Expanding Nurse-Family Partnership

Children born to low-income parents are subject to above-average risk for abuse, neglect, poor nutrition, slower cognitive development and illness. To help improve the health, well-being and self-sufficiency of low-income, first-time mothers and their children and families, The Duke Endowment in 2008 partnered with other private and public funders in a $42 million, seven-year effort to expand the Nurse-Family Partnership program in North Carolina and South Carolina.

Based on the success of this project, the Endowment is partnering with other funders to expand Nurse-Family Partnership to an additional 3,200 first-time mothers in South Carolina. This project, which includes $17 million committed from philanthropic funders, is the first Pay for Success project undertaken by the state of South Carolina. Nationwide, it is the first Pay for Success project aimed at improving health outcomes for mothers and children living in poverty.


Successful early childhood development requires many facets of care: physical health and nutrition, mental stimulation and brain development, and a nurturing environment with stable parents. For low-income, first-time mothers, meeting all of the needs of a baby as it grows to school age can be an enormous challenge. Failure to meet those needs puts the younger generation at great risk. While many programs address some of the issues facing this population, few provide an effective, comprehensive approach with measurable results.


Nurse-Family Partnership is a nonprofit, evidence-based, nurse home visiting program that improves the health, well-being and self-sufficiency of low-income, first-time parents and their children. From its national office in Denver, Colorado, Nurse-Family Partnership works closely with "implementing agencies" at the state and local level to deliver a consistent, proven model for successful early childhood development.

Through the program, first-time mothers meet with a registered nurse early in pregnancy and regularly scheduled nurse home visits continue through the child's second birthday.

Nurse-Family Partnership Goals

    1. Improve pregnancy outcomes by helping women engage in preventive health practices, including obtaining thorough prenatal care from their healthcare providers, improving their diet, and reducing their use of cigarettes, alcohol and illegal substances
    2. Improve child health and development by helping parents provide responsible and competent care
    3. Improve economic self-sufficiency by helping parents develop a vision for their future, plan future pregnancies, continue their education and find work.
    4. While nurses target new mothers for home visits, they encourage the participation of fathers and other family members, and help both parents improve their skills in money and debt management, communication, problem solving and decision making.

    Expanding Nurse-Family Partnership in North Carolina and South Carolina

      The Duke Endowment's Health Care and Child Care program areas are partnering with the Kate B. Reynolds Charitable Trust, the North Carolina Department of Health and Human Services Division of Public Health, BlueCross BlueShield of North Carolina Foundation, The North Carolina Partnership for Children (NC Smart Start) and Prevent Child Abuse North Carolina to expand the Nurse-Family Partnership program in North Carolina.

      While one site was operating in Guilford County before this initiative, since July 2008 the program has grown to serve Buncombe; Cleveland; Mecklenburg; Pitt; Robeson and Columbus; Rutherford, Polk and McDowell; and Wake counties.

      In 2009, the program was launched in South Carolina, and serves Anderson; Berkeley; Charleston; Colleton; Dorchester; Georgetown and Horry; Greenville; Lexington and Richland; and Spartanburg counties. In addition to The Duke Endowment, funding partners include BlueCross BlueShield of South Carolina Foundation, South Carolina Department of Health and Environmental Control, South Carolina First Steps to School Readiness, the Self Foundation, The Children's Trust Fund of South Carolina, and the Administration for Children and Families.

      Federal support through Maternal Infant and Early Childhood Home Visiting Program has led to even greater expansion. A Medicaid waiver is allowing the program to target the lowest income counties across the state.

      In 2016, the Endowment and other funders partnered with the state of South Carolina to launch a Pay for Success project to expand Nurse-Family Partnership. The Endowment, BlueCross BlueShield of South Carolina Foundation, the Boeing Company, Greenvile First Steps, and the Laura and John Arnold Foundation are providing upfront capital to expand the program. The state will contribute to program costs if predetermined goals are met. 

      Participating Sites

      North Carolina

      • Buncombe County
      • Cherokee County
      • Cleveland County
      • Columbus County
      • Edgecombe County
      • Forsyth County
      • Gaston County
      • Guilford County
      • Halifax County
      • Haywood County
      • Hertford County
      • Jackson County
      • Macon County
      • Mecklenburg County
      • Northampton County
      • Pitt County
      • Polk County
      • Robeson County
      • Rockingham County
      • Rutherford County
      • Swain County
      • Wake County

      South Carolina

      • Abbeville County
      • Anderson County
      • Berkeley County
      • Charleston County
      • Colleton County
      • Darlington County
      • Dillon County
      • Dorchester County
      • Edgefield County
      • Florence County
      • Georgetown County
      • Greenville County
      • Greenwood County
      • Horry County
      • Lexington County
      • Marlboro County
      • McCormick County
      • Oconee County
      • Orangeburg County
      • Pickens County
      • Richland County
      • Saluda County
      • Spartanburg County
      • Union County
      • Williamsburg County


      Area of Work

      • Prevention and early intervention for at-risk children

      • Prevention

      Program Area

      • Child & Family Well-Being
      • Health Care

      Grantmaking Status

      The Endowment is continuing to work through current grantees and is not accepting new applications.

      Areas of Work

      • Prevention and early intervention for at-risk children

        To equip children and families with skills to ensure that children reach developmental milestones to lead successful lives.

      • Out-of-home care for youth

        To drive child welfare systems toward greater accountability for child well-being.

      • Quality and safety of health care

        Improving the quality and safety of health care delivery

      • Access to health care

        Improving health by increasing access to comprehensive care

      • Prevention

        Expanding programs to promote health and prevent disease

      • Academic excellence

        Enhancing academic excellence through program and campus development

      • Educational access and success

        Increasing educational access and supporting a learning environment that promotes achievement

      • Campus and community engagement

        Promoting a culture of service, collaboration and engagement among schools and communities

      • Rural church development

        Building the infrastructure and capacity of United Methodist churches to enhance ministry and mission

      • Clergy leadership

        Strengthening United Methodist churches by improving the quality and effectiveness of church leadership

      • Congregational outreach

        Engaging United Methodist congregations in programs that serve their communities