North Carolina and Forsyth County are making progress on efforts to promote healthy birth outcomes and reduce infant mortality rates. The NC Department of Health and Human Services announced that in 2018 the infant death rate reached its lowest point in 31 years, decreasing for a third straight year. Still a task force convened by the North Carolina Institute of Medicine notes that our infant mortality rate ranks 39^th nationally. And racial disparities stubbornly persist. At the state level, Black children are more than twice as likely as white children to die in their first year of life. These racial disparities are reflected in Forsyth County rates where Black and Hispanic infant mortality rates are higher than infant mortality rates for whites. Overall, infant mortality rates are steeper in Forsyth County than the state average. The state Early Childhood Action Plan makes reducing the statewide infant mortality disparities a top priority.

The aim of the Great Expectations initiative is to ensure that children in Forsyth County enter kindergarten ready to learn and leave set for success in school and life. To achieve these aims it is critical to support healthy births and birth justice. The Trust works with partners statewide to promote Medicaid expansion and enrollment in Affordable Care Act insurance policies. We know that mothers gaining access to insurance before pregnancy improves birth outcomes. Studies show that Medicaid expansion states are better able to close disparities in infant mortality rates.

Locally, the Trust is supporting organizations to convene and develop community-informed action plans for closing racial disparities in infant and maternal mortality rates. The goal of this work is to identify opportunities and gaps for what is needed to effect lasting change in Forsyth County. The Trust is interested in hearing from organizations implementing action plans. Efforts could include communications and advocacy campaigns, community engagement and public education work, capacity building, and convening partners. It could also involve grassroots groups working with health care delivery systems to address barriers to care. Organizations responding to this opportunity should have been involved, or show a willingness to get involved, in planning and convening with other community groups.

The Trust may support several approaches to meeting this goal. Applicants could include, but are not limited to, advocacy or legal service organizations, groups with experience convening or organizing Medicaid beneficiaries, or other nonprofits with expertise in Medicaid and patient engagement. The purpose of this opportunity is to directly engage the families most impacted by Medicaid transformation.

The purpose of this funding is to help grassroots nonprofits and networks develop sustainable organizations adept at skills such as action planning, communications, and data literacy to advance systems and policy change efforts that improve equitable health outcomes in identified regions. These efforts should also provide opportunities for grassroots organizations to lend community voice to state level initiatives, task forces, and advisory councils. The goal is to improve local systems, especially for systemically marginalized people and communities of color, and to create ongoing feedback loops between state and local health improvement efforts.

Technical assistance groups should have deep connections in rural regions, experience working with marginalized populations, and knowledge about organizational capacity building. Applicants should also know state policies and systems impacting local and regional health improvement initiatives.