Georgia WIC Program
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Georgia WIC Program
- 1. Adidja Amani, Lod Hambanou, Julie Jabaley, Rose Kattakayam, Emma Konan
- 2. History and Legislation Child Nutrition Action of 1972 (PL 92-433) began as 2-year pilot administered by USDA/FNS at federal level evidence of importance of maternal nutrition for pregnancy outcomes potential for permanent physical damage to malnourished infants By1975… became permanent program nutrition education mandated programmatic changes By 1978 income eligibility guidelines set funding formulas for states Healthy Meals for Healthy Americans Act of 1994 Special Supplemental Nutrition Program for Women, Infants, and Children
- 3. Organizational Structure Private Contract Agency n1 Contract Agency n2 State Government Department of Human Resources (DPH) WIC Branch Federal Government Food and Nutrition Services
- 4. WIC Branch Flowchart Policy Mgmt & Consultation Vendor Management Systems Information Planning and Resources Compliance Analysis Clerical Support Unit Branch Director Financial Management
- 5. Georgia WIC Functions 1-Nutrition education and health surveillance 2-Vendor and case load management 3-Food instrument production4-Food instrument payment and reconciliation 5-Monitoring and audit 6-System administration
- 6. Georgia WIC Partnerships American Association of Pediatricians Wellstar Hospital and the Timber Ridge Conference Center Emory Non-WIC food programs
- 7. Outcome Goal Improve health status and reduce infant mortality by nutrition and health services for women, infants and children.
- 8. Who? Pregnant Breastfeeding women Non-breastfeeding postpartum women Infants Children
- 9. Eligibility Criteria Resident or receiving healthcare Family income at or below 185% of federal poverty income guidelines Persons receiving other services – Medicaid, TANF, Food Stamps Documented nutritional risk
- 10. What is done? Nutritional assessment health screening medical history body measurement hemoglobin check Vouchers for food supplements Immunization assessment Referrals Voter registration
- 11. Nutritional Risk Assessment VENA (Value Enhanced Nutrition Assessment) Inadequate dietary intake Abnormal hematological measurements Documented nutritional or medical needs Predisposition
- 12. milk, cheese, iron-fortified formula eggs, dried beans, tuna carrots, fruit juice dried cereal
- 13. Food Voucher Progression Local Agencies Participants Grocery Stores
- 14. Nutritional Education For whom? adult participants parents guardians of infant and child participants By whom? local agencies Content? information and education materials
- 15. Breastfeeding Support & Education By whom? Local agency Breastfeeding coordinator Content? Preferred method Encouragement Support
- 16. Budget and Resources No independent budget for WIC Problems with projected states’ revenues in recent years States agencies required to reduce budget of 6% -10% for FY- 2009 & 2010 Suspension of certain activities to reduce expenditures • Recruitment of additional personnel • Travel and participation in conferences • Vehicle purchases
- 17. Down to the Nitty Gritty… Reduction priority Subprogramor activity Reduction Cumulative reduction Cumulative percentage Comments 15 Infant & Child Health Promotion - Laboratory Supplies 325,000 9,736,316 5.37% Savings from closing GPHL on Saturdays including testing kits $275,000 and utilities $50,000 16 Infant & Child Health Promotion - Contract Elimination 140,000 140,000 9,876,316 5.44% YMCA Fit for Life $100,000; Safe House Outreach $40,000 17 Infant & Child Essential Health- Contract Reduction Infant & Child Essential Health- Contract 582,000 10,458,316 5.76% Reduce Hemophilia of Georgia $382,000 (20%); Tertiary Care Centers $200,000 (10%)
- 18. Georgia Budget & Resources FFY 2005 WIC Expenditures in Georgia Total: $ 230,465,330 WIC FFY 2005 Funding Sources Federal (Food + NSA) $159,952,282 Formula Rebate $70,513,048 Total $230,465,330
- 19. Budget & Resources Foodcosts: $ 188,552,366 Federal food:63% Formula Rebate:37%
- 20. Budget & Sources: Expenditures 0 200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 Total federal Local Match Food: $1,309,243 Administrative: $290,572
- 21. The BIG Picture ecological, upstream intervention step toward Healthy People 2010 goals example of evidence-based programming that works
- 22. Some Granularity $22K/lb versus $40/lb WIC Mothers have longer pregnancies get earlier prenatal care/better nutrition have greater breastfeeding initiation rates breastfeed babies10-25% more frequently than non-WIC babies WIC Children demonstrate better academic performance have greater assurance of normal growth access regular healthcare/vaccines more
- 23. More Granularity GA WIC serves monthly… 81K infants 145K children 24K pregnant mothers 21K BF mothers 33K PP mothers GA WIC contributes $301million to economy
- 24. Strengths, Weaknesses & Opportunities Cost Smoking intervention concurrent w/nutrition interventions/education Improve breastfeeding rates
- 25. References Ahluwalia, I.B., Tessaro, I., Grummer-Strawn, L.M., MacGowan, C. & Benton-Davis, S. (2000, June). Georgia's breastfeeding promotion program for low-income women [Electronic version]. Pediatrics, 105(6). Delahanty, J.C., DiClemente, C.C., Havas, S., & Langenberg, P. (2008). Smoking status and stages of change for dietary behaviors among WIC women [Electronic version]. American Journal of Health Behavior, 32(6), 583-593. Georgia Department of Human Resources. (2008, August). Department of Human Resources board meeting August 2008. Retrieved on November 26, 2008, from http://health.state.ga.us/phchanges/pdfs/ DHR_Board- Budget%20Reduction%20Presentation_08-20-2008.pdf Georgia Department of Human Resources. (n.d.). 2008 Georgia WIC procedures manual & Georgia state plan. Retrieved on November 8, 2008, from http://health.state.ga.us/pdfs/wic/2008_Georgia_WIC_Procedures_ Manual.pdf Georgia Department of Human Resources. Division of Public Health. (2006, May). Georgia WIC facts and figures FFY 2005. Retrieved on November 26, 2008, from http://health.state.ga.us/pdfs/wic/wic.Facts%20and%20Figures% 20Report%20FFY%202005.pdf Georgia Department of Human Resources. Division of Public Health. (n.d.). Supplemental nutrition program for women, infants & children (WIC). Retrieved November 8, 2008, from http://health.state.ga.us/programs/wic Georgia Department of Human Resources. Division of Public Health. (n.d.). WIC fact sheet. Retrieved November 8, 2008, from http://health.state.ga.us/ pdfs/wic/wic.faq.pdf United States Department of Agriculture, Food and Nutrition Service. Program data. (n.d.). Retrieved November 27, 2008 from http://www.fns.usda.gov/pd/wicmain.htm United States Department of Health and Human Services. Healthy people 2010: Understanding and improving health [Electronic version]. (2nd ed). Washington, DC: U.S. Government Printing Office, November 2000. United States Government Accountability Office. (2006, February). Breastfeeding. Retrieved November 8,2008, from http://www.gao.gov/new.items/d06282.pdf United States General Accounting Office. (2001, December). Food assistance. Retrieved November 8,2008, http://www.gao.gov/new.items/d02142.pdf
Notas del editor
- In 75: upped admin cap from 10 to 20%, allowed education costs to be under admin costs, upped age from 4 to 5
- Can we put fed/state in top field and collapse cell on right to one cell
- NUTRITION EDUCATION AND HEALTH SURVEILLANCE =Maintain Nutrition Education Data ,Maintain appointment schedules for enrollees that are to receive nutrition education =Perform Individual Client Health Monitoring dietary behavior =Perform Analysis of WIC Population Nutrition Education and Health Surveillance: Monitor changes in WIC participant population health status, Provide WIC participant population data to other state health agencies, Provide WIC participant population data to CDC VENDOR and CASELOAD MANAGEMENT =Allocate Caseload, Determine maximum state caseload which could be served with available funds, VENDOR MANAGEMENT consist of Support vendor authorizations, Monitor Vendor Education ,Track Investigations and Routine Monitoring Capture compliance buys and routine monitoring data performed on Vendors, Monitor Compliance Cases and Sanctions, Coordinate With Food Stamps Program Maintain FSP violation data on WIC vendors, Monitor Expenditure for nutrition services, administration and food obligations and Expenditures, Process Manufacturer Rebates FOOD INSTRUMENT PRODUCTON Maintain Food Package Database , Print Food Instruments on Demand, Print and Distribute Food Instruments in Advance of Pick-Up, Monitor Food Instrument Stock : Record stock receipt, shipment and usage of food instruments FOOD INSTRUMENT PAYMENT AND RECONCILIATION =Void Unissued and Unredeemed Food Instruments, Reconcile Redeemed Food Instruments ,Process, Produce Vendor Payment Detail ,Produce payment detail for checks Monitoring and Audits every 2 years : This goal is achieved by: 1.) Reviewing local agencies and newly established clinics to ensure programmatic compliance with Federal and State Regulations, 2.) Coordinating with Georgia licensed Certified Public Accountants (CPA) to review and complete local agency financial reviews for federal regulation compliance SYSTEM ADMINISTRATION Maintain System Data Tables Administer System Security Maintain user identification , Archive System Data:
- The Nutrition Section partnered with the American Association of Pediatricians (AAP) to promote WIC and other public health services and programs to pediatricians in targeted communities. Wellstar Hospital and the Timber Ridge Conference Center were added to the list of agencies providing clinical and foodservice opportunities respectively, for our dietetic interns. The Nutrition Section continues to work closely with Emory to facilitate the nutrition and medical care services given to especially high-risk infants and children. for leveraging the coordination of information and resources with state and local partners in order to respond to the needs of pregnant women and young children and improve Maternal and Child Health (MCH) outcomes. 1) Coordination of WIC and immunization services at the state and local levels. 2) Collaborative partnerships with other non-WIC food assistance programs at state and local levels.
- Think of goal of ph as prevention of health problems, programs like WIC are consistent w/that mission. Also consistent w/overarching goals of Healthy People 2010: Increase quality and years of healthy life and eliminate health disparities, as it begins in vitro to address the needs of the child and consequently the mother and serves a population on the negative end of the health disparity spectrum. Healthy People 2010 also focuses specifically on health of community, not just individual—WIC supports that goal by focusing on a “community” of those often disengendered by HC system—holistically: screenings, nutrition education, eating behaviors, access to care, etc. Efforts to use the environment to support healthy behaviors by location of care, breadth of stores accepting vouchers, counseling toward healthier nutrition (by education, like breastfeeding Rose mentioned, but products available via vouchers, etc), etc Evidence-based programming nutritional provisions meet those lacking in target population, not random Evidence of ongoing evaluation and efforts to improve. For example, found that advertising through formula samples offered at hospital was resulting in lower than optimal breastfeeding rate, Gov’t Accountability Office issued advertising standards and discouraged practice—overall still “in progress.” 2008 Georgia guidelines state: “The best food for most infants is breastmilk. Until the maternal milk supply is well established at 4-6 weeks of lactation, no formula should be offered. Infant formula should not be provided, through food package assignment or free samples, to breastfeeding participants who do not want or need it. Breastfeeding is defined as feeding a mother's breastmilk to her infant(s) at least once a day.” BUT really only a recommendation…some states have restricted free samples from hospital NY and MA) -documents all aspects of program—to tune of nearly 1000 pages for 2008 GA manual. Rules (administrative and programmatic) and due process clearly defined. Critical for public health policy and admin. Also includes disaster plan, very comprehensive Online learning modules for HC workers, discussion forum, idea exchange for health promo ideas, etc
- To raise a low or very low birth weight baby costs 22,000 per pound VERSUS cost of WIC services to women WIC Moms: iron, protein, calcium, and vitamin C breastfeeding initiation rates up 10% since 1990, currently about 44% (Healthy People 2010 sets goal of 75% at birth); GA has made special effort to increase this, still below goals, but 5 specific steps have resulted in significant increases:1) enhanced breastfeeding education, 2) breast pump loans, 3) hospital-based programs, 4) peer counseling, and 5) community coalitions. [Data from Pregnancy Nutrition Surveillance System (PNSS) and Pregnancy Risk Assessment Monitoring System (PRAMS)] WIC Children: Have better vocabulary test scores than non-participants (four to five year olds) Have better digit memory test scores than non-participants
- Monthly service reflects preliminary figures for FY2008 FY 2007: 301 million breakdown: $165.6 million in food million in food (2008 Prelim data=160,342,577), $78 million in formula rebate, and $58 million in administrative funds (prelim 2008 data=49,141,487).
- Could save $3.6 billion in direct and indirect health care costs if breastfeeding rates met federal Healthy People goals; serving more people with less money earlier dietary intervention study, the Maryland Supplemental Nutrition Program for Women, Infants, and Children (WIC) 5-A-Day Promotion Program, found significant increases in servings of fruit and vegetable consumption and positive movement forward through the stages of change for eating 5 or more servings of fruits and vegetables daily for the women who received the intervention. Other studies do not show positive assn, but… Despite appreciable increases in rate of breastfeeding, still far below Healthy People 2010 and in South lower than elsewhere in country. Need ecological approach to address and understand socio-cultural norms and create working interventions/health promo campaigns