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

Bergh, Anne‐Marie; Rooyen, Elise Van; Pattinson, Robert Clive

doi:10.1186/1478-4491-6-13

Cited by 34 publications

(40 citation statements)

References 7 publications

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“…The tool, available as an online supplement (Additional file 1 ), had previously been applied in South African KMC outreach trials [15,16] and had been adapted for use in Malawi [17], Ghana [18], Nigeria [19], and Indonesia [20]. …”

Section: Methodsmentioning

confidence: 99%

Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa

Bergh

Kerber²,

Abwao

et al. 2014

BMC Health Serv Res

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131

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BackgroundSome countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda.MethodsA cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress.ResultsAcross the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care.ConclusionThe integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems.

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Section: Methodsmentioning

confidence: 99%

Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa

Bergh

Kerber²,

Abwao

et al. 2014

BMC Health Serv Res

Self Cite

131

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“…43 Previously articulated strategies to overcome these challenges include training health workers, 44 and extending KMC to the community level, 45,46 as well as effective training and postpartum support to achieve correct and adequate skin-to-skin contact practices in the community setting. 46 Corticosteroids have been shown to help accelerate lung maturation and reduce the incidence of respiratory complications, 47,48 but fear of side effects 48,49 could have contributed to the lack of provision.…”

Section: Discussionmentioning

confidence: 99%

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Wichaidit

Alam

Halder

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.

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“…This scale was used to compare different implementation strategies, including provision of a standard implementation package with and without visits from a facilitator, [113] and on-site versus off-site facilitation [114]. For all approaches, most hospitals showed evidence of practice, implying that the strategy can be implemented successfully.…”

Section: Scaling Up Interventions: Concrete Examplesmentioning

confidence: 99%

Global report on preterm birth and stillbirth (4 of 7): delivery of interventions

Victora

Rubens

2010

BMC Pregnancy Childbirth

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BackgroundThe efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies.Barriers to scaling up interventionsAchieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment.Strategies and examplesScaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention.ConclusionEquitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities.

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

Cited by 34 publications

References 7 publications

Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa

Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Global report on preterm birth and stillbirth (4 of 7): delivery of interventions

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