The David & Lucile Packard Foundation: Landscape Assessment of Maternal and Child Health Systems

The Challenge

Black, Indigenous, and Latino families in the United States face stark inequities in maternal and child health, with pregnancy-related mortality rates for Black and American Indian/Alaska Native women more than three times those of White women. Families with young children often must navigate fragmented health, child care, and financial support systems, a process that varies widely by county and creates barriers to timely, coordinated care.

In response, the David and Lucile Packard Foundation launched its 10-year Children and Families Initiative (CFI) in 2024 to improve maternal and infant health and support healthy child development from birth to age three, with a focus on Black, Indigenous, and Latino families. CFI embraces a system of care model, emphasizing collaboration across sectors to more effectively meet families’ interconnected needs.

To catalyze this work, the Foundation needed a clear picture of how these systems are organized locally, where families face the greatest barriers, and where opportunities exist to strengthen cross-sector collaboration. This landscape assessment was designed to answer a central question:

How can health, child care, and financial support systems be strengthened and integrated to create a coordinated, family-centered system of care that improves maternal and child health outcomes?

The Approach

VIVA partnered with the Foundation to conduct a three-county landscape assessment (Alameda, Fresno, Monterey) selected for their diverse populations, geographies, and system structures. 

Our approach included:

• Stakeholder engagement: A cross-county design team of system leaders and community partners helped shape research questions and validate findings.
• Family Perspectives: Interviews with parents across Alameda, Fresno, and Monterey Counties provided firsthand insight into navigating health, child care, and financial support systems as well as recommendations for improvement.
• System mapping:  Three interactive maps visualize how major federal, state, and local programs are organized, administered, and subcontracted.
• Cross-county analysis: Findings were synthesized into the CFI Landscape Assessment of Maternal and Child Health Systems report, which highlights county strengths, persistent challenges, and opportunities for philanthropy and policymakers to support system alignment.

The Impact

The resulting system maps and landscape report provide a level of clarity that has not existed before. With this new visibility, stakeholders can:

• Identify gaps and barriers such as redundant eligibility requirements, language access challenges, and shortages in maternal mental health services.
• Spot promising practices such as culturally responsive prenatal care models and innovations like WIC’s online application and document upload process, which reduce administrative burden and improve families’ access to benefits.
• Guide strategic investment by aligning philanthropic and public resources with the areas of greatest need and opportunity.

Explore the Interactive Maps

Alameda County System Map

Monterey County Systems Map

Fresno County Systems Map

Together, the maps and report equip stakeholders to not only make smarter, equity-driven investments, but also to re-engineer health, child care, and financial support systems so they work better for families.