Kangaroo Mother Care in Colombia: A Subaltern Health Innovation against For‐profit Biomedicine

Abadía‐Barrero, César Ernesto

doi:10.1111/maq.12430

Cited by 20 publications

(10 citation statements)

References 33 publications

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“…A first step promoting RI is awareness of potential opportunities within the health sector. Innovations can represent context-adapted alternatives with much improved cost-benefit ratios ( Tran and Ravaud, 2016 ; Abadía-Barrero, 2018 ), increased quality of care for underserved areas ( Sharifi et al., 2013 ), or optimized resource use ( Snowdon et al., 2015 ; Premji and Hatfield, 2016 ; Basu et al., 2017 ; Zhou et al., 2020 ). Factors facilitating innovation can be less established infrastructure that allows more freedom to experiment ( Crisp, 2014 ) and less retrofitting ( van Dam et al., 2017 ) and an existing cultural ‘forgiveness of failure’ ( Dalton, 2017 ).…”

Section: Resultsmentioning

confidence: 99%

From reverse innovation to global innovation in animal health: A review

Crump

Maidane

Mauti

et al. 2021

Heliyon

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Reverse innovation refers to learning from or diffusion of innovations developed in low income settings and further translated to industrialized countries. There is lack of consensus regarding terminology, but the idea that innovations in low-income countries are promising for adoption in high-income contexts is not new. However, in healthcare literature globally, the vast majority of publications referring to ‘disruptive innovation’ were published in the last ten years. To assess the potential of innovative developments and technologies for improving animal health, we initiated a literature review in 2020. We used a combined approach, incorporating targeted searching in PubMed using a key word algorithm with a snowball technique, to identify 120 relevant publications and extract data for qualitative coding. Heterogeneity of articles precluded meta-analysis, quality scoring and risk of bias analysis. We can distinguish technical innovations like new digital devices, diagnostic tests and procedures, and social innovations of intersectoral cooperation. We profile two case studies to describe potential global innovations: an integrated surveillance and response system in Somali Regional State, Ethiopia and a blockchain secured One Health intervention to optimally provide post-exposure prophylaxis for rabies exposed people in West Africa. Innovation follows no borders and can also occur in low-income settings, under constraints of cost, lack of services and infrastructure. Lower administrative and legal barriers may contribute to produce innovations that would not be possible under conditions of high density of regulation. We recommend using the term global innovation, which highlights those emanating from international partnership to solve problems of global implications.

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Section: Resultsmentioning

confidence: 99%

From reverse innovation to global innovation in animal health: A review

Crump

Maidane

Mauti

et al. 2021

Heliyon

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“…Information about family centred care in low-and middle-income countries is scarce although the impact of KMC introduced in Colombia in 1978 is well known. In spite of robust supporting evidence for this lowcost innovation in resource-limited settings (12) it has been slow to spread; Abadía-Barrero (13) suggests that the conflict between politics of care and politics of profit play a part in making it difficult for health professionals to accept that a mother's loving, close contact might be superior to technical advances and scientific training.…”

Section: Accepted Articlementioning

confidence: 99%

Non‐evidence‐based beliefs increase inequalities in the provision of infant‐ and family‐centred neonatal care

Mendizabal-Espinosa

Warren

2019

Acta Paediatrica

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Aim: To identify barriers that might explain why healthcare staff struggle to implement infant and family centred developmental care programmes in two neonatal intensive care units in Mexico. Methods: Ethnographic fieldwork over the course of ten months examined interactions among healthcare professionals, parents and babies in two Mexican publicly funded hospitals. Data are drawn from interviews with 29 parents and 34 healthcare professionals and participant Accepted Article This article is protected by copyright. All rights reserved. observations in the hospitals' neonatal units. Results: Healthcare professionals believed they acted in babies' best interests by excluding parents from the neonatal unit. Professional frustration with working conditions seemed to be increased by the belief that parents were ignorant and unhygienic. Parents were perceived as a source of infection; in contrast, healthcare professionals failed to see themselves as a possible source of cross-contamination. Conclusions: Beliefs and biases increase health inequalities when evidenced-based measures to prevent cross-infection and potentially life-saving programmes, such as kangaroo mother care and breastfeeding, are not implemented. It is imperative to develop context-appropriate education and practice guidelines to implement basic programmes.

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“…Within the NICUs of high income countries such as Aotearoa New Zealand, a traditional neonatal care paradigm that results in early and enduring maternal-infant separation and inconsistent application of KMC may predominate (Abadia- Barrero, 2018;Nyqvist, 2016). This perspective is speculative, given that no empirical evidence exists at this time to support or refute the idea.…”

Section: Problem Statementmentioning

confidence: 99%

“…Rich countries are being asked to create novel healthcare solutions based on 'reverse innovations' and lessons learned from poor countries (Syed, Dadwal, & Martin, 2013), with specific reference to KMC (Syed et al, 2012). In addition, evidence of expensive market-driven overuse of biotechnology for infant care, including rising rates of non-essential NICU admission, is growing (Abadia- Barrero, 2018;Carroll, 2015;Harrison & Goodman, 2015).…”

Section: Problem Statementmentioning

confidence: 99%

“…The combination of societal, organisational and individual influences converge to produce the 'culture' or 'ecology' of a social system which has contributed to multiple barriers to developmental care and KMC on a global scale. Highly contextual factors attributable to health systems, practitioner, and parent/patient perspectives are consistently preventing effective programme development and the breakdown of existing KMC programmes (Abadia- Barrero, 2018;Chan, Bergelson, Smith, Skotnes, & Wall, 2017;Chan et al, 2016;Griscti et al, 2017;Smith et al, 2017;Soni et al, 2016). The ability to assess and quantify care paradigms as they relate to the 'developmental ecology' within individual neonatal intensive care units, in support of more positive developmental outcomes for preterm patients and their families, has therefore become a pressing issue in maternal-infant healthcare (Atun-Einy & Scher, 2008, White, 2014.…”

Section: )mentioning

confidence: 99%

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Kangaroo Mother Care: Participatory Action Research within a Neonatal Intensive Care Unit in Aotearoa New Zealand

Bear¹

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<p>Human infants share common biological and developmental needs in the postnatal period that are optimally met during intimate contact with their mother or primary caregiver. In the case of infants hospitalised in tertiary-level neonatal intensive care units (NICUs), there is a departure from instinctual caregiving and nurturing found in the mother-infant pair, due in part, to a model of care which supports maternal-infant separation. This can lead to suboptimal physiological responses, altered neurobiology and life-long negative health effects. The social construction of neonatal care currently positions it within the paradigm of biomedical science. Where family-centred, developmental care frameworks have been integrated, and Kangaroo Mother Care (KMC) has been embedded into caregiving routines, enhanced patient, whānau/family, staff and organisational outcomes have been found. This study is underpinned by the importance of KMC for the enhancement of infant and whānau/families’ health and developmental outcomes. Despite its classification as an evidence-based practice, and recommendations by the World Health Organisation for its use in all healthcare settings, KMC is inconsistently applied. The highly complex and contextual nature of the environments where medically-dependent babies are cared for is acknowledged. There is a need for health services to explore innovative research approaches, through a social science lens, to assist in the implementation of KMC. This thesis illustrates one such approach. The purpose of this study was to explore and activate improvement of the KMC programme within one NICU in Aotearoa New Zealand using Participatory Action Research (PAR). The research was theoretically informed by Als’ developmental biology and care theories, D’Agata’s Infant Medical Trauma model, and the Foucauldian concept of power/knowledge through a critical feminist lens. A participatory approach was chosen in the hope that transformation of KMC practice would be achieved and embedded within this NICU. In addition, I intended to contribute to the emerging body of evidence calling for the collaboration of all community members toward enhanced quality of KMC. Multiple methods were used to capture data relating to the NICU’s KMC programme through audit, observation and interview of key stakeholders. Project planning included the conventions of PAR generally applied to research using this methodology. Three iterative cycles of exploration, implementation and evaluation of the KMC programme were envisaged within this setting. Active participation with multiple NICU stakeholders was planned for, forming the basis of action-based change and improvement of KMC. However, the three-cycle process was not achieved within the time limitations of my research, with field work finishing at the conclusion of the first exploratory cycle. This thesis describes the unfolding processes of PAR, as well as the inclusion of a secondary discourse analysis and parental perspectives from local and global literature. Key findings showed inconsistently documented KMC and the near-absence of KMC practice for a significant group of babies. Whilst the benefit of KMC was embedded in the understanding of participants, this knowledge did not translate to practice. There was an unrealistic optimism about the functioning of KMC by most of the stakeholders. In addition, participants expressed ambiguity about their programme, contributing to and influenced by suboptimal KMC education and training. A pathway to improvement of their KMC programme was lacking, and the lines of responsibility for it were unclear. This factor undoubtedly contributed to the difficulties of implementing a full PAR project. Whilst parental, staff and organisational factors were found to influence KMC implementation, arguably the greatest effect on the intervention were the power relations inherent within the normative technocratic, biomedical paradigm. Power relations constituting what was considered authoritative knowledge, and who was authorised to speak, impacted on the participatory nature of the research itself. This resulted in the research not proceeding past the first PAR exploratory cycle through to rounds of implementation and evaluation. This thesis describes participatory inquiry into one KMC programme in the high-income NICU setting, through the lenses of multiple participants within the context of Aotearoa New Zealand. These were not previously known. It also provides an example of how Foucauldian- and feminist-informed PAR methodology may be used within the NICU setting for inquiry into KMC, an intervention positioned outside of the normative biomedical framework.</p>

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Kangaroo Mother Care in Colombia: A Subaltern Health Innovation against For‐profit Biomedicine

Cited by 20 publications

References 33 publications

From reverse innovation to global innovation in animal health: A review

From reverse innovation to global innovation in animal health: A review

Non‐evidence‐based beliefs increase inequalities in the provision of infant‐ and family‐centred neonatal care

Kangaroo Mother Care: Participatory Action Research within a Neonatal Intensive Care Unit in Aotearoa New Zealand

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