Kangaroo Mother Care Im Implementation Le Lessons Dr. Tedbabe Degefie Hailegebriel UNICEF HQ, NY Maternal Newborn Health
Kangaroo Mother Care • Each year, preterm complications account for over 1 milli illion deaths , or 35% of all ll neo eonatal l mortali lity . • KMC can avert up to 45 450, 0,000 pre preterm dea deaths each year if near-universal coverage is achieved. • Investment in KMC has beneficial effects beyond survival, including hea ealt lthy growth and develo lopment . • However, global implementation of quality KMC for preterm newborns has not kept pace with the robust, long-standing evidence. KMC – Implementation Lessons
Kangaroo Mother Care UNICEF is responsible for 8 global SDG indicators Goal 3 Custodian Indicators UNICEF supports countries in generating, analyzing Skilled Under-5 Neonatal attendance and using data for these indicators for all their mortality mortality at birth citizens KMC – Implementation Lessons
Current Groundwork Countries are varied in where development has been stable and where challenges have hindered effective implementation and advocacy How many countries have national KMC policy/guideline? Out of 76 countries reported to ENAP progress tracking : 26 has, 20 in process and 30 don’t have KMC – Implementation Lessons
Methodology Data collection tool was developed, pretested and disseminated to all UNICEF regional offices offices KMC – Implementation Lessons
Health Delivery and Workforce KMC – Implementation Lessons
Facilities and Levels of Care Facilities Providing KMC Level of Care 80 70 60 50 40 30 20 10 0 Tanzania Namibia Sudan Lesotho Ghana Iraq Afghanistan Pakistan Bangaldesh Tertiary Regional District Primary (Local) Other KMC – Implementation Lessons
Facilities and Levels of Care Facilities Providing KMC Level of Care 1000 900 800 700 600 500 400 300 200 100 0 Iran India Tertiary Regional District Primary KMC – Implementation Lessons
Health Information Da Data for or hea health facil ilities s that ha have bee been sup supported by y UN UNIC ICEF wit ith KM KMC implementatio ion for or the per period of of 1 Jan Jan to to 31 31 Dec Dec 201 2017 KMC – Implementation Lessons
Country Examples Lesotho Syria Implemented KMC in one hospital The humanitarian crisis undermines completely internally and organically. implementation attempts in Syria and From the bottom up, followed by a emphasizes a need for integration of national response KMC in all emergency newborn care responses India Iran Following nationwide implementation, the All NICUs and special care units are national guideline on KMC prioritizes a currently implementing KMC services. detailed operational plan to scale up KMC, Remaining challenges include national beginning with district hospitals and monitoring and evaluation program subsequent expansion to lower levels and for KMC home KMC KMC – Implementation Lessons
Lesotho • Launched KMC within hospital without presence of national guidelines • Healthcare provider initiated Queen Mamohato • The country is adapting the essential new born care package and Memorial Hospital conducted a ToT in September 2018 Maseru, Lesotho • The package will guide service delivery moving forward • Plan to introduce KMC in all 16 public hospitals starting March 2019 KMC – Implementation Lessons
Syria Civil War & MNH • Ministry of Health decision makers are not yet convinced that KMC is a priority at this stage of the Syrian crisis • No further policy changes or legislation have been made at this stage KMC – Implementation Lessons
Facilities providing KMC services India 1 11 91 • National Guidelines for KMC were 167 released in September 2014 • KMC services are expected to be provided Teaching Hospitals District Hospitals at all facilities providing delivery services Sub district Hospitals Primary health center and fulfil the minimum facility readiness requirements Health workers trained in KMC • The National RMNCHA Communication Strategy, MNH Toolkit and other 1373 documents on MNH clearly indicate 1943 KMC as one of the strategies to reduce newborn mortality Doctors Nurse Midwives KMC – Implementation Lessons
Iran Factilities providing KMC services • KMC program was notified formally as 222 a nationwide program in 2012 308 • All NICUs and special care units are currently implementing KMC services • National Society of Neonatology aids 410 Tertiary Secondary Primary MoH in KMC programming and revising KMC service package Health Workers Trained in KMC 1 14 • National Health Budget includes a budget line for KMC 44 • KMC indicators are included in the 20 national HMIS Doctors Nurses Midwives Occupational Therapist KMC – Implementation Lessons
Levels of Implementation Governance Finance Health Delivery Advocacy • National Health • National Health • Facilities offering • Community Programming Budget KMC services awareness and • Maternal and • MNH Operational engagement • Training of Trainers Newborn Health Plan • National Advocacy • Health workers Guidelines • HMIS Indicators offering KMC Plan services • Essential Supplies • Data collection and tracking KMC – Implementation Lessons
UNICEF Support - Leadership and Governance UNICEF has supported national newborn health In governance, national programming in Ministries of Health are developing/updating national leading the momentum KMC guidelines in almost all for partnership and the reporting countries that KMC implementation have or are developing KMC services into their national MNH programs All responding countries, if not already implemented, have a plan for national implementation within the next 5 years KMC – Implementation Lessons
UNICEF Support - Health Financing KMC is often incorporated into RMNCH plans in national budget and is not specified with separate budget lines Reports state that despite the presence of national guidelines, there is little funding available for commodities and supplies and practitioners mostly depend on donor funding and support KMC – Implementation Lessons
UNICEF Supplies - Essential Supplies With or without UNICEF support, minimum KMC supplies are generally specified in MNH national plans However, gaps are noted in availability of specifically assigned KMC wards UNICEF has supported countries in equipment procurement, development and distribution of specific promotional materials, training accessories, and establishing or upgrading KMC units KMC – Implementation Lessons
UNICEF Support - Community Engagement and Advocacy Many countries do not have a national advocacy KMC tends to fall within plan that includes KMC broader RMNCH advocacy promotion in place plans Community acceptance remains a challenge to implementation Social mobilization and awareness about the importance of KMC is needed in every country KMC – Implementation Lessons
Challenges Despite widespread national level consideration, sustained implementation seems to be the most pressing challenge to KMC service Lack of specific budget line means limited financial resources Advocacy and Awareness • Lack of community awareness mandates partners working at community level and/or managing male involvement projects KMC – Implementation Lessons
Challenges In Inconsis istent t an and inc incomple lete data • KMC indicators are rarely included in the national HMIS • Lack of a reasonable national monitoring and evaluation program for KMC • Inadequate data on implementation and for decision making Collaboration of national, public, and private partners to develop data collection methods that can be practically implemented and tracked is critically needed KMC – Implementation Lessons
Continuing Support Capacity building of health care workers and community health workers • Development of more SBCC material for community level • Increased funding to increase KMC coverage and documentation in country • Scale up of KMC – ToT and supply procurement “When health staff are well trained, they put up their best thus improving the survival rate. Parents are ready to accept referral to the KMC units because they see small babies surviving. It is expensive to do KMC in terms of staff time and client resources.” - DDNS, GHS-UER Ghana KMC – Implementation Lessons
Continuing Support Support in documenting lessons learnt on KMC • Data review • Analysis and feedback • Research in knowledge Bridging gaps in implementation • Critical integration of KMC in overall newborn strengthening programs • Inclusion of KMC indicators into national HIS and KMC standards/policy/guidelines • Training that contributes to adding knowledge, changing attitude for most of the participants KMC – Implementation Lessons
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