What GAO found
The United States has the highest maternal and child mortality rate among developed high-income countries. The Healthy Start Program, administered by the Department of Health and Human Services (HHS), has three of her goals: reduce infant mortality, improve maternal health outcomes, and reduce racial and ethnic disparities.
HHS provided funding to 101 Healthy Start grantees, including departments of health and nonprofit organizations, during the 2019-2024 grant period. In 2022, grantees served approximately 85,000 participants, including pregnant women, their partners, and children. Slightly more than half of the participants were Black or African American. In addition to connecting participants with medical services, grantees are expected to provide one-on-one consultations and health and parenting education classes.
Percentage of Healthy Start participants by race in 2022
Note: “Other” includes Asian, Native Hawaiian or other Pacific Islander, and multiple races.
HHS will use performance data to evaluate progress toward the first two of Healthy Start's three goals. It plans to stratify these data by race and ethnicity in 2024 to assess progress toward its third goal of reducing racial and ethnic disparities. HHS is also conducting an evaluation to assess the program's progress toward all three goals, which is expected to be completed in 2025.
Healthy Start data for measuring program performance (referred to as performance measures) are consistent with most of the key attributes of effective measures identified by GAO. However, this measure is inconsistent with two attributes related to clarity and reliability. For example, from 2019 he updated his HHS measures for the 2024 grant period, making it difficult for grant recipients to collect consistent and reliable data. This occurred because HHS lacked a documented process for reviewing performance measures prior to implementation. Such a process helps ensure that HHS uses measures that allow for the collection of clear and reliable data.
HHS officials also said they are working to align performance evaluations across Healthy Start and two related programs. However, HHS lacks a documented process for coordinating the selection of measures used across programs, and the agency could not provide examples of coordination. Having a documented process in place will help ensure that HHS is taking the most appropriate actions. Ultimately, this could help her HHS gather the best evidence across its programs as it pursues the common goal of improving the health outcomes of mothers and infants.
Why GAO conducted this study
The Healthy Start Program provides funding to organizations in areas with high rates of infant mortality and other adverse maternal and child health outcomes. In fiscal year 2022, the Healthy Start Program received a budget of $131 million.
The CARES Act included a provision for GAO to review and evaluate Healthy Start. This report describes Healthy Start grantees and participants, examines HHS's efforts to measure progress toward Healthy Start goals, and confirms that Healthy Start performance measures support effective interventions. Examines the extent to which key attributes are met and HHS's efforts to align Healthy Start performance measures with effective interventions. Related his HHS program stuff.
GAO will provide Healthy Start and other HHS program documents and data from the most recent grant period (April 2019 to March 2024) and the next period (from April 2024), including performance measurement information. I analyzed it. GAO also interviewed HHS officials and her six Healthy Start grantees, who were selected by factors such as geography and years as grantees.
