Missouri Foundation for Health is requesting proposals from organizations seeking to partner in learning and evaluation of the Foundation’s Infant Mortality Reduction Initiative (IMRI). The intended scope of work includes providing thought partnership to various initiative partners and foundation staff, as well as evaluating the IMRI’s contributions toward (1) system-level changes in maternal and infant health promotion, and (2) improving the experiences and health outcomes of women and their infants.
The Infant Mortality Reduction Initiative is in the seventh year of a 10-year MFH commitment (2013-2022) aimed at decreasing infant mortality rates in St. Louis and six counties located in Missouri’s Bootheel (Scott, Stoddard, Pemiscot, Dunklin, Mississippi, New Madrid), where infant mortality is twice that of the state and disproportionately affects black infants.
Recognizing that a complex array of social determinants drives high rates of infant mortality – including racial and economic inequity – MFH has partnered with a range of stakeholders (such as, community-based organizations, local governments and health care providers) to develop a framework for collectively improving the range, type, and quality of services available to vulnerable mothers, and where possible, to innovate new approaches. Central to this framework is the understanding that those most impacted by high infant mortality rates are those most likely to identify root causes, suggest effective solutions, and participate in their implementation.
Using this approach, MFH and community partners have collaborated over the past seven years in the development and implementation of aligned, equity-focused infant mortality reduction goals, strategies, and shared measurement using the following three lenses:
- Community Led: Our approach acknowledges that those most impacted by the issue are the ones most likely to identify root causes, suggest effective solutions, and participate in their implementation. In the second five years of the 10-year commitment, an increased emphasis has been placed on empowering communities to drive the priorities of the initiative and direct the flow of resources supporting the unique place-based strategies of the two efforts.
- Equity Centered: Starting in 2018, the initiative’s goals explicitly include a focus on eliminating the inequities between white and black infant deaths, with place-based efforts developing to engage people of color and address issues of structural racism and poverty.
- Learning and Adaptation Focused: Through continuous learning and adaptation, the initiative aims to create sustainable systems change by facilitating the continuous improvement of policies and programs to best serve the needs of women.
Initiative “Backbone” Stakeholders
IMRI has two site-based efforts, FLOURISH in St Louis, and Bootheel Babies and Families (BBF) in the Bootheel. The initiative originally was based in a collective impact framework but has evolved into a framework that is rooted in the voices and power of communities. For the incoming evaluation partner, familiarity with collective impact approaches is important, but measurement of fidelity to the collective impact model is not.
Based on the framework, FLOURISH is supported by a “backbone” organization (Generate Health). The Bootheel site, BBF, is supported through a fiscal agent with three staff and multiple capacity-building consultants. Each site has a common agenda and is building shared measurement systems. Each site supports mutually reinforcing activities (“aligned activities”) and uses a participatory grantmaking to guide further investments toward the common agenda.
Current Learning and Evaluation Objectives and Activities
The evaluation model used for this initiative thus far has been rooted in learning and adaptation. Moving forward, the evaluation will focus on the following objectives:
- What system-level changes have occurred in maternal and infant health promotion as a direct or indirect result of the work of IMRI (backbones, partners, and foundation)?
- How has the IMRI contributed to improvements in the experiences and health outcomes for women and infants?
Both sites have developed and implemented data collection activities over the course of the initiative. Each site, with support, is coordinating the collection of a variety of primary (listening sessions, surveys, individual program outcomes, RedCAP, partner interviews) and secondary data regarding the activities and outcomes of site-specific components of work and regional trends in maternal and infant outcomes. Progress is captured from all funded partners through various dashboards (BBF sample, FLOURISH sample). The Foundation supports flexible and participatory evaluation approaches, allowing sites to focus their data collection efforts on indicators and outcomes that are most meaningful to them.
A successful learning and evaluation partner will:
- Lead the initiative-level evaluation activities, including developing new data collection methods, while integrating existing methods (site dashboards), and analysis and reporting related to the initiative’s theory of change and three key frames outlined above. This will include a combination of light support for site-based data collection activities as well as the robust development of initiative-wide methods to garner, analyze, and compile insights on overall impact. Applicants are encouraged to propose innovative methods and approaches while being sensitive to placing additional burden for data collection activities on the site partners.
- Continue support of the evaluation activities related to FLOURISH partners, including completing dashboards based on stakeholder and grantee interviews, key document reviews on a quarterly and biannual basis for evaluation of FLOURISH initiative and grantee partners.
- Ensure the evaluation methodology contributes to equity, while being responsive to the unique geographical context of each collaborative and include a variety of methods, sources and voices.
- Share insights in meaningful and digestible ways for multiple audiences, including Foundation staff, lead organizations, and general audiences.
- Support backbone partners in ongoing development of their evaluation plans with an increasing focus on right-sized and sustainable methods for each site.
- Facilitate continuous learning conversations with foundation staff and two lead organizations, generating emerging insights that can be translated into action.
- Support grantee learning by contributing to communities of practice, virtual learning summits, and offering coaching support to backbones.
At a minimum, key deliverables must include (1) a retrospective yearly report (spring 2021, 2022, & 2023), comprised of an initiative-level evaluation, as well as BBF/FLOURISH-specific reviews, (2) timeline and insightful thought partnership, and (2) methods for sharing of findings at the annual convening in Missouri. We encourage evaluators to develop concise reports and, where possible, include visualizations as part of their communications. Creative approaches to the key deliverables and additional dissemination methods and products (factsheets, presentations, webinars, etc.) are welcomed and encouraged.