H4952999

Healthy Start Initiative-Eliminating Racial/Ethnic Disparities - The Puerto Rico Healthy Start Initiative: West Corridor (Comienzo Saludable-Oeste) represents an enhanced and robust scaling-up endeavor aimed at catering to a minimum of 700 participants each year. This encompassing participant group comprises pregnant, preconception women, inter-conception women, fathers/partners, as well as infants and children from birth to 18 months of age.

The core of Comienzo Saludable Oeste lies in its provision of case management and care coordination services for up to 450 participants and a minimum of 250 individuals in group education annually. Based on evidence-based criteria including need, feasibility, and capacity, seven municipalities have been chosen as the geographic target area: Mayaguez, Hormigueros, Cabo Rojo, San Germán, Sabana Grande, Guánica, and Yauco which collectively exhibit an infant mortality rate (IMR) of 10.4, accounting for a total of 39 infant deaths, an LBW rate of 10.9%, and a preterm birth (PTB) rate of 12.2% (PRDOH, 2023).

The target population under consideration faces significant socioeconomic challenges: high percentage of families living below the poverty level (50.7%-76.9%), obesity before pregnancy (45.2%), single female-headed households (23.8%), adolescent mothers (7.0%), a majority with a high school education or lower (50.9%), concerning 53.2% of births are delivered via cesarean section, and limited access to obstetric care (only four out of six hospitals having fully equipped maternity wards). Therefore, Comienzo Saludable-Oeste target population will consist of the municipalities of Hormigueros, Cabo Rojo, San Germán, Sabana Grande, and Yauco with the most worrisome maternal and child indicators between our target area as evidenced by the US Census data from 2022.

Among these, Cabo Rojo and Yauco are classified as rural areas. To the best of our knowledge, the project area proposed does not overlap with the project area of a recipient funded through an HRSA-19-049 grant. Our primary goal is to continually reduce infant mortality rates, disparities in infant mortality, and perinatal health outcomes in high-risk areas of Puerto Rico, United States. This approach comprises five key components.

Firstly, it includes direct and enabling services such as case management, care coordination, and health and parenting education, ensuring access to quality healthcare, and promoting positive health outcomes. Secondly, a Community Action Network Consortium to foster collaboration and address community needs. Thirdly, technical, and capacity-building support will be provided to staff, healthcare providers, community organizations, and individuals involved in the program.

Fourthly, sustainability and dissemination plans will be prioritized to ensure long-term impact and share knowledge with other organizations. Finally, a robust monitoring & evaluation system will track progress, identify areas for improvement, and ensure the effectiveness and sustainability of interventions. By implementing this comprehensive approach, we aim to address various social determinants of health, promote evidence-based strategies, and strive for significant improvements in perinatal outcomes and infant health.

With this array of services, we can empower and enhance the well-being of families in the project area. Our approach includes selecting adjacent municipalities to establish an impactful "Impact Corridor" and leveraging previous interventions and community services to improve perinatal health and eliminate health disparities. Through this visionary initiative, we aim to seamlessly integrate resources and amplify their impact, ultimately achieving improved health outcomes for the target population.

Grupo Nexos

NOT APPLICABLE

93.926 - Healthy Start Initiative

HRSA Office of Federal Assistance Management (OFAM) [HHS - HRSA]

Maternal and Child Health Bureau (MCHB) [HHS - HRSA]

San Juan Zona Urbana, Puerto Rico United States

City-Wide

Healthy Start Initiative: Eliminating Disparities in Perinatal Health (HRSA-24-033)

Amendment Since initial award the total obligations have increased 218% from $1,008,333 to $3,208,333.