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 Management Minute

 By Michael R. Fraser, PhD, CAE, Chief Executive Officer, AMCHP

 “When elephants battle, the grass suffers…”
African proverb

The African proverb above appeared in a Washington Post article this past week on the looming federal budget sequester. Animal references aside (we Americans could change it to “When elephants and donkeys battle, the grass suffers…”) the proverb speaks to the damage those at the bottom, or on the ground, suffer when two large powers engage in battle. It is an apt saying for these troubling times: reports on the impact of the sequester have shown that we can expect there to be “collateral damage” once it goes into effect. We know that reduced funds for federal programs, including the Title V Maternal and Child Health (MCH) Services Block Grant and other programs that serve vulnerable women and children, will translate into fewer available services. We know that fewer available services will mean fewer resource for families that depend on those programs in our states and communities. Indeed, as the saying goes, the grass suffers.

Indeed, as the elephants battle, AMCHP is working with federal partners to understand the impact of the across-the-board cuts that most likely will be in the implementation phase as you read this. We anticipate a cut to the Title V Block Grant. We anticipate a cut to other discretionary MCH programs, including the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. We anticipate a cut to the federal funding that helps support AMCHP programming and builds your capacity in the states and territories.

The sequester was designed to be a worst-case scenario, a Draconian tool to force Congress to find a better way to constrain federal spending and address our budget challenges. A year ago, many anticipated it would never happen. And here we are: it is happening. Given this reality, what is an MCH leader to do?

Rather than try to stop elephants in battle, I believe our job is to help protect the grass. What is your vision for the women, children, and families served by your programs and how can you continue to commit yourselves and your team to fulfilling the vision even as resources shrink and needs expand? How can you rally your resources and marshal your partners to transform your existing work in light of expected cuts and continue the important work of Title V? While these might not be the best of times, they are not the worst of times: even with these cuts we still have a vision for maternal and child health and organizations poised to strengthen and improve MCH outcomes nationwide. Our work might take longer, and more will feel the impact of these difficult times, but the need for our work actually grows in times like these. To shrink away from change, or to try to “do more with less,” might actually be worse and distract us from our mission. Instead, as resilient MCH leaders, we have to ask what can we transform? What can we give up? With all that shrinking, is there an opportunity to refocus, reprogram and potentially grow? It is cliché to say “crisis is opportunity in disguise” but I think it is right to say that “one should never let a good crisis go to waste.”

I wish it were otherwise. These are neither aspirational nor inspirational times. It is hard to lead amidst the roar of elephants. We can take pause and survey all that we are doing and mourn what we will lose but we cannot stop our work. Too much rides on what you do in the states. Too much rests on what we do to support your work and your leadership on behalf of women, children, and families. As the sequester unfolds, AMCHP wants to hear from you on how we can best meet your needs in these difficult times. We promise to share what we know about the effect of the sequester on your programs and we ask that you let us know how the sequester will impact your programs and what we can do to help. Together, we might not stop the elephants but we can push them away from trampling even more blades of precious grass. And that, in times like these, is success.