Central Harlem Healthy Start Program

To address the access, coordination and gap issues outlined earlier in the needs assessment of our grant proposal, the Central Harlem Healthy Start Program has developed the following four-year planning process to strengthen the perinatal system of care in Central Harlem.

The Healthy Start Consortium will function as the planning and implementation unit responsible for carrying out the plan. To realize the objectives of the plan, Consortium members will recruit leaders from the business community, clients from Central Harlem Healthy Start’s Consumer Involvement Organization, New York City Department of Health strategic planning staff, members of the faith community, and staff from Community Planning Board 10 to join the planning process.

NMPP’s Executive Director, the Healthy Start Program Director and the Consortium Manager will play an instrumental role in making sure the plan is carried out each year. The logic of our local plan focuses on altering the local health system’s weaknesses to achieve our infant mortality reduction goal.

Ensuring that high-risk women enter prenatal care is not enough to solve the low birth weight and infant mortality problems in Central Harlem. The Central Harlem Healthy Start plan will engage community stakeholders to take anticipatory actions to develop a healthy community instead of responding to problems as they arise.

The program’s definition of public health extends beyond the focus on isolated approaches that target the source of disease. Central Harlem’s plan will address the underlying structural causes of poor birth outcomes in Harlem. The program will use a public health framework that recognizes the ways in which decisions about housing, transportation, crime, unemployment, and managed care affect the health of communities.

Health Systems Action Plan Goals:

To mobilize and coordinate services within the Central Harlem perinatal, medical and social service community by the following:

1. Strengthening care coordination and data system expansion;
2. Improving women’s access to quality perinatal services; and
3. Fill service system gaps with new program models that extend the level of
social services and health care for women and their children.

Year One Action Plans: June 1, 2001 to May 31, 2002

Problem I:

Central Harlem is one of the only communities in New York City that does not have a Birthing Center. The influx of several immigrant women settling in Central Harlem has increased the need to develop a Birthing Center option that meets the culture of this new customer segment in Harlem. The Birthing Center will also promote early access to prenatal care, a drug-free birthing process, maternal and familial social support during the birthing process, and interconceptional counseling and family planning options.

Performance Objective:

By July 1, 2002, the Georgia McMurray Whole Life Birthing Center will open to the public at Harlem Hospital.

Action Steps:

By February 1, 2001, the NMPP executive director and the Harlem Hospital executive director will make a financial and strategic decision to build the Birthing Center in Harlem (task completed).

By February 28, 2001, a business plan will be developed and presented before the Healthy Start Consortium for review and approval…Dr. Palmer & Mr. Drummonds-task completed.

By March 12, 2001, the Harlem Birthing Center Organizing Committee will be formed that will include consumers; midwives, nurses, case managers and doctors will be formed ……task completed Mr. Drummonds.

By April 3, 2001, the Organizing Committee will agree on the management and clinical leadership, supplies and equipment, and floor plans for the Birthing Center…task completed by Organizing Committee.

The final CON application will be sent to the New York State Department of Health for review and approval by June 1, 2001 (task completed by Director of Planning at Harlem Hospital and the NMPP executive director).

The Organizing Committee will begin to hire midwives to be stationed at six of Harlem Hospital’s outpatient clinics starting on August 1, 2001. The above staff will prepare each clinic to make referrals of appropriate customers to the Birthing Center.

They will also begin to work with the clinic staff to make changes in their intake, treatment and discharge polices that adhere to the philosophical principles of natural childbirth at each outpatient clinic. By October 21, 2001, the construction of the Birthing Center on the fourth floor of the hospital will begin.

The Organizing Committee will begin to carry out promotional and marketing action steps outlined in the Birthing Center business/marketing plan by January 1, 2002. This will prepare the Central Harlem community for the projected opening of the project by July 1, 2002. The Organizing Committee will plan for the grand opening of the Birthing Center starting on March 1, 2002.

The Organizing Committee will review the status of the construction work to make sure the construction crew builds to specifications on March 20, 2002 and on April 12, 2002.
Final approval of the construction project will be completed by the NYC Health Department and the NYC Building Department by June 12, 2002 (Harlem Hospital Facilities Director). The Birthing Center grand opening ceremony will take place on July 1, 2002.

Problem 2:

Today in Central Harlem, the concept of infant mortality is an abstraction to community residents and high-risk pregnant and parenting women. The fight against infant mortality is not high on the list of our clients, elected officials, business leaders or local community leaders. Achieving a sustained reduction in infant mortality and eliminating racial disparities in poor birth outcomes will not be realized, unless the general Harlem community understands the nature of the problem and what they can do to address the problem.

Performance Objective:

By May 31, 2005, the general Harlem community will come to understand the causes of infant mortality and join action groups to combat this problem in Central Harlem.

Action Steps:

On July 1, 2001, the full Healthy Start Consortium will meet to review the entire proposal and agree on their tasks and mission to address this performance objective.

An infant mortality communications plan will be developed that will begin to demystify the concept of infant mortality to the general public and lay out a number of strategies to educate the Harlem community starting on September 1, 2001…Consumer Involvement Organization Chairperson, Consortium Manager, Executive Director.

Consortium leadership will join the newly established (March 20, 2001) Citywide Coalition to End Infant Mortality that was organized by NMPP and City Councilperson Bill Perkins. This new Coalition plans to organize a citywide forum in Harlem on May 4, 2001, that will begin to raise awareness regarding what infant mortality is, its causes, and review medical, social and community solutions to the problem.

The Consortium’s Advocacy Committee will take the Fact Sheet produced by the above coalition and begin to distribute the fact sheet door to door, in community centers and they will be placed in the grocery bags at major shopping areas in Harlem starting on May 5, 2001 and ongoing until May 31, 2004.

The Healthy Start Advocacy Committee will work with the Citywide Coalition to End Infant Mortality to begin to develop an allocation plan for NYC City Council funds secured due to a major media and advocacy plan started by NMPP on February 5, 2001 to the present (see appendix 6).

This plan will secure resources totaling 5 million dollars each year to be allocated to organizations throughout NYC who are working to end infant mortality and will add to federal funds secured through this Healthy Start grant. This task will take place starting on June 30th 2001 and every year around this time.

The Advocacy Committee will carry out the action steps in the Communications Plan to meet with local civic groups, elected officials, tenant organization leader and their base and educate them about infant mortality and its solutions. Two meetings will take place every months starting on July 1, 2001 and ending on May 31, 2005.

Three times a year, a consumer and provider from the Consortium will be invited to present before the 200-member Central Harlem Community Board 10. The nature of their presentation will cover the following themes: Central Harlem Healthy Start progress report; barriers to achieving our racial disparities objective, solutions that the Community Board could carry out to reduce fragmentation within the local health system; and testimonies from consumers who have received Healthy Start services.

Starting during the first of each year, a media campaign will be launched that will ask the print and electronic media to continue to focus on the problem of infant morality in Harlem. Press conferences will be planned so the media can question key leaders in the fight against infant mortality. The Consortium Manager, the Program Director, the Consumer Involvement Organization Chairperson and the Executive Director will carry out this assignment every year.

Every six months the above Healthy Start Consortium leadership will meet with leaders of the hospital community, the NYC Department of Health and the New York State Title V Block Grant Advisory Committee and staff in Albany to communicate ongoing perinatal system gaps, fragmentation bottlenecks and solutions to solve these problems.

The Healthy Start Consortium leadership will work with the Federation of County Networks and the Association of Perinatal Networks of New York when they organize their annual legislative breakfasts in December and February of each year. Consortium leadership will begin to talk directly to policy makers in Albany who can develop legislation to address access, coordination and gap filling issues.

Year Two Action Plans: June 1, 2002 to May 31, 2003

Year One Carryover Tasks:

On July 1, 2002, the Birthing Center in Harlem will open to service women who want a drug-free birthing experience in Harlem. The Health Systems Action Plan Committee will continue to monitor the development of this service unit to ensure its efficacy in filling the service gap within the community.

Every three months, the Healthy Start consortium executive committee will meet with the administrative and clinical staff at the Birthing Center to receive a progress report. Staff will also begin to interview consumers of the service to see how the Birthing Center intervention can be improved.

The communications plan outlined during Year 01 through Year 02 will be carried out. New and creative forums will be organized to achieve the Year 01 performance objective.

Problem 3:

Central Harlem is a community that has been defined as a Federally-Designated Health Professional Shortage Area (HPSA). While there are a many hospitals and clinics who serve Central Harlem, there are very few private pediatricians or OB/GYN doctors who service this community. This reality is a glaring weakness in the Central Harlem perinatal health system. There are many women who live in Harlem who have asked NMPP to locate a private doctor for them in their community. To secure a private physician, these women have to travel outside of Harlem to be served.

Performance Objective:

By May 31, 2005, the Central Harlem community will have developed a pool of private practice doctors who have made a commitment to service the needs of mothers and babies.

Action Steps:

By July 1, 2002, the Healthy Start Consortium Advocacy Committee will review the literature that documents the private practice doctor problem in Harlem.
Meetings will be organized with the deans of the major medical schools in the region who train doctors that intern at St. Luke’s Hospital, Presbyterian Hospital Center, Harlem Hospital, Northern General Hospital and the Health & Hospitals Corporation.

All of the above meetings will be held by October 31, 2002. The purpose of the meetings will be to ascertain from the medical school leadership their plans to address the health professional shortage in Harlem, propose to them the Consortium ideas and plans to transform the problem and finally, obtain a commitment from each dean to work collaboratively with the Healthy Start Consortium to solve this problem (Executive Director, Program Director, Consumer Involvement Organization Chairperson, and the Consortium Manager).

After obtaining medical school permission, the Advocacy Committee will set up meetings with new and advanced students at each medical school to communicate the physician shortage in Harlem and make a pitch to them to make career decisions to locate their practice in Harlem. These meetings will take place from November 15, 2002 to February 1, 2003 (Consortium leadership outlined above).

The Advocacy Committee will organize a print & electronic media campaign to educate the entire Harlem community about the private physician problem and communicate a state of emergency concerning the issue and convince more medical students to practice in Harlem. The task will be completed by January 30, 2003 (Consortium Manager & Executive Director).

The Advocacy Committee will work with a committee of development staff from the three medical schools who serve Harlem to develop an application to HRSA’s National Health Service Corps Scholarship and Loan Repayment program. This program provides scholarships and pays loans to physicians, dentists and other health professionals who decide to practice in designated underserved areas. The proposal will be developed and contact with HRSA will take place by March 3, 2003 (Consortium Manager, Executive Director, Medical School Development Staff, and Consumer Involvement Organization Chairperson).

President Bush recently communicated that he plans to amend the Health Professional Shortage Area definition to reflect other non-physician providers practicing in communities and present a clearer picture of need. The President also plans to order HHS to coordinate with immigration programs to place foreign-born practitioners in underserved communities. He also recently stated that health-profession grants would be redirected to areas where there are staffing shortages, including minority practitioners and nurses.

The Advocacy Committee will ask the FCN and the APN to place this problem on their legislative agendas during their annual legislative breakfast meetings in Albany and New York City for 2003 and 2004 ………Executive Director.

The Advocacy Committee will continue to meet with members of the housing development community in Harlem to target space for individual and group practice organizations in Harlem starting from May 31, 2003 to May 31, 2005 (Program Director, Executive Director, and Consumer Involvement Organization Chairperson).

The Advocacy Committee will meet each year with staff from the New York State Department of Health and the Health Committee Chairpersons in the Assembly and the Senate to make sure Graduate Medical Education resources can be leveraged to secure more private doctors for Harlem (Consortium leadership outlined above).

Year Three Action Plans: June 1, 2003 to May 31, 2004

Year Two Carryover Tasks:

The communications plan outlined during Year 01 will continue during Year 02 and beyond. New and creative forums will be organized to achieve this performance objective. The work to recruit more private practice doctors will continue during Year 03.

Problem 4:

The NYSDOH has not re-designated OB hospitals throughout New York State since 1985. The fact that no Regional Perinatal Center has been designated in Northern Manhattan has created a situation of uncoordinated perinatal care in our service area. There is no structured plan to evaluate perinatal data between hospitals. The community has no perinatal data system in NYC. Furthermore, the lack of data has impacted the practice of managed care on perinatal health in the region.

There are no perinatal clinical guidelines between hospitals and no regional plan for outreach and education of pregnant women. Finally, the regional hospitals, clinics and private doctors in Harlem have not completed a regional perinatal needs assessment.

Performance Objective:

By May 31, 2004, all hospitals in Harlem will have received their designation by the NYSDOH and they will have begun to work together to carry out a coordinated plan for perinatal care in Harlem.

Action Steps:

By August 1, 2001, the New York State Department of Health will make their preliminary designation of all hospitals that serve mothers and babies in Harlem (NYSDOH’s Bureau of Women’s Health).

By October 1, 2001, the final designations will be made after additional information is reviewed by Bureau staff and the final site visits are completed.

By January 5, 2002, the first meeting of the Perinatal Regional Forum will take place and based on the NYSDOH vision, NMPP’s executive director will be positioned as the Co-Chairperson of this body in collaboration with the president of the hospital that has been designated as the Regional Perinatal Center.

The first meeting of the PRF will also begin to develop a planning agenda of action for all of the hospitals, clinics and midwives who operate in northern Manhattan. The NMPP executive director will attempt to get the PRF to adopt a good portion of the Healthy Start health systems needs assessment and action plan.

By April 1, 2002, all medical providers who are members of the PRF will adopt the current standards of care, both maternal and newborn outlined in AAP/ACOG Guidelines for Perinatal Care.

By January 1, 2003, an Internet-based communications system will be developed between all hospitals and clinics in Harlem that will showcase a general schedule of meetings and events, project the next dates for PRF meetings and begin the slow process of building links between each medical facility’s perinatal data system (MIS staff of medical facilities in Harlem, Healthy Start MIS Coordinator).

By February 2, 2003, the Healthy Start Consortium leadership will attempt to get the members of the PRF to adopt the perinatal outreach and marketing plan of NMPP’s Sisterlink Coalition as the main method to locate, motivate and enroll high-risk women into prenatal care.

By May 1, 2003, the Regional Perinatal Forum will contract with a health economist to complete a study addressing the impact of managed care on the local health care system including the pattern of patient transfers in Harlem. The study will be completed by December 30, 2003 (Regional Perinatal Forum).

By September 1, 2003, the RPF will begin to address the problem that the Statewide Perinatal Data System (SPDS) does not include data from hospitals and Birthing Centers in New York City. NYC is a separate Vital Records Registration District. NYC has their own birth certificate and electronic system for gathering the data. Historically there has been resistance from both the NYSDOH and NYCDOH to adopt one SPDS.

The Northern Manhattan RPF will call a meeting of other Regional Perinatal Centers across NYS to gather to develop a strategy to address the differences between the two health departments and develop an action plan to develop one system by November 1, 2003.

A meeting of hospital executives will be called by December 1, 2003 to secure their support to set up a meeting between the health commissioners from the NYSDOH and the NYCDOH. Historically, the meetings between both departments have been between the Vital Statistics Department administrators.

Each RPC will communicate the benefits of one data system in New York State as it relates to monitoring quality of care indicators for women and infants in hospitals; monitoring birth outcomes regionally and statewide; identifying appropriate transfer patterns and outcomes within managed care organizations and a consolidated data system would help identify problems and help to develop plans to address issues at a regional and statewide level.

If the meeting between both health department commissioners does not achieve the objectives of a consolidated data system, the Regional Perinatal Forums across NYS will assemble a coalition of maternal and child health stakeholders to broker a meeting between the new Mayor of NYC and the new Governor of NYS by February 1, 2004.

Year Four Action Plans: June 1, 2004 to May 31, 2005

During the last year of Healthy Start, the local health systems action plan will focus on following up on the action areas started during the first year of the program. The Birthing Center will submit a full report to the Healthy Start Consortium on their operations and outcomes.

Members of the Healthy Start Consortium will join members of NMPP’s and Harlem Hospital’s staff to complete a full administrative and clinical review of the Birthing Center’s operations on June 30th 2004.

A survey of the Harlem community will be organized by the Healthy Start Evaluation Director to determine the general knowledge of the community concerning infant mortality. This task will be completed by November 30th 2004.

The Healthy Start Consortium will begin to evaluate how many new private practices that opened in Harlem as a result of tasks implemented in the action plan. Ongoing work will continue on this issue beyond 2005 to address this structural problem within the local health care system.

NMPP will continue to lead the Regional Perinatal Forum (RPF) in a direction that will respect the opinions of community members and perinatal advocates on maternal and child health issues. The work to build closer ties between hospitals, clinics and the Birthing Center in Harlem will continue.

Local Health Systems Action Plan Update Central Harlem
Summation of Healthy Start Phase III/Year01 Activities
May 2, 2002

During the second year, the Central Harlem Healthy Start program will focus on two areas of planning to strengthen the local perinatal system in Central Harlem. The team will continue the work to open the first Birthing Center in Harlem. The Birthing Center will add another service plank to the continuum of care in Central Harlem providing women with another option to have a child.

The Birthing Center is also part of a larger plan to save Harlem Hospital, the only public hospital system in Central Harlem. Harlem Hospital has suffered over the last five years from fiscal and quality of care problems. As a result, the hospital’s operating staff has decline from 4,000 employees in 1998 to about 2,200 full-time employee’s today. We plan to open the Birthing Center by November 30th 2002.

The number of births taking place at Harlem Hospital declined steadily from over 4,000 births a year in 1990 to just over 1100 births at the end of 2001. NMPP and Harlem Hospital viewed developing a Birthing Center on hospital grounds as one of many tactics to reposition this public hospital in the healthcare marketplace and systematically provide poor and working class women who live in Harlem with another safe and caring option to have a child.

The Central Harlem Healthy Start program will continue our efforts to secure New York City Council/Mayor’s Office funds to fill program gaps in perinatal care in high-need communities throughout New York City. We will fill this gap by implementing a public information campaign and legislative campaign to reinforce New York City’s role in funding community-based infant mortality reduction activities.

This is our second area of planning work to strengthen Central Harlem’s local perinatal system. We have decided to continue both our first year objectives during the second year of funding. Starting in the third year, we will focus on resolving the health professional shortage in Central Harlem. However, by building a growing Central Harlem-based midwifery practice begins to address this problem.

Harlem-based midwives, nurses, consumers, and Doula support staff from NMPP’s Harlem Birthing Center Organizing Committee have joined the Local Health System Action Plan subcommittee of the Consortium to push forward the work to build the Birthing Center in Harlem. For the remainder of the first year of Phase III and during the second year, the subcommittee will focus on three areas of work to make the Birthing Center a reality. Resolving the midwife salary difference issue, developing a Birthing Center marketing plan and completing the final proposal to finance the project will guide the work for the remainder of the first year and all of the second year.

Midwife Salary Issue:

Currently, the hospital has three senior midwives who each have been with the hospital over twenty years. These professionals all make between $67,000 to $69,000 a piece. The Birthing Center Hiring Committee recently hired three more midwives all making between $70,000 to $75,000 a piece. The three new midwives do not have the same clinical experience as the midwives who have been with the hospital historically.

The midwives have met and are planning a work action if there is no parity between the pay of both sets of professionals. The Harlem Hospital administration understands the problem and is looking to resolve the problem. The performance objective for this work as follows:

By May 31, 2002, the pay differential problem between the midwives will be resolved by standardizing a compensation package for all midwives that is driven by clinical experience and seniority.

Action Steps:

1. By March 29th 2002, Mr. Drummonds will obtain data on midwife compensation levels from Metropolitan Hospital which is another hospital like Harlem that is apart of the HHC’s Generations Plus Network. This pay scale will be presented to Ms. Whitley, the Director of Human Resources at Harlem Hospital.

2. By April 7th 2002, the Hiring Committee will reconvene to review regional compensation levels and begin to develop an equity proposal for Harlem Hospital midwife pay.

3. During the April 7th 2002 meeting, the Hiring Committee will listen to a presentation from the senior midwife at Harlem Hospital that explains the pay differential problem and her proposal to resolve the problem.

4. The Hiring Committee will consult with Dr. Palmer, the President of Harlem Hospital and Dr. Chu the President of the Health & Hospitals Corporation to find the extra financial resources to construct a midwife compensation proposal that will end the pending labor action.

Birthing Center Marketing Plan:

Another important issue that could make or break this project is developing a coherent marketing message that will motivate various customer segments to select the Birthing Center to have their next child. Currently, Harlem Hospital suffers from a poor history of quality medical practice, three recent deaths at the hospital due to medical malpractice and a poor front door system that fails to treat customers with respect.

While the hospital has a current quality improvement program, the reputation of the hospital in the community is weak and the number of patients who utilize the hospital has declined over the last five years. To address the service quality and marketing roadblocks outlined above, the subcommittee and Harlem Hospital Deputy Executive Director for Marketing and Planning will achieve the following performance objective:

By June 30th 2002, a diversified marketing plan will be developed and approved and carried out by the hospital administrative staff and the local health systems plan subcommittee.

Action Steps:

1. Starting on March 28th 2002, the subcommittee will plan a meeting with Harlem Hospital’s Deputy Executive Director for Marketing and Strategic Planning to agree on a work plan to develop a marketing framework for the Birthing Center.

2. Beginning on April 7th 2002, the marketing work group will decide on five customer segments and develop a variety of focus group questions.

3. By May 15th 2002, five focus groups will have been organized and results of each focus group will be presented in the form of reports.

4. The subcommittee and hospital creative teams will take the results of the focus group to develop marketing messages for the West African, teen market, baby boom-mom, and working class mom customer segments by June 1, 2002.

5. These core messages will be transformed into mass flyer, direct mail letter and radio and television advertising copy by June 15th 2002.

6. The creative teams will also develop social marketing health education messages that each midwife will use as she goes about her work in the outpatient clinics building a customer base for the Birthing Center. These messages will be developed by June 20th 2002.

7. The full campaign will roll out by July 1, 2002 and run for six months.

Facility Financing Plan:

Currently, Dr. Ben Chu, the President of the Health & Hospitals Corporation has allocated $500,000 toward the construction of the Birthing Center and the rehabilitation of the Labor and Delivery Suite at Harlem Hospital. However, to build the Birthing Center and rehab the Labor and Delivery Suite, the planning team needs one million dollars to complete both projects.

Dr. Chu has already called Manhattan Birthing Borough President C. Virginia Fields to request capital dollars to build the Birthing Center. She recently has agreed to give the project one million dollars to build the Birthing Center. A funding application has been submitted to Congressman Rangel to raise another $750,000. The performance objective below will guide the financing work over the next period.

By July 15th 2002, the planning committee will secure another $500,000 to complete the financing of the Birthing Center and the rehab of the Labor & Delivery Suite. The construction of both areas will start on August 15th 2002 and end on November 30th 2002.

Action Steps:

1. The financing team will complete the Manhattan Borough President’s three-page capital grant program application and submit it by April 15, 2002. They will request one million dollars.

2. NMPP’s Deputy Executive Director, Dr. Nicole Hollingsworth will lead the financing team to target seven community foundations that fund capital projects and send the Birthing Center business plan to secure the remaining capital dollars by May 3, 2002.

3. The financing and construction team will decide on the final resting place for the Birthing Center on the fourth floor of Harlem Hospital by April 30th 2002.

4. A detailed construction budget will be finalized by Mr. Drummonds, Dr. Chu and Dr. Palmer by May 30th 2002.

5. Dr. Hollingsworth will complete fund development work to create an endowment to fund the Chief Midwife position first starting with the Russell Grinnell Foundation based in Boston that wants to make a contribution to one of NMPP’s programs. She will reach out to four other foundations to secure up to $100,000 a year for this position by November 1st 2002.

6. The construction will begin on July 25th 2002.

7. The planning team will make monthly site visits to make sure the construction team is building to specifications.

8. The Deputy Executive Director of Planning at Harlem Hospital will submit the Article 28 application to the New York State Department of Health by May 1st 2002.

9. Mr. Drummonds will contact the Dr. Wade, the Director of the Title V agency to expedite the approval process of the Article 28 application.

10. By December 20th 2002, the Birthing Center will open at Harlem Hospital.

Launching a new legislative and media campaign to persuade Mayor Bloomberg and the City Council to place two and half million dollars in the budget for infant mortality initiatives will be the focus of the subcommittee’s work for the second year.

Currently, New York City has a five billion deficit at the beginning of fiscal year that begins on July 1, 2002. The focus of the Mayor and the entire city has been on recovering from the 9/11 tragedy, patching the deficits by cutting services and reviving the New York City economy.

Unlike last year when every elected official in NYC was talking about infant mortality reduction activity in Central Harlem and in nine other high-risk communities, this issue does not define the climate today. The Local Health Systems Action Plan Subcommittee’s task is to transform the debate in NYC to take a more holistic development path that includes physical, mental health and maternal health recovery and funding. The performance objective that will guide this work is as follows:

By July 1st 2002, the committee will work with the Citywide Coalition to End Infant Mortality to place 2.5 million dollars in the budget to continue the work by the perinatal networks and community-based organizations to reduce racial disparity in perinatal health.

Action Plan:

1. On March 1st 2002, the citywide advocacy team met with Peter Williams, the Deputy Public Advocate for Policy to win this public official to our infant mortality policy positions. Mr. Williams agree to meet with the Public Advocate Betsy Gotbaum.

2. Mr. Williams wants Public Advocate Gotbaum to be known as the Children’s Advocate and the local planning committee agreed to work with Mr. Williams to help develop policy papers on children’s health insurance and infant mortality to reposition this elected official as the sole representative of mothers and babies in NYC. Ms. Gotbaum has agreed to speak to Mayor Bloomberg to encourage him to fund our agenda.

3. Mr. Drummonds worked with Mr. Williams to draft Ms. Gotbaum’s speech delivered at Harlem Hospital’s Renaissance Health Care Network’s Community Advisory Board meeting on March 9th 2002 communicating a Health First Policy Statement.

4. Mr. Drummonds set up a meeting with Deputy Mayor Dennis Walcott who is responsible for health care policy for Mayor Bloomberg. This meeting is scheduled for March 28th 2002 at City Hall. The purpose of this meeting is to update the Deputy Mayor on the status of the Citywide Coalition to End Infant Mortality’s current funded campaign and begin to pitch the message for ongoing funding within next year’s budget.

5. On March 28th 2002, the Manhattan Public Health Consortium will join the other borough organizing entities at NMPP to develop the media and legislative work plan for the spring and summer period. This meeting will take place from 11:00 a.m. to 12:30 p.m. This meeting with the Deputy Mayor will take place from 2:30 p.m. to 4:00 p.m.

6. The Manhattan Public Health Consortium will organize a press conference in Harlem to reveal the latest infant mortality rate reduction for Central Harlem released by the New York City Department of Health. This report revealed that the infant mortality rate declined in Central Harlem by over 20% where the rate declined from 15.5 deaths per one thousand live births in 1999 to 10.3 deaths in 2000. This press conference will take place by April 30th 2002.

7. Building off the press conference, Consortium members will complete print and electronic interviews with the media to highlight the fact that the infant mortality rate declined in Central Harlem and that New York City has to continue funding community-based providers if the rate will continue to decline in the out years.

8. The Manhattan Public Health Consortium will work with their colleagues from the Citywide Coalition to End Infant Mortality to hold our second annual community conference on infant mortality. Like last year, the media and citywide elected official will be invited as each borough organizing committee will provide an update on their City Council funded infant mortality reduction activities on June 5, 2002.

9. The Manhattan Public Health Consortium will mobilize consumers and community members to distribute 100,000 Infant Mortality Fact Sheets throughout Central Harlem to educate the general public about infant mortality and create the conditions where community members will contact their elected officials to do something about this issue from May 1st 2002 to May 31st 2003.

10. Consumers and staff from the Manhattan Public Health Consortium will appear on seven radio talk shows to apply pressure on the Mayor’s office and the City Council to prioritize funding for infant mortality reduction initiatives throughout New York City. The scheduling of these interviews will be the responsibility of Mario Drummonds, Dr. Mae Sanchez and Dr. Hollingsworth.

11. From August 1st 2002 to May 31st 2002, Consortium members will educate the general community about infant mortality, its causes and solutions at health fairs, public speaking engagements, through a direct mail campaign and a print/radio advertising campaign.

By implementing the above work plan, the concept of infant mortality will no longer be an abstraction to community residents, elected officials, and the media. The social and political base of a public health social movement will have been built that will take ownership of this problem and work through the Central Harlem Healthy Start Program’s Consortium to resolve this problem in Harlem.

Local Health Systems Action Plan Update Central Harlem
Summation of Healthy Start Phase III/Year 02 Activities
February 28, 2003

During Healthy Start Year 02, measurable progress has been made on building the Birthing Center at Harlem Hospital. CHHS and other MCH advocates won another five million dollars toward infant mortality reduction activities from the Mayor’s office and the City Council.

During year 02, the Harlem Hospital Birthing Center Planning Committee and the NMPP Planning Committee merged to form one planning body. This development increased the productivity of the organizing group. During the project period, we resolved the problems of the midwife salary issue. The midwives who worked for the hospital for over twenty years received salary increases proportional to their experience. While the older midwives are not totally satisfied with their final compensation packages, a work stoppage was prevented through the efforts of Mr. Drummonds and Dr. Chu who now is the President of the Health and Hospitals Corporation.

Due to the hospital preparing for a Joint Commission on Accreditation of Healthcare Organizations review, the work to develop a comprehensive marketing plan was not completed during Year 02. The entire hospital clinical and administrative staff took about five months to prepare and adhere to the review. Harlem Hospital received a score of 98% and senior clinical and administrative hospital staff was reassigned back to the development of the Birthing Center project. Attached is the appendix is a copy of the marketing plan outline developed by Mr. Drummonds and Miss. Sylvia White, Deputy Executive Director for Strategic Planning for the Health and Hospitals Corporation that will guide our work during Year 03.

During year 02, over one million dollars was secured to fund the physical plant renovations of the fourth floor of Harlem Hospital. During the project period, Mr. Drummonds and Dr. Chu submitted a capital proposal to Manhattan Borough President C. Virginia Fields. On July 1, 2002, we received notice that our proposal was funded. The Birthing Center Planning Committee now has the resources to build the Birthing Center on the fourth floor of Harlem Hospital. The Planning Committee carried out most of the tasks that were outlined in our Healthy Start/Local Health System Action Plan for year 02 to realize this goal.

The second area of action outlined for Year 02 was launching another infant mortality advocacy/media campaign to secure 2.5 million dollars for Perinatal Networks and other community-based organizations. The Local Health Systems Action Plan Committee and maternal and child health activists from across New York City wrote their City Councilperson, secured print and electronic media placements concerning the problem of infant mortality in 10 communities throughout NYC and demonstrated at City Hall.

As a result of the activities outlined above, as well as the successful implementation of the work plan action steps that appear in our Local Health Systems Action Plan for Year 03, NMPP and the Central Harlem Healthy Start Program was able to secure another five million dollars starting on July 1, 2002. Our objective for Year 02 was 2.5 million. We exceeded that goal by 2.5 million. Copies of the award information and organizational funding allocation were forward to Mr. John McGovern and other senior officials at HRSA/MCHB. Copies of the media work and final funding allocations appear in Appendix 6-C.
Comprehensive System for Perinatal Care/Local System Action Plan

Our first priority during the coming program year will be to finalize our plan to start-up the Birthing Center by January 1, 2004. On March 28th 2003, an all-day retreat has been planned to address some of the pressing clinical issues and review and approve the draft of the marketing plan outline. Several mini-meetings have been held starting in February to address the relationship between midwives, obstetricians, and nurses.

We will finalize at the retreat which medical profession will define the character for this new income-generating business. Clinical protocols will be developed that guide staff roles from outreach, intake, prenatal and treatment considerations and post-discharge services. Physical plant renovations began on February 1, 2003. By March 30th 2003, the first phase of the construction will be completed. Several of the five birthing rooms will be completed. Staff from the hospital and from the CHHS will review the construction work with the architect and NYCDOH personnel. By October 30th 2003, the entire fourth floor renovations will be completed.

By January 1st 2004, the grand opening ceremony will take place. HRSA/MCHB staff will be invited to the grand opening. Once the outline for the marketing plan is reviewed, edited and approved at the March 28th 2003 retreat, Mr. Drummonds and Ms. Sylvia White, the Deputy Executive Director for Strategic Planning at the Health & Hospital Corporation plan to interview three Madison Avenue marketing firms. One firm will be selected and they will begin the market research and carry out the other tasks in the marketing plan beginning on April 15th 2003.

Focus groups will be organized to gain insight from women of childbearing age throughout Harlem. Finally, marketing messages will be developed for at least four customer segments and the final proofs of the campaign will be approved by September 15th 2003.

Our second priority during Year 03 will be to launch another infant mortality advocacy and marketing campaign to secure another five million dollars. During the first three months of 2003, NMPP/CHHS appeared in several major print and electronic media venues talking about the need for the NYC Mayor to continue funding infant mortality activities in Central Harlem and other communities where the infant mortality rate is twice NYC’s rate.

We have already begun to place pressure on the Mayor’s office and the New York City Department of Health to include infant mortality funds in the budget that will begin on July 1, 2003. From March 1, 2003 to July 1, 2003 the CHHS program plans to step up our street work and expand our media coverage on this issue. We are planning a national conference on infant mortality that will take place in New York City by July 1, 2003. We have plans to march our pregnant and parenting mothers back down to City Hall to send a message to Mayor Bloomberg that infant mortality is a social problem that has public health consequences. Despite a bleak fiscal climate in NYC, CHHS staff and consumers believe that working with our allies, we will be able to advocate placing another five million dollars in Mayor Bloomberg’s budget to further our infant mortality reduction and Healthy Start work plans.

Our final priority for Year 03 is to highlight the burgeoning nursing shortage in NYC and the pending Ob/Gyn shortage in our communities. On October 6th 2002, CHHS staff and consumer worked with staff and consumers from the other two Healthy Start projects in the downstate region to write a press release that defines the problem and proposed solutions to the healthcare workforce shortages.

We have combined our forces within the Perinatal Systems Change Subcommittee of the CHHS Consortium to carryout an eight-point program to transform the problem. A copy of the press statement can be found in Appendix H. During Year 02 the Perinatal Systems Change committee worked with the New York Perinatal Society to organize a forum on workforce issues that was held on November 19th 2002.

Lillian R. Blackmon, M.D., Clinical Associate Professor of Pediatrics, University of Maryland School of Medicine presented on, “Anticipating the Future-Physician Workforce Needs in Neonatal-Perinatal Medicine.” Dr. Norman Gant, the Director of the American Board of Ob/Gyn also spoke on, “Workforce Issues.”

By November 2003, the Perinatal Systems Change Committee plans to invite Mr. Edward Salsberg, Executive Director, Center for Health Workforce Studies, School of Public Health, University at Albany to speak to our regional consortium members and the doctors and nurses who are members of the Manhattan Regional Perinatal Forum. Mr. Salsberg is currently writing a paper on nurse and Ob/Gyn workforce shortages in New York State. He will also complete a brief analysis on midwife workforce projections for New York State.

CHHS consumers and staff believe that adding a Birthing Center to the level of care will improve the quality of care to pregnant women in Central Harlem and give our women another option to have a child in this community. Our work to secure five million dollars for infant mortality reduction activities by community-based organization will institutionalize local government responsibility for reducing infant mortality through ongoing funding. Finally our work to grow the perinatal workforce within our local system of care will ensure greater healthcare access and improve the quality of care for pregnant and parenting women living in Central Harlem.

Georgia McMurray Birthing Center

Proposed Marketing Plan Outline & Work Plan
Mario Drummonds, NMPP & Sylvia White, Harlem Hospital

February 14, 2003


NMPP and Harlem Hospital are responsible for developing a marketing plan for the new Birthing Suite/Center at Harlem Hospital that will serve as a guide to locate, motivate, listen to, support and enroll low-risk pregnant women enter our care system. We must communicate the qualitative birthing experiences that will take place at the Birthing Center that would motivate Harlem and South Bronx-based customers to utilize this new service.

Five years ago many hospitals, clinics and social service agencies believed that marketing was useless. These executives believed that good health care does not need to be sold. Today, this is a false notion where the leadership of every social institution understands the importance of marketing for the continued survival of the institution. To achieve the business, clinical and marketing objectives of the Birthing Center, we have decided to be in the business of social change. Our objective is to change the behaviors of various types of pregnant women to select our service offering.

Social marketing is the business of creating, building and maintaining exchanges. For example, I give you 89 cents and you give me a bar of sweet-smelling soap, or I walk two hours to get to the doctor’s office, wait there three more hours, and worry that my house and children are being neglected, and the doctor gives my baby an immunization which protects her from measles. The ultimate goal of a social marketing campaign is to influence behavior. Either we want to change our customer’s behavior (walk into our Birthing Center and adopt new women’s health and well-baby care behaviors) or keep it the same in the face of other pressures.

Social marketers have a unique mindset when they go about their work. That mindset is best described as a customer-centered mindset. We must begin to answer the following questions. To whom are we planning to market? Where do these customers live and what are the characteristics that define them as a customer segment? What are their current positive and negative perceptions about service quality at Harlem Hospital? What messages would motivate a particular segment to utilize the Birthing Center?

Will these perceptions, needs and wants be different in the future when our marketing strategy is implemented? How satisfied are our customers with Harlem Hospital’s current service mix? Why don’t high-risk and low-risk pregnant women utilize Harlem Hospital’s birthing services more often? How can Harlem Hospital change the nature of their services to influence the behaviors of our target audience segments?

Marketing is the business of offering benefits people want, reducing barriers people face, and using persuasion not just information. We are in the business of creating a better birthing experience for targeted women and their families and therefore we have to modify what we offer to our customers (CHANGE) in order to get the people we’re trying to serve to change and utilize our service.
Strategic Social Marketing Planning Process (SSMPP)

1. Birthing Center Mission Statement & Business Definition:

In three paragraphs, what is the mission and unique business definition of the Birthing Center? How does this mission relate to the mission of Harlem Hospital and NMPP? What unique birthing experience are we selling to Harlem and South Bronx women that differentiate our business from the competition? What are our unique value propositions that will motivate customers to utilize our service? What are the differences in service offerings between a Birthing Center/Suite and a regular OB/GYN ward? The mission and business definition should be brief, feasible, motivating and distinctive.

2. Analysis of External Environment-Marketing Research:

The team must develop an up-to-date picture of the various forces that can influence whether we achieve our marketing objectives. The plan must sum up the status of target customers now and possibly in the future. Reviewing available statistics and organizing a few focus groups can tell us more about our potential customers as well as how well the hospital is serving its current patient base.


*Demographic and socio-economic data on women of childbearing age
in Harlem and the South Bronx-examining 2000 Census data
*# of immigrant women living in our target area who need services
*Health status of teenagers who decided to have a child
*Status of women in our target area who are over 35 who are pregnant
*Class and race analysis of differences in perinatal health
*Perinatal needs of substance abusing women
*Low birth rate and infant mortality data for Harlem & South Bronx
*Health access roadblocks for various target customer groups
*Review data on late/no prenatal care by race of mother
*Examine birth rate data sets by class and ethnic groups in target areas

3. Internal Audit of Harlem Hospital’s System of Care:

Marketing is not only concerned about what is happening externally to our customers but it must critically examine how we function as a system of care in meeting our customer needs. Completing this audit will help the planning team identify actions, policies and structures that produce results. Also, we can begin to make the tough decisions to abandon strategies, policies, programs and interventions that have failed to motivate our customers to utilize Harlem Hospital for pregnancy services:

*examine current appointment system at labor & delivery suite
*examine how intake staff interacts with patients at front door of system
*talk to patients about the quality of clinic care received on L&D suite
*examine discharge system and aftercare interventions for pregnant women
*examine current marketing efforts to motivate women to use existing service
*examine physical environment on 4th floor to see if it is patient friendly
*Why has the number of births at Harlem Hospital declined over the last ten years?
*What are some of the strengths about Harlem Hospital’s service system?

4. Marketing/Customer Definitions:

NMPP believes that there are four distinct customer segments that the marketing plan will reach. They are as follows:

1. African-American Working Class/Medicaid Segment
2. South Harlem South Bronx (SoHa) West African Population
3. Strivers Row Segment of Urban Settlers or Pioneers of Various Ethnicities
4. Growing Latina Segment: Mexicans, Dominicans and Puerto Ricans

Our review of statistics and focus group results will help us define the nuances of the above market segments or decide on some new ones that are not mentioned above.

5. Competitive Analysis:

No marketing plan would be complete without an assessment of Harlem Hospital’s competition. We need to examine the service offerings of St. Luke’s Hospital Center and the larger Continuum Health Partners network the hospital is apart of. We need to closely examine the growth of this competitor’s outpatient clinic expansion in Harlem which is their main strategy to capture market share (women of childbearing age and pregnant women) from Harlem Hospital. The Presbyterian Hospital System Allen Pavilion midwife practice patient flow from Harlem to Washington Heights must be studied. Why are Harlem-based pregnant women traveling to Washington Heights or Bellevue Hospital in lower Manhattan to receive prenatal and pregnancy services instead of Harlem Hospital? What is Mount Sinai Hospital and Cornell’s plans for Harlem when it comes to serving pregnant and parenting women? This analysis should communicate in a grid format the differences between Harlem Hospital and its competitors on:

*front door contact with patients during intake and triage
*time it takes to obtain an appointment for pregnancy testing and ongoing treatment
*quality, levels and intensity of care by midwives, nurses and obstetricians
*status of home-like nature of each facility’s birthing rooms
*quality and extent of pre-pregnancy counseling, child birth classes and prenatal care
*review how family members are integrated into the treatment process
*quality of discharge plans and follow-up post-natal and well-baby visits
*status of midwife clinical and business practice development at each site

6. Set Quantitative and Qualitative Marketing Objectives by Quarter

7. Develop Marketing Strategies & Messages for Each Customer Segment

8. Set Marketing Tactics, Timeframes and Team Members
e.g., direct mail, print & electronic media work, flyer distribution work, poster work, beauty
parlor activities, door-to-door outreach, public speaking engagements, health fair
organizing, website development, blast fax activity, radio talk show circuit, mobilize
maternal and child health organizations to steer potential patients, complete Pathmark
and other neighborhood supermarket package stuffing work, develop brochure for
upscale market segment, develop unique church and teen marketing strategies,
coordinate e-mail blast work, use mapping software to target flyer distribution sites,
organize grand opening ceremony, saturate West African and Dominican civic
institutions with Birthing Center marketing materials in their language, etc.

9. Implement Strategies and Tactics and Evaluate Results-Begin Process Again