Implementation of kangaroo mother care: A randomized trial of two outreach strategies

Abstract

Aim: To test whether a well‐designed educational package on the implementation of kangaroo mother care (KMC) used on its own can be as effective in implementing KMC in a healthcare facility as the combination of a visiting facilitator used in conjunction with the package. Setting: Thirty‐four hospitals in KwaZulu‐Natal Province, South Africa. Method: The hospitals were paired with respect to their geographical location and annual number of births at the facility. One hospital in each pair was randomly allocated to receive either the implementation package alone (group A) or the implementation package and visits from a facilitator (group B). Hospitals in group B received three facilitation visits. All hospitals were evaluated by a site visit 8 mo after launching the process and were scored by means of a progress‐monitoring tool. Outcomes: Successful implementation was regarded as demonstrating evidence of practice (score>10) during the site visit. Results: Group B scored significantly better than group A (p<0.05). All 17 hospitals in group B demonstrated evidence of practice, with the median score of the group being 15.44 (range 10.29–22.94). Twelve of the hospitals in group A demonstrated evidence of practice and the median score was 11.33 (range 1.08–21.13). Conclusion: Successful implementation was achieved in most of the hospitals irrespective of the strategy used. However, facilitation with an implementation package was clearly superior to using a package alone. Some sites do not need facilitation for successful implementation.

Scaling up kangaroo mother care in South Africa: 'on-site' versus 'off-site' educational facilitation

“…Hospitals were paired and assigned either to receiving an evidence-based multimedia educational package on its own or to receiving on-site regional facilitation in conjunction with the use of the package. The results of the study confirmed Grimshaw et al's observation [ 1 ] – facilitation using an on-site, face-to-face strategy, combined with a carefully designed implementation package, was found to be significantly more effective than using the package on its own [ 9 ].…”

“…The implementation of KMC was successful and the scores of Group A (on-site facilitation) were remarkably similar to the on-site facilitation scores in the Ukugona trial [ 9 ]. This confirms the assumption that face-to-face facilitation is effective in the scaling up of new health care strategies.…”

“…Ideally a new health care intervention should be introduced in all the relevant health care facilities simultaneously. This was the approach followed in the Ukugona Outreach [ 9 ]. However, practical constraints, budgetary considerations and the availability of human resources are realities that often have to be taken into account when planning an outreach.…”

Implementation of Kangaroo mother care by health workers in Nigeria

“…6 Within the health facility, Provision of a private comfortable environment and having written protocols has also been identified as one of the supporting factors that promote KMC practice. 6,7 In Nigeria KMC was first introduced in the late 1990s through a resident pediatrician at the University of Lagos Teaching Hospital following a month-long training in Bogotá, Colombia. 8 KMC was also declared as the best option of practice in 1998 during the 29 th annual general and scientific conference of the paediatric association of Nigeria.…”

Measuring implementation progress in kangaroo mother care

“…Where some provinces leave it to the individual hospitals to decide on the way they would implement KMC, others initiated outreaches to assist the implementation process. Some outreaches aimed at reaching all hospitals at once, such as the Ukugona Outreach in the KwaZulu‐Natal Province 18. Others, for example the Fara Ngwana Outreach in Gauteng Province and the Ukubamba Umtwana Kuwe Outreach in Mpumalanga Province, follow a staggered approach, targeting a certain number of hospitals each year 19, 20.…”