Taking infant mortality prevetnion to the people: Successes and challenges in state initiated community based interventions

Low-income neighborhoods in Memphis experience infant mortality rates as high as 36 per 1000 live births, with large health disparities between African-Americans and European-Americans. As part of the Governor's Infant Mortality Initiative, the March of Dimes implemented the Community Voice Program, designed to reduce infant mortality among African-Americans by training Lay Health Advisors (LHA) to take accurate information about perinatal health and infant mortality to the local community. Two years into the project, our multi-method evaluation of process and outcomes has provided us with unique perspective on the program's successes and challenges. Results indicate that over 95% of participants pass the post-test with a score of 80% or better and become certified LHAs. LHAs are challenged to “Take it to the People” by delivering information in individual and small group settings, and documenting delivery through contact reporting forms. Although LHA's report anecdotally that they are talking in the community, in two years approximately 12% have returned contact forms. As evaluators, our team has discovered ironic tensions between the goal to empower and the inclination to commodify knowledge and micromanage grassroots action. For example, the curriculum and support materials remain expensive intellectual property restricting capacity to train new LHAs. Certified LHAs are cautioned not to deliver information to large audiences, but to instead refer requests back to agency supervisors. As the push-pull nature of the program conflates social justice and authoritative knowledge, the true impact of lay health advisors might be witnessed only after they achieve emancipation from the program.