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Leading doctor: chronic disease links to experiences in infancy

Kim Wilson, the Minister of Health, and Dr Sylvanus Nawab, chief of paediatrics at the Bermuda Hospitals Board and a paediatrician with Edgewood Paediatrics, share the findings from the First 1,000 Days Integrated Care Pathway initiative. (Photograph by Akil Simmons)

The prevalence of chronic diseases such as diabetes could be influenced by a lack of proper maternal and child healthcare, the Bermuda Hospitals Board’s Chief of Paediatrics said yesterday.

Sylvanus Nawab highlighted that although the long term conditions were once perceived to be predominantly a result of adult lifestyles and behaviours, early childhood healthcare also had a significant impact.

He and Kim Wilson, the Minister of Health, provided an update on the First 1,000 Days Integrated Care Pathway initiative, which is part of the Government’s effort to implement universal health coverage.

Dr Nawab, a paediatrician at Edgewood Paediatrics, said: “Chronic diseases such as chronic kidney disease and diabetes have a notable impact on maternal and child health within the current First 1,000 Days Integrated Care Pathway.

“While once regarded as products of adult behaviour and lifestyle, these diseases are now being linked to processes and experiences during pregnancy or infancy.”

Dr Nawab said that the results from a community survey highlighted the difficulties women and their families faced in accessing information that will support better care experiences including antenatal information, pregnancy records and the lack of insurance coverage for antenatal, breastfeeding and birthing classes.

The First 1,000 Days pathway was prioritised by the Government in its 2022 Throne Speech.

Its importance came into focus again thanks to the 2023 Joint Strategic Needs Assessment, a study that set out to properly understand the population’s health needs, which recommended a public health needs assessment on child and maternal health.

Ms Wilson said: “The objectives were to better understand current maternal and child health provisions in Bermuda, to assess the user experiences and to identify existing challenges and opportunities.”

She explained that the care pathway work focused on five main lines of inquiry:

• service provider roles and responsibilities

• service touch points, processes and hand overs of care between service providers

• patient and family experiences

• areas of overuse or duplication, or redundancy of services and inefficiencies in their provision

• existing and perceived challenges in the delivery and access of services.

Stakeholder engagement included 40 interviews with patients and their families, clinicians — such as nurses, primary care providers and mental healthcare providers — and operational professionals, including people who provide service coordination.

Three interactive stakeholder workshops were held to capture the views and feedback of care providers, and the community survey received 375 responses. Data was analysed according to gaps, household income and the type of insurance held.

The results were used to draft a service map for maternal and health services which helps to identify areas of improvement and optimise service delivery.

A “patient journey map” was then created to break down patient experiences across different stages of their care and to provide insights into their perspectives, needs and paying points, which enables healthcare providers to enhance patient satisfaction and outcomes.

Ms Wilson said: “All of this work combined to highlight eight key findings and ten key challenges being identified along with 16 opportunities for improving the current state of the First 1,000 Days Integrated Care Pathways.”

The challenges included inefficient exchange of health-related information between healthcare providers, patients, and across various healthcare settings.

A lack of consistency was identified in the amount of antenatal care information provided to women across providers, while access to maternal and child health services remained a challenge for many.

“Financial constraints and the limited availability of specialised care can impede individuals’ ability to receive timely and equitable healthcare services,” Dr Nawab said.

There was also a lack of affordable childcare options reported while the antenatal model of care is perceived as outdated by both patients and providers.

It was found that care is fragmented across the island, mostly due to “lack of communication between providers”, and there is a lack of explicit considerations for mental health concerns, both during and post-pregnancy.

Additionally, the number of families that need access to early intervention services has risen in recent years and delays are prevalent.

Opportunities identified in the report included enhanced collaboration, the establishment of community engagement and improved information-sharing, addressing barriers to care and enhancing the role of midwives.

Universal health coverage update

The First 1,000 Days Integrated Care Pathway initiative is part of the Government’s effort to implement universal health coverage.

Kim Wilson, the Minister of Health, provided a progress update on UHC.

She said: “We have been speaking about it for quite some time, we recognise the importance of it and the Government remains committed to the implementation.

“We anticipate, in the not too distant future, being able to outline what the core benefits package will look like.

“Then, from that we will continue with the modelling and the financial analysis of how much it will cost, and what it will cost each individual.

“There is still work to be done with regard to that and as we progress towards that particular goalpost I will be able to provide more details but we are working feverishly to be able to address the modelling and financial analysis.

“The working group is in the final stages of being able to articulate as to what will the core benefits package will look like.

“Once we know what is included in the core benefits package, we will conduct the modelling so we know how we will pay for that core benefits package – all that work is ongoing.”

Ms Wilson said: “The First 1,000 Days Organisation tells us that ‘the 1,000 days from pregnancy to age two offer a crucial window of opportunity to create brighter, healthier futures. How well or how poorly mothers and children are cared for during this time has a profound impact on a child’s ability to grow, learn, and thrive.’

“There should be no question then, that ensuring our families have equitable access to needed, quality healthcare in the first 1,000 days of a child’s life, is a critical component in creating a foundation on which our youth can thrive as they move through their lives. And this needs to happen without creating a financial burden for families to receive that care.

“Together, we have the opportunity to enhance Bermuda’s First 1,000 Days Integrated Care Pathway, making it more accessible, affordable, navigable, and ultimately, improving health outcomes for our children.”

A working group for the next phase will be formed to prioritise recommendations contained with the report and then facilitate implementation.

To download the First 1,000 Days Patient Journey Map and Service Map, visithealthstrategy.bm/latestupdates

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Published April 09, 2024 at 7:46 am (Updated April 09, 2024 at 10:44 am)

Leading doctor: chronic disease links to experiences in infancy

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