov. Nikki Haley, Nurse-Family Partnership, and Social Finance launched the nation’s first Pay for Success initiative aimed at improving health outcomes for mothers and children living in poverty. The program expanded Nurse-Family Partnership’s evidence-based program to an additional 3,000 first-time mothers with low incomes, and their young children, across South Carolina. The program supported these mothers by helping them maintain healthy pregnancies and become knowledgeable, responsible parents so they could give their children the best possible start in life. This project aimed to spark multigenerational change and help break cycles of poverty by strengthening families and improving early childhood development.
“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 mobilized $29 million to expand Nurse-Family Partnership’s services. Philanthropic funders committed $17 million to the project and Medicaid funded approximately $12 million via a 1915(b) Medicaid Waiver, awarded to the South Carolina Department of Health and Human Services (SCDHHS) by the federal Centers for Medicare and Medicaid services. South Carolina agreed to make up to $7.5 million in success payments if the evaluators found positive results, 100% of which would be reinvested in the program.
To read an example of how NFP supports mothers, read “A story of impact: Nurse-Family Partnership supports mom Terri and her daughter Aubrielle.”
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
Develop project, mobilize capital, manage for results
Provide home visitation services
First-time, low-income mothers
Participate in NFP’s services
J-PAL North America
Conducts evaluation (RCT)
Provide upfront capital, reinvest payments in additional services
The project concluded April 1, 2021, with J-Pal North America (J-PAL), the project’s independent evaluator, publishing an interim evaluation report indicating that NFP did not have an impact on the four preselected Pay for Success outcomes.
The interim results for the three outcomes, preterm births, healthy birth spacing, and child injury, measured by randomized control trial, only captured outcomes for a subset of the enrolled clients and were not statistically significant, meaning there was no distinguishable difference between the results for the families that received NFP services and those who did not. However, this does not mean that the project had no impact on the mothers and children that were served.
A more comprehensive assessment of NFP’s impact will emerge through J-PAL’s longer-term evaluation, which will continue for 30 years. Learn more on the study’s website.
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 MIT, will lead the evaluation of the project.
The philanthropic funders include:
- The Duke Endowment
- BlueCross BlueShield of South Carolina Foundation
- The Boeing Company
- Greenville County, SC First Steps
- Laura and John Arnold Foundation
- Blue Meridian Partners
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.
- “How Government, Academic, and Nonprofit Partners Are Working Together to Evaluate a Home Visiting Program in South Carolina to Improve Family Health and Wellbeing,” J-PAL
- “South Carolina Nurse-Family Partnership Social Impact Bond: Interim Project Assessment,” Social Finance
- “‘Government only pays for the positive outcomes.’ A strikingly new approach to social problems,” The Washington Post
- “‘Pay for Success’: An idea with bipartisan appeal,” Governing
- “Social Impact Bonds: Something Democrats and Republicans agree on,” Forbes
- “A new public finance tool to help the most vulnerable,” Time