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- Framework and Tools
- List of Tools by Step
- Step 1. Engage Partners
- Step 2. Assess Needs
- Step 3. Examine Strengths and Capacity
- Step 4. Select Priorities
- Step 5. Set Performance Objectives
- Step 6. Develop Action Plan
- Step 7. Seek and Allocate Resources
- Step 8. Monitor Progress for Impact on Outcomes
- Step 9. Report Back to Partners
- State and Jurisdiction Links

5. Set Performance Objectives
Introduction
On Your Mark: Start Here with Grounding Concepts and the Evidence Base
In step 5, setting performance objectives consists of two phases. In the first phase, each Title V agency will develop action strategies to address their identified priority needs. Agencies will select five National Performance Measures (NPMs), Evidence-based or -informed Strategy Measures (ESMs) for each of the selected NPMs, and State Performance Measures (SPMs).
Secondly, the agency will set five-year targets (i.e., performance objectives) for the five selected NPMs, the ESMs and the SPMs. The anticipated results of this stage are the identification of NOMs, NPMs, ESMs and SPMs that directly relate to community priorities and establish a level of accountability for achieving measurable progress.
Importance of Setting Performance Objectives
Setting performance objectives is a critical component of the five-year needs assessment, as it provides a structured framework for planning, evaluating, and improving public health programs and interventions. Benefits include:
- Alignment with Goals. Performance objectives ensure that MCH programs align with the overall goals and priorities of the community and the Title V agency, ensuring resources are used efficiently and effectively.
- Measurable Outcomes. Objectives specify what needs to be achieved, and they are typically accompanied by measurable indicators. This allows for the quantification of progress and the evaluation of success in addressing needs.
- Accountability. By clearly defining performance objectives, responsibilities are established, and individuals and organizations can be held accountable for their roles in addressing the needs of MCH communities. This promotes transparency and responsible governance.
- Resource Allocation. Setting objectives helps in the allocation of resources, as it identifies the areas and activities that require funding, staff, and other resources. This promotes efficient resource utilization.
- Continuous Improvement. Objectives serve as benchmarks for assessing the effectiveness of MCH programs. If the objectives are not met, it signals the need for adjustments and improvements, fostering a culture of continuous learning and enhancement.
- Community Engagement. Clearly defined objectives can be communicated to the community, fostering engagement and collaboration. Community involvement is essential for addressing MCH needs effectively, as it ensures that interventions are culturally sensitive and relevant.
- Evidence-Based Decision-Making. Objectives should be based on solid evidence and data from the needs assessment. This data-driven approach ensures that interventions are grounded in reality and have a higher likelihood of success.
- Policy Development. Performance objectives can inform the development of policies and guidelines, as they provide a clear path for achieving desired outcomes and improving public health in the long term.
- Health Outcomes. Objectives can be designed to address health disparities and promote health outcomes, ensuring that all segments of the population receive the necessary attention and resources to meet their specific needs.
Barriers to Setting Performance Measures
Some of the most critical barriers to setting performance objectives as part of a public health needs assessment include:
- Data Availability. Limited access to accurate and timely data.
- Resource Limitations. Insufficient funding, personnel, or infrastructure.
- Political Factors. Influence of politics on objective setting.
- Stakeholder Conflicts. Conflicting interests among stakeholders.
- Lack of Community Engagement. Inadequate involvement of the community.
- Changing Health Landscape. Dynamic nature of public health challenges.
The MCH Evidence Center has reviewed the literature to find strategies for setting performance objectives:
- Rich, R., D’Hont, T., Murphy, K.E., Veillard, J. and Chatwood, S., 2021. Selecting contextually appropriate performance indicators in a circumpolar context: a modified Delphi approach. BMC Health Services Research, 21(1), pp.1-10.
- Gauri, S.K. and Das, P., 2017. A framework for performance evaluation and monitoring of public health programs using composit performance index. International Journal for Quality Research, 11(4), p.817.
- Powis, L., Ramirez, G.G., Krisowaty, L. and Kaufman, B., 2022. Shifting Power in Practice: The Importance of Contextual and Experiential Evidence in Guiding MCH Decision Making. Maternal and Child Health Journal, 26(Suppl 1), pp.204-209.
Learn What Works
Get Ready: Immerse Yourself in Effective Strategies and Learn MoreSetting evidence-based, outcome-driven performance objectives should be based on:
- Data-Driven Objective Setting. Base objectives on comprehensive data from needs assessments, epidemiological studies, and relevant public health data sources, ensuring that objectives are well-informed and aligned with real needs.
- Partner Involvement. Collaborate with diverse partners, including community members, healthcare professionals, and public health experts, to gather input and ensure objectives reflect community priorities.
- SMART Objectives. Employ the SMART criteria (Specific, Measurable, Achievable, Relevant, Time-bound) to frame objectives that are clear, quantifiable, attainable, relevant to the target population, and have defined timelines for achievement.
- Health Outcomes Consideration. Tailor objectives to address health disparities and promote outcomes by considering the unique needs of different demographic groups and communities.
- Evidence-Based Decision-Making. Utilize scientific evidence and best practices to inform the development of objectives, ensuring that they are grounded in data and supported by research.
- Continuous Review and Adaptation. Regularly assess and adjust objectives to accommodate evolving health landscapes, emerging data, and shifting community needs, promoting flexibility and responsiveness.
These trainings have been collected by the MCH Navigator:
- Developing Performance Measures: An Overview & Practical Pointers. Developed: 2013. Source: National Network of Public Health Institutes. Presenter(s): Tom Chapel and Clay Cooksey. Type: Narrated Slide Presentation. Level: Intermediate. Length: 90 minutes. Summary
- Performance Measurement and Title V Transformation: Building Skills to Select and Design Measures for MCH 3.0. Developed: 2015. Source: AMCHP. Presenter(s): Donna Petersen, ScD, MHS; Michael Kogan, PhD. Type: Video Conference. Level: Intermediate. Length: 130 minutes.
- Performance Measures in Public Health. Developed: 2015. Source: Public Health Centers for Excellence. Presenter(s): Public Health Centers for Excellence. Type: Narrated Slide Presentation. Level: Introductory. Length: 8 minutes.
Tools to Try
Get Set: Use these Tools to Move from Knowledge to ImplementationThese tools and examples have been developed by the National MCH Workforce Development Center or collected by the MCH Digital Library:
- ESM Review & Resources: National Summary. This report serves as a conversation starter as we learn how to strengthen our strategies, work with the Evidence Center, and look toward the next iteration of block grant applications and work.
- Results Based Accountability (RBA) Tip Sheet. Check out this quick "cheat sheet" to learn about how RBA relates to ESMs and for tips on writing effective measures.
- Logic Models. Logic Models are simplified graphic depictions of a program, initiative, or strategy. They provide a map of the relationships between the resources, activities, and benefits or changes that result. Logic Models demonstrate the theory of change, and can be useful in program planning, management, communicating with partners, and needs assessment. This tool (downloadable as a Word document) contains instructions and an editable logic model template.
These resources have been collected by the MCH Digital Library:
- Key Questions When Choosing Health Care Quality Measures. Agency for Healthcare Research and Quality offers guidance to determine if a measure is good and appropriate.
- Performance Measures Criteria. The American Academy of Family Physicians provides information about performance measures.
- Quality Measurement and Quality Improvement. CMS uses quality improvement and quality measurement to achieve the goals and priorities of the Meaningful Measures Framework. The purpose of the Framework is to improve outcomes for patients, their families and providers while also reducing burden on clinicians and providers.
- Science of Improvement: Establishing Measures. Institute for Healthcare Improvement creates a Model for Improvement: How will we know that a change is an improvement?
- Developing Program Goals and Measurable Objectives. CDC explains how program goals and objectives establish criteria and standards against which one can determine program performance.
Title V Tools and Examples
Go: Learn from Your Peers Across the CountryTools
These tools have been collected by AMCHP and the MCH Evidence Center:
- Colorado: HP 2020 Comparison Table. Colorado used this table to compare how the state was doing in areas of interest, in reference to national targets. This was one quantitative data product, among many considered by decision-makers, but served as a helpful tool in determining areas to work on. (Note: this is an Excel file).
- Title V Five-Year Needs and Capacity Assessment Values Informing the Prioritization of Maternal and Child Health Needs. Pennsylvania shares their values that informed the prioritization of MCH Needs.
- Strategic Plan for the Nevada Statewide Maternal and Child Health Coalition. Nevada has a PowerPoint that illustrates how their National Performance Measures, Priorities and Barriers relate to one another.
Stories and Strategies for Peer-to-Peer Learning
These stories and strategies have been collected by AMCHP and the MCH Evidence Center related to Step 5:
- Commonwealth of the Northern Mariana Islands: Include CYSHN and families with lived experiences in the action plan. Having all MCH managers involved in the needs assessment. It will address more domains.
- Delaware: Boot camp: putting together in-person, all day internal stakeholders to examine strengths/capacity and select partners using state developed ranking sheet.
- Nebraska: Activities: partnering with accreditation team to track needs assessment indicator between assessment, periods using their software. Other programs are able to utilize state to improve their work and Title V can align activities more easily. Advice: simplify all the resources for your state/jurisdiction. There is an endless amount of info, but every jurisdiction is different. Just take what you need and leave the rest
- Idaho: Forming internal advisory team. Conducting external stakeholder meetings (in person and virtual) to help prioritize and identify new partners for the work ahead. Working with contracted facilitator for meetings and small team strategy work.
- Vermont: I'm the SSDI coordinator, so I'm working with the new measures in the FAD to see where we are strong and weak. It works by giving us a fuller picture on how we are doing in advance of selecting measures and (if I get to the stratified evidence in time) will help with SDOH. It's very time consuming, but will help a lot when we are writing up the report in the spring.
- Commonwealth of the Northern Mariana Islands: Partner engagement. Ensure population representation. Keep partners in the loop (informed) of every stage of the NA process.
- U.S. Virgin Islands: The plan is to utilize the performance objectives in the staff's daily assignments and ensure all members and staff understand the objectives, and what we are working towards daily.
Share Your Stories and Strategies
Please take a moment to share your stories and strategies related to Step 5 of your needs assessment that you would like highlighted on this page. By sharing your stories, you help to document the needs assessment process for use by other Title V agencies during this cycle and will help preserve this knowledge for needs assessment processes in the future.