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

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

Interim Results

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.

Key Resources

Partners

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.

Funders

The philanthropic funders include:

Legal

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.

Publications