Results From First 1,000 Days Integrated Care Pathway says Kim Wilson Health Minister

This morning, Dr. Sylvanus Nawab and I will give an overview and share the results of the recently completed third integrated care pathway titled “First 1,000 Days.” This is part of Bermuda’s efforts to implement Universal Health Coverage.

Recognising this, the Government prioritised this pathway in the 2022 Throne Speech,
emphasising its importance for the Ministry of Health. Ensuring access to fulsome quality care
from day 1 is foundational for a child to have the best chance at living a healthy life. Further, the 2023 Joint Strategic Needs Assessment, a study that set out to properly understand our population’s health needs, recommended a public health needs assessment on Child and
Maternal Health, emphasising the importance of focusing on the First 1,000 Days Integrated Care

The Report that we are sharing today, presents the findings of the study that was conducted to
assess and map the Island’s current First 1,000 Days Integrated Care Pathway. It incorporates
maternal and child health, and adjacent services.
Led by Dr. Nawab, who is Chief of Pediatrics at the Bermuda Hospitals Board and a Pediatrician
with Edgewood Pediatrics, the multi-disciplinary working group overseeing this pathway
included: Dr. Ricky Brathwaite – CEO of Bermuda Health Council, Tiara Carlington – Policy Analyst at Bermuda Health Council, and Dr. Attiya Talbot – Pediatric Officer at Department of Health.

The objectives were to better understand current maternal and child health provision in Bermuda, assess user experiences, and identify existing challenges and opportunities. The work on this care pathway focused on five main lines of enquiry, including:

– service touchpoints, processes, and handovers of care between service providers;

– patient and family experience and what their care journey looks like;

– areas of overuse and/or duplication or redundancy of services and inefficiencies in their
provision; and

– existing and perceived challenges in the delivery and access to services.

As always, stakeholder engagement was a critical component of this work. 40 interviews were
conducted with patients and their family members; clinicians, such as nurses, primary care providers, mental health care providers, and specialists; and operational professionals, such as those providing service coordination, family services and other relevant services.

Three interactive stakeholder workshops were facilitated to capture the views and feedback of
care providers involved in the current First 1,000 Days Integrated Care Pathway; and the
Community Survey received 375 responses, the data of which was analysed according to age,
household income, and the type of insurance held.

The results were used to draft a Service Map for maternal and health services. A Service Map is
a graphic depiction of the various components and interactions of a healthcare service,
highlighting processes, stakeholders and touchpoints involved. It helps to identify areas of
improvement and optimise service delivery.
Patient personas were also developed to understand patient experiences in the Care Pathway and those experiences were plotted on the Service Map to create a Journey Map.

The Journey Map breaks down patients’ experiences across different stages of the care service. It provides insights into patient perspectives, needs, and pain points, enabling healthcare providers to enhance patient satisfaction and outcomes. All of this work combined to highlight eight key findings, with ten challenges being identified, along with 16 opportunities for improving the current state of the First 1,000 Days Integrated Care Pathway.

Dr. Nawab will now take you through those key findings and recommendations, after which I will discuss where we go from here, as we continue to work collaboratively to strengthen the First 1,000 Days Integrated Care Pathway in Bermuda.


Over the past several months, you have increasingly heard me speak about the importance of, and the Government’s commitment to, implementing Universal Health Coverage and how
– service provider roles and responsibilities;

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.

You have also heard me say that the ongoing work that is being undertaken to implement priority recommendations coming out of all the integrated care pathway initiatives will only be successful with the collaborative work of all stakeholders. This includes the Government, health service providers, insurers, people with lived experience, and residents.

So let me echo Dr. Nawab’s expression of appreciation to the members of the First 1,000 Days Working Group and all stakeholders who came together in this work – especially the patients and families with lived experience. Your time and effort will have a positive impact and will guide the next phase of work.
A Working Group for that next phase of work will be formed. Their work will include prioritising recommendations contained with the recently completed Report and then facilitating the implementation of the priortised recommendations.

To download the First 1,000 Days Patient Journey Map and Service Map, go to
In the words of Seth Berkley, an American medical epidemiologist, “Healthy children are more likely to attend school and are better able to learn.” Let’s ensure all our children have the care they need to thrive from the start. It is our privilege to make this happen.

Any content which is considered unsuitable, unlawful, or offensive, includes personal details, advertises or promotes products, services or websites, or repeats previous comments will be removed.

User comments posted on this website are solely the views and opinions of the comment writer and are not a representation of or reflection of the opinions of TNN or its staff.

TNN reserves the right to remove, edit or censor any comments.

TNN accepts no liability and will not be held accountable for the comments made by users.