Investigating Harrow’s Infant Mortality Rate, a Case for Integrated Care

My integrated care journey started when I was working in an integrated training post, doing half the week in Paediatrics and the other half in General Practice. I worked in a practice that ran Learning Together clinics and I became interested in this. I had the opportunity to work with the Paediatric Public Health team and participated in the Learning Together clinics from this side, as well as a range of other projects. As I moved to a Public Health job, I wanted to bring with me some of what I had learned here, and I took up the opportunity to lead on a project investigating Harrow’s Infant Mortality rate, which evolved into my PICH project.

The infant mortality rate (IMR) of a population is affected by a range of factors and is an important marker of the overall health of a society. Harrow’s IMR is the second highest in London, at 5.1 per 1000 live births. I investigated the key risk factors affecting Harrow’s IMR, including the main ethnic disparities, aiming to devise a set of recommendations that could be implemented locally, using a cross-agency approach to integrate services to help to bring this rate down. I contacted key stakeholders in the local community to develop an understanding of the services currently available tackling the risk factors I had highlighted; the gaps present and the main ethnic groups that were at risk. These conversations were incredibly eye-opening, and I went on to present what I had learned to the CCG, as well as to local organisations such as Homestart. Homestart used this work to support a bid for government funding for additional support for around 80 vulnerable families in Harrow with young children.

I found that Somali women were particularly at risk of not accessing antenatal care, with < 50% booking before 12 weeks of gestation, and were also less likely to vaccinate their children, with a < 90% uptake rate at the age of 1 year (both risk factors for infant mortality). With my local champion, members of the Public Health team and HASVO (Harrow Association of Somali Voluntary Organisations), I helped to design focus groups with local Somali women, to be led by Somali speaking doctors in their language, to gain an insight into the barriers these women face when accessing healthcare, thus giving us a better understanding of the interventions needed. At the time of writing this, we are at the ethical approval stage of setting up these focus groups and I am excited for the important conversations we will hopefully be having and the outcome from these.

Top Tips to Share

  • Find a project in line with your day job, it saves time, and it helps to use the contacts and wealth of knowledge already around you!
  • Speak to a range of stakeholders – they know the local landscape best, many having worked in their given field for years – their insights were invaluable.

If I could do it all again…

I would try to collaborate with other PICH participants working with a shared aim as this would help when we inevitably get stuck at different points in the project journey, from sharing learning to gaining useful tips and tricks!