Bergh: Kangaroo Mother Care_a Multi Country Evaluation in Africa

7/28/2019 Bergh: Kangaroo Mother Care_a Multi Country Evaluation in Africa

1/25

Kangaroo

mothercare

:

amul

ti-coun

try

ev

aluatio

ninA

frica

Anne-MarieBergh

On

be

ha

lfo

fSa

ve

the

Childrena

ndMCHIP

Me

dicalResearchCouncil

Un

itforMaternalandInfantH

ealthCareStrategies,

Univers

ityofPretoria,

SouthAfrica

GlobalNewbo

rnHealthConference

2013,

Johannesburg,

SouthAfrica,

15-18April2013


2/25

F

ourAfricancou

ntries

M

ALI

UGANDA

RWANDA

MALAWI

(http://www.l

ib.u

texas.e

du/ma

ps/africa/africa_

pol_2003.jpg)

Febru

ary

May

20

12


3/25

P

artners

andspo

nsors

MedicalResearchCouncil

UnitforMaternalandInfant

HealthCareStra

tegies,

UniversityofPreto

ria,

SouthAfrica

Ministryo

fHealth

,Ma

li

Ministryo

fHea

lth

,Mala

wi

Ministry

ofHea

lth

,Rwanda

REPUBLICOFRWANDA

MINISTRYOFHEALTH

Ministryo

fHea

lth

,Ugan

da

SNL

Program


4/25

Thequestion

s

What

isthescop

eandextentof

institu

tionalisationofKMCinthefour

countries?

What

arethebar

riersandfa

cilitatorsto

sustainableKMC

implemen

tation?

What

worksinfa

cility-based

KMCscale-up

andw

hatnot,un

derwhatcircumstances

andin

whichcon

text?


5/25

O

utline

B

ackground

M

ethodolog

y

F

indings

Imp

lementa

tion

scores

Ma

jor

implemen-

tation

facto

rs

K

eylessons


6/25

Bac

kground

fourcountries

Differentcontexts

Differentsocio-politicalhisto

riesand

econo

micpolicie

s

Widevariationso

nbasicde

velopment

indica

tors

DifferentapproachestoKM

C

implementationa

ndscale-u

p

Snapshot

evaluationnostatistical

comparisons


7/25

New

bornin

dicators

,2011/12

Indicator

M

alawiMali

Rwanda

Uganda

Neona

talm

orta

lity

rate/1000live

births

27

49

21

28

Pre

term

birth

rate

18%

12%

10%

14%

Neona

tald

ea

ths

due

topre

term

comp

lic.

36%

33%

34%

38%

Births

ina

hea

lth

fac

ility

73%

45%

69%

57%

Lancet(2012)Liuetal;Blencoweetal

C

ountrydemographicandh

ealthsurveyresults;UNICE

F:Levelsandtrendsofch

ildmortality(2011)


8/25


9/25

M

ethodol

ogyth

etools

Focus:

fac

ility-base

dKMCserv

icess

itev

isits

Capac

ity

bu

ilding:

teamo

floca

lmon

itors

Standard

ise

dprog

ress-monito

ring

too

l:

Key-in

formant

interv

iewsc

hedu

le

Che

cklistfor

observa

tions

Qua

ntitativeand

qua

lita

tive

items


10/25

Resultsnumbers

Country

F

acilities

implemented(n)

Facilitie

s

visited(

n)

*Malaw

i

121

14

*Ugan

da

19

11

+Mali

7

7

+Rwan

da

30

7

Total

177

39

*Longdela

ybetweenintr

o-

ductionatfirsthospital(s)

andcountryscale-up

+

Estab

lishmentofac

entre

ofexcellencewithscale-up

follow

ingwithinafe

wyears


11/25

Resultsnumbers

Co

untry

Facilities

impleme

nted(n)

M

alaw

i

12

1

R

wan

da

3

0

#U

gan

da

1

9

#M

ali

7

Total

17

7

#Implementation

lim

itedtosouth

ern

partofcountry

Comprehensive

scale-u

pinitiatives


12/25

Pro

gress-m

onitorin

gmodel

2.2.Comm

ittoimplement

Comm

ittoimplement

3.3.

Preparetoimplement

Preparetoimplement

4.4.Implement

Implement

5.5.Integrateinto

Integrateinto

routin

epractice

routin

epractice

6.Sustainnew

6.Sustainnew

practices

practices

INSTITUTIONALIS INSTITUTIONALIS--

ATION ATION

PRE PRE--IMPLEMENT IMPLEMENT--

ATION ATION

IMPLEMENT IMPLEMENT--

ATION ATION

Ge

tacquainted

Ge

tacquainted

1.1.CCreateawareness

reateawareness

STAGESOFCHANGE

STAGESOFCHANGE

Cumulative

score

2

2

6

7

7

6

30


13/25

0246810

12

14

16

18

20

22

24

26

28

30

1.

1.CCreateawareness

reateawareness

2.

2.Comm

ittoimplement

Comm

ittoimplement

3.

3.Preparetoimplement

Preparetoimplement

4.

4.Implement

Implement

5.

5.Integrateinto

Integrateinto

routinepractice

routinepractic

e

6.

Sustain

new

6.

Sustain

new

practic

es

practic

es

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

MALAWI

0246810

12

14

16

18

20

22

24

26

28

30


reateawareness

2.

2.Committoimplement

Committoimplement

3.

3.Preparetoimpleme

nt

Preparetoimpleme

nt

4.

4.Implement

Implement

5.

5.Integ

rateinto

Integ

rateinto

routin

epractice

routin

epractice

6.

Sustainnew

6.

Sustainnew

practices

practices

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

MALI

0246810

12

14

16

18

20

22

24

26

28

30

1.

1.CCreateawareness

reateawareness

2.

2.Comm

ittoimplement

Comm

ittoimplement

3.


Preparetoimplement

4.

4.Implement

Implement

5.

5.Integrateinto

Integrateinto

routinepractice

routinepractic

e

6.

Sustain

new

6.

Sustain

new

practic

es

practic

es

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

0246810

12

14

16

18

20

22

24

26

28

30

1.1.

CCreateawareness

reateawareness

2.

2.Committoimplement

Committoimplement

3.

3.Preparetoimpleme

nt

Preparetoimpleme

nt

4.

4.Implement

Implement

5.

5.Integ

rateinto

Integ

rateinto

routinepractice

routin

epractice

6.

Sustainnew

6.

Sustainnew

practices

practices

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

RWA

NDA

UGANDA


14/25

0246810

12

14

16

18

20

22

24

26

28

30

1.

1.CCreateawareness

reateawareness

2.

2.Comm

ittoimplement

Comm

ittoimplement

3.


Preparetoimplement

4.

4.Implement

Implement

5.

5.Integrateinto

Integrateinto

routinepractice

routinepractic

e

6.

Sustain

new

6.

Sustain

new

practic

es

practic

es

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

MALAWI

0246810

12

14

16

18

20

22

24

26

28

30


reateawareness

2.

2.Committoimplement

Committoimplement

3.

3.Preparetoimpleme

nt

Preparetoimpleme

nt

4.

4.Implement

Implement

5.

5.Integ

rateinto

Integ

rateinto

routin

epractice

routin

epractice

6.

Sustainnew

6.

Sustainnew

practices

practices

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

MALI

0246810

12

14

16

18

20

22

24

26

28

30

1.

1.CCreateawareness

reateawareness

2.

2.Comm

ittoimplement

Comm

ittoimplement

3.


Preparetoimplement

4.

4.Implement

Implement

5.

5.Integrateinto

Integrateinto

routinepractice

routinepractic

e

6.

Sustain

new

6.

Sustain

new

practic

es

practic

es

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

0246810

12

14

16

18

20

22

24

26

28

30

1.1.

CCreateawareness

reateawareness

2.

2.Committoimplement

Committoimplement

3.

3.Preparetoimpleme

nt

Preparetoimpleme

nt

4.

4.Implement

Implement

5.

5.Integ

rateinto

Integ

rateinto

routinepractice

routin

epractice

6.

Sustainnew

6.

Sustainnew

practices

practices

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

RWA

NDA

UGANDA


15/25

0246810

12

14

16

18

20

22

24

26

28

30

1.

1.CCreateawareness

reateawareness

2.

2.Comm

ittoimplement

Comm

ittoimplement

3.


Preparetoimplement

4.

4.Implement

Implement

5.

5.Integrateinto

Integrateinto

routinepractice

routinepractic

e

6.

Sustain

new

6.

Sustain

new

practic

es

practic

es

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

MALAWI

0246810

12

14

16

18

20

22

24

26

28

30


reateawareness

2.

2.Committoimplement

Committoimplement

3.

3.Preparetoimpleme

nt

Preparetoimpleme

nt

4.

4.Implement

Implement

5.

5.Integ

rateinto

Integ

rateinto

routin

epractice

routin

epractice

6.

Sustainnew

6.

Sustainnew

practices

practices

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

MALI

0246810

12

14

16

18

20

22

24

26

28

30

1.

1.CCreateawareness

reateawareness

2.

2.Comm

ittoimplement

Comm

ittoimplement

3.


Preparetoimplement

4.

4.Implement

Implement

5.

5.Integrateinto

Integrateinto

routinepractice

routinepractic

e

6.

Sustain

new

6.

Sustain

new

practic

es

practic

es

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

0246810

12

14

16

18

20

22

24

26

28

30

1.1.

CCreateawareness

reateawareness

2.

2.Committoimplement

Committoimplement

3.

3.Preparetoimpleme

nt

Preparetoimpleme

nt

4.

4.Implement

Implement

5.

5.Integ

rateinto

Integ

rateinto

routinepractice

routin

epractice

6.

Sustainnew

6.

Sustainnew

practices

practices

(2)

(2)

(4)

(7)

Cumulativescore

Scoreperstage:

(7)

(6)

RWA

NDA

UGANDA


16/25

Findings

MajorfactorsinK

MCimplementation:

Gover

nance,leadershipandmanagem

ent

Tra

inin

gan

dorien

tation

Suppo

rtivesupervision

Integr

atingKMC

intoqualityimprovem

ent

Continuityofcar

ebeyondt

hebirthfac

ility

Client

fac

tors

influ

enc

ingupta

keo

fKMC


17/25

Governance,leader

shipand

man

agemen

t

Na

tiona

l/reg

iona

lleve

l:

Po

litica

lw

ill

Synergy

be

twe

engovern

men

tand

donors

Centra

lisa

tion

decentra

lisa

tion

Opin

ion

lea

ders


18/25

S

upportivesupervision

Anelu

siveideal

What

isneededatalllevels

:

Suff

icien

tbuy-in

for

KMCimp

lemen

tation

Superv

isionasa

priori

ty

Superv

isorsnee

d:

SufficientKMCknowledgeand

skills

Sufficienttimea

ndresources


19/25

KMCaspartofq

uality

improvemen

t

Mechanismsforreportingonprogress

of

KMCimplementa

tion

Recor

dsforKMC

Variab

ilityinqualityandcom

pleteness

of

record

keepinganddocumentation

Datacollectionm

ostlyproje

ctdrivenand

notpa

rtofofficia

lhealthma

nagement

inform

ationsyste

ms


20/25

Continuityofc

arebeyo

ndthebirth

facility

Prepa

rationforK

MCinante

natal

educa

tion

Major

barrier:

Adequateanda

ppropriate

follow-up

systemsfor(preterm)infa

ntreview

afterdischarge

fromfacility

Comm

unityhealthworkersinthe

contin

uumofcar

efornewborns


21/25

Key

lessons

KMCto

bepartofa

llnew

bornc

are

initiative

s

Scoringan

dp

lottingo

ffac

ilities

p

lann

ing

informa

tion

form

inistries

Toorap

idsca

le-up

maycompro

misequa

lity

of

care

Engagemen

to

fMin

istryo

fHea

lthan

do

ther

imp

lem

en

tingpartn

ers

from

beg

inn

ing

Focus:support

ing

therou

tinehea

lthsys

tem

to

integra

teKMCserv

ices

Approp

ria

teongoin

gmon

itoring

mec

han

ism

s


22/25

Aspecia

lthankyou

t

oalltheh

ealthcareproviders

whosharedtheirinformationwith

us


23/25

toallth

emothersand

caregiverswillingtopracticeK

MC

Aspec

ialthankyou


24/25

Aspecia

lthankyou

Malawi:

ReubenLigowe

RichardLuhanga

LydiaBanda

ThokoLipato

GetrudeNgwira

JobyGeorge

Uganda:

NamaalaHanifah

Sengendo

PatrickAliganyir

a

ChristineOtai

AgnesKirikumw

ino

Mali:

ModiboKante

MariamS

ylla

Isabelle

Traor

HawaDiall

NialenKaba

Rwanda:

BataMukarugwiro

FidleNgabo

FelixSayinzog

a

JeremieZoungrana

GlorioseAbay

isenga

ClaudineKare

ra

CarolineIkiriza

AssumptaMw

ali

SouthAfric

a:

KateKerber

KarenDavy

ElisevanRooy

en

UnitedStates:

StellaAbwao

Josephde-Gra

ft

Johnson

NathalieGamache

BarbaraRawlin

s

RachelTaylor

JessicaHulse

SylviaAlford


25/25

T

ransla

tingof

ficial

policyand

best-practice

int

ochan

geinhealth-

w

orkerb

ehaviourat

grassr

ootsle

vel:

No

teasy,butpo

ssible

Bergh: Kangaroo Mother Care_a Multi Country Evaluation in Africa

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Transcript of Bergh: Kangaroo Mother Care_a Multi Country Evaluation in Africa