Pregnancy and Early Childhood: Performance Management Process Needed for Three Programs
Fast Facts
Many pregnant women, children through age 5, and their families use support services like food assistance or childcare. Over 200 federal programs provide these services, and 15 provide direct services only to this population.
12 of these 15 programs have federal performance management processes that set goals, collect data, and use the information to assess whether the programs are meeting goals.
We recommended that the remaining 3 programs without these processes fully develop them to ensure programs are meeting goals, identifying potential improvements, and targeting resources appropriately.
Two young children use an abacus in a preschool classroom.
Highlights
What GAO Found
GAO found that 242 federal programs, inclusive of 12 tax expenditures, provide a range of benefits and services to pregnant women, children through age 5, or their families, among other groups. Of the 242 programs, 15 provide some amount of direct services solely to this population.
Fiscal Year 2024 Federal Programs That Provide Some Amount of Direct Services Solely to Pregnant Women, Children Through Age 5, or Their Families, by Agency
The 15 programs are fragmented across five federal agencies, meaning the programs overlap across the agencies to some extent—with similar populations or services. However, the programs are not duplicative because they vary in beneficiary population characteristics or type of services provided. Officials from all 15 programs reported coordinating with other programs serving pregnant women, children through age 5, or their families. Coordination improves agencies’ ability to provide services and improves outcomes for beneficiaries.
Three of the 15 programs have not fully established a performance management process at the federal level—in which they set performance goals, collect performance information, and use that information to assess results:
- HHS’s Preschool Development Grants Birth Through Five Program. HHS officials said this program does not set federal performance goals because it monitors progress toward state-defined goals in order to maximize state flexibility. However, a federal performance management process allows a program to assess national progress across varied state activities.
- USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Farmers Market Nutrition Program. USDA officials said such a process is not warranted, in part, because the program is small and lacks dedicated funding for this. However, regardless of program size, Congress and taxpayers need to know how effectively tax dollars are being spent.
- VA’s Veterans Health Administration (VHA) Maternity Care Coordinator Program. Officials said they are working on establishing a process, but have not yet completed it.
By fully establishing such a process, the agencies would have a more systematic way to identify potential strategies to reduce any unnecessary fragmentation and overlap, ensure that the programs are achieving their intended results, and target resources appropriately.
Why GAO Did This Study
Federal programs play a significant role in supporting many pregnant women, children through age 5, and their families by providing services to address their distinct needs.
GAO was asked to identify programs that serve pregnant women, children through age 5, or their families. This report examines (1) federal programs that serve this population, including programs that provide some amount of direct services solely to this population; (2) the extent to which duplication, overlap, or fragmentation exists among programs that provide some amount of direct services solely to this population; and (3) the extent to which programs that provide some amount of direct services solely to this population have established a performance management process.
GAO identified 250 potentially relevant programs primarily using the federal assistance listings on the System for Award Management website, SAM.gov. To verify the list of programs and collect additional information about them, GAO sent a data collection instrument to the 18 federal agencies that administer the programs. GAO also reviewed relevant agency documentation and interviewed agency officials, as appropriate.
Recommendations
GAO is making three recommendations. Two recommend that HHS and USDA establish a federal performance management process for one of their programs. One recommends that VA finalize its federal performance management process for one of its programs. HHS disagreed with GAO’s recommendation. USDA neither agreed nor disagreed. VA agreed. GAO maintains its recommendations, as discussed in this report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of Health and Human Services should establish a performance management process at the federal level for the Preschool Development Grants Birth Through Five Program. (Recommendation 1) |
HHS disagreed with this recommendation, stating that it already has a performance management system that monitors state progress toward state-defined goals for their early childhood systems. HHS officials said the agency collects and monitors data from grant recipients (e.g., states) to assess progress on state goals that are aligned with the program's implementing statute. The agency collects information from states on their specific goals in its Annual Performance Progress Report on their efforts to strengthen the early childhood care and education workforce. We acknowledge the value of monitoring state progress toward state-level goals. However, a federal-level performance management process is also important to assess national progress toward performance goals across state activities. A federal-level performance goal could relate to the various efforts that HHS already asks about in its Annual Performance Progress Report, such as ensuring that a certain number of states meet their goals. We will consider closing this recommendation when HHS develops performance goals and establishes a performance management process at the federal level.
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| Department of Agriculture | The Secretary of Agriculture should establish a performance management process at the federal level for the WIC Farmers Market Nutrition Program. (Recommendation 2) |
USDA neither agreed nor disagreed with this recommendation. USDA officials stated that the WIC Farmers Market Nutrition Program does not have a performance goal-the first step of a performance management process-because it does not have dedicated funding for this purpose. Officials stated that the program collects performance information and uses it to assess results-the second and third steps of a performance management process-by conducting management evaluations of the state agencies that implement the program and by collecting performance information through state plans and state agency reports. This information allows USDA to determine that state agencies are compliance with program requirements and that federal funds are being used appropriately, and to identify areas for improvement. However, we believe that without set performance goals to guide such evaluations, the management evaluations cannot fulfill the second and third steps of a performance management process. Officials noted that participation rates-which the larger WIC program uses as a performance goal-are not an appropriate performance goal because they vary widely across state agencies. However, there are other possible federal-level performance goals that could be appropriate, such as a goal related to any outcome measures that the program is already evaluating at the state level. We maintain that the WIC Farmers Market Nutrition Program should develop performance goals and establish a performance management process at the federal level. We will monitor the agency's efforts in this area.
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| Department of Veterans Affairs | The Secretary of Veterans Affairs should complete the process of establishing a performance management process at the federal level for the VHA Maternity Care Coordinator Program. (Recommendation 3) |
VA agreed with this recommendation. The agency anticipates completing a federal-level performance management process for the VHA Maternity Care Coordinator Program by October 2026. We will monitor the progress of these efforts.
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