Home Visiting Nurse-Family Partnership Program reduces infant mortality

The “Nurse-Family Partnership” home-visiting service has a proven positive impact on reducing infant mortality. The health authorities' experience with the program in Baltimore City, USA, shows unequivocally that within 10 years of implementing the service, infant mortality has decreased by 20%. These and more data were shared during the National Round Table on "Home-visiting care for vulnerable pregnant women and mothers and children up to 2 years: international experience and perspectives for Bulgaria" held last week. Nurse-Family Partnership is implemented in dozens of countries outside Bulgaria.

International guests at the roundtable were Ms Carolyn Wilson, Head of Child and Maternal Health Support in the Scottish Government, responsible for the implementation of the Nurse-Family Partnership (NFP) home-visiting service nationally, and Dr Gena O'Keefe, Consultant to Baltimore’s Strategy for Improving Pregnancy Outcomes, who oversees the successful implementation of NFP at the local level. The third speaker at the roundtable was Associate Professor Krassimira Kostadinova, Head of the Department of Child and Adolescent Health at the National Center for Public Health and Analysis (NCPHA).

The round table started with a welcome by the Deputy Minister of Labour and Social Policy Ms. Nadia Klissurska-Zhekova, who once again expressed her support for NFP and stressed that it is one of the most effective interventions related to maternal health care. In the context of the long-standing efforts to ensure the sustainability of the project, she pointed out that the results of home-visiting care are key and should be correlated precisely with national policies. A welcome letter from the Minister of Health, Dr. Assen Medjidiev, was also presented, stating maternal and child health policy as a top priority of the Ministry, and highlighting the presence of home-visiting care among the measures envisaged in the National Strategy for Child and Adolescent Health and Pediatric Care in the Republic of Bulgaria (2021-2030).

Ms Carolyn Wilson presented on the role of the Family-Nurse Partnership (as the service is known in Scotland) in reducing social and health inequalities in Scotland since 2008. Her presentation set out the experience of a specifically targeted home-visiting service for vulnerable young pregnant women, mothers and their children. Currently in Scotland NFP and the Universal Health Visiting Pathway (UHVP) operate successfully together. Research has shown that, once introduced as a national programme, the home-visiting service for vulnerable mothers increases the wellbeing of women and children whose outcomes had not changed for years through the universal service. Dr. Gena O'Keefe portrayed the history of integrating home-visiting care for vulnerable mothers into Baltimore's health policies in the context of limited funding and deep socioeconomic divisions between the city's white and black populations. In 2009, the city’s infant mortality rate among the black population was 5 times higher than among the white population, and Baltimore had the fourth highest infant mortality rate in the United States. The identified need for targeted approaches led to the creation of the B'More for Healthy Babies (BHB) initiative, which aims specifically to reduce health and social disparities in the city. Thus, as part of BHB, in 2012, the home-visiting service for vulnerable mothers became one of the services offered by local health authorities. Thanks to the intervention and the coordinated efforts of all stakeholders, impressive results were achieved in the following ten years, including a 20% drop in infant mortality in the city.

Both presentations emphasized the preventive nature of the model and its essence of an investment in the health and social inclusion of vulnerable families that has a high return - through the proven effectiveness of the service in terms of improving pregnancy outcomes; helping mothers return in the education system and join the labour market; improving children's school readiness and a range of early childhood development indicators that are relevant to all later life.

During the meeting Assoc. Professor Krassimira Kostadinova, Head of the Department of Child and Adolescent Health at the National Center for Public Health and Analyses at the Ministry of Health (NCPHA) illustrated the need for national dissemination of an evidence-based home-visiting care service by analyzing the health and demographic situation in the country, the available statistics on maternal and child health and the health inequalities in the country, and then presented options for integrating the home-visiting service into the Bulgarian health system. The meeting ended with an expert panel, which included Assoc. Professor Diana Dimitrova from Medical University - Varna; Dr. Rumen Velev, II Specialized Obstetrics and Gynecology Hospital "Sheynovo"; Milka Vassileva, Bulgarian Association of Health Care Professionals; Pavlina Gerina, Association of Bulgarian Midwives. All of them expressed their support for the program and its national dissemination. A number of topics were discussed among the attendees of the round table, including possible ways to integrate NFP into the health system; the potential for collaboration between GPs and home-visiting nurses in the Bulgarian context. Ms. Anna Temelkova, Chief Expert at the Medical Directorate of the Ministry of Health, confirmed the Ministry's intention to commit to developing a national home-visiting care programme by the end of 2023.

The NFP team looks forward to having the opportunity to expertly support the process of developing the model for home-visiting care at national level in Bulgaria.

In the coming months, the team will publish a study on the impact of the service in Bulgaria, which is currently being finalised by research experts at Utrecht University. A round table will be held in May to announce and discuss the results of the study.