The Olive Clinic - Reducing health inequalities for Albanian-speaking women (Green Maternity Challenge)

Project completed as part of the National Green Maternity Challenge 2024-25 by the Kingston and Richmond NHS Foundation Trust.

Team members:

• Perrine Dhaisne - Project Lead Midwife, Professional Midwifery Advocate
• Melissa Fox-Blach - Project Lead Safeguarding Midwife
• Frances Rivers, Consultant Midwife

Setting / patient group: Maternity Services

Issue: 

Equitable healthcare is considered a fundamental right. However, vulnerable groups such as migrants and ethnic minorities, face various barriers in accessing healthcare, and as a result, face poorer clinical outcomes. One such example is that of Albanian speaking women in Kingston. Comprising of 1% of all maternity care bookings at Kingston (as compared to the 0.2% national population), Albanian women face various challenges such as language barriers, asylum seeking status, poor socio-economic status, lack of support, histories of human trafficking and sexual abuse, and pre-existing mental health conditions. They are also subject to discrimination and culturally insensitive care. All these factors contribute to underutilisation of healthcare services, limited access to high quality care, concerns about confidentiality as well as lack of faith in healthcare system.

Delay in getting timely and appropriate care can lead to poorer health outcomes, often necessitating more intensive and resource heavy treatments. This increases financial costs, healthcare system inefficiencies and workforce pressure.

Intervention:

Healthcare inequalities are aimed to be reduced by various interventions such as:

1. Setting up a dedicated midwifery led clinic and a female face to face interpreter, with the help of Safeguarding team.

2. Increasing the availability of written information in Albanian language for patients

3. Spreading health awareness among Albanian women through dedicated classes in Albanian

4. Enhancing care in labor by looking to arrange for an Albanian speaking doula

To begin with, a in depth review of current practice was conducted to clearly define and understand the issues. Issues such as lack of continuity of care, inadequate language support and safeguarding issues were identified. The former two issues are sough to be addressed by a dedicated clinic for Albanian women, led by a Safeguarding team. A female interpreter attending these clinics would also serve as a doula, a woman whose job is to provide emotional and physical care to a woman in labor and to the woman and her child after birth. They also offered to be on call to support woman in labor whom they had met during visits to such clinics. Studies show that this would improve communication, provide emotional support, enhance patients experience and foster mutual trust.

An Olive Clinic was commenced in Nov 2024 welcoming Albanian women every Thursday. Written resources are also now available in Albanian language on the website on various topics related to maternal health and childbirth.

Further interventions that are being planned to be implemented include recruiting an Albanian doula, arranging for antenatal classes and further translation of health-related information into Albanian, optimising access of care to the Olive Clinic, and increasing health literacy and designing inclusive health care models. A follow up review will be conducted 12-24 months after implementation of the project to measure impacts of interventions.

Outcomes

Environmental

Baseline emissions for the system in place have been calculated. Calculation of emissions 1 year after the interventions can help to evaluate the impact of changes on carbon emissions. However, calculations based on previous estimates show that there will be a slight increase in the carbon footprint of 3.27 kgCO2e per year due to the travel of the interpreter. The overall carbon footprint of the new interpreting service remains low whilst providing better quality services.

Social

Having the same midwife and interpreter at regular checkups has been found to have a positive impact on patient experience. The project has also been accepted by the staff and is supposed to have a positive impact on overall workload and time management. Staff satisfaction also improved knowing that Albanian women will have better access to health care and information.

Clinical

By implementing these changes, care can be made more patient centred, timely and efficient. Maintaining the continuity of care and continuity of interpreting service will improve the standard of care that such women receive. Studies have shown that maintaining continuity of care make it less likely for women to require caesarean or instrumental assistance during labor. Moreover, promoting healthcare education and supporting informed choices enhances trust and engagement in healthcare services during and beyond pregnancy.

Financial

The project comes at an additional annual cost of £6,049 and a one-off cost of £1,326 to translate key documents.

Key learning point:

The project providers an opportunity to pilot a low carbon service which is aimed at reducing health inequalities in vulnerable maternity care patients. It also offers continuity of care and promotes patients to make their own decisions by empowering them. This builds trust in the healthcare system which is important for improving long term health outcomes for both mothers and their families and reduces their long-term reliance on healthcare services.