Taking kangaroo mother care forward in South Africa: The role of district clinical specialist teams

Abstract

The global agenda for improved neonatal care includes the scale-up of kangaroo mother care (KMC) services. The establishment of district clinical specialist teams (DCSTs) in South Africa (SA) provides an excellent opportunity to enhance neonatal care at district level and ensure translation of policies, including the requirement for KMC implementation, into everyday clinical practice. Tshwane District in Gauteng Province, SA, has been experiencing an increasing strain on obstetric and neonatal services at central, tertiary and regional hospitals in recent years as a result of growing population numbers and rapid up-referral of patients, with limited down-referral of low-risk patients to district-level services. We describe a successful multidisciplinary quality improvement initiative under the leadership of the Tshwane DCST, in conjunction with experienced local KMC implementers, aimed at expanding the district's KMC services. The project subsequently served as a platform for improvement of other areas of neonatal care by means of a systematic approach. Low birth weight (LBW) and prematurity are significant contributors to neonatal mortality and have become major barriers in reaching child mortality targets. [1] Kangaroo mother care (KMC) is a high-impact, lowtech, cost-effective intervention to reduce neonatal mortality and morbidity.[2] It has proven advantages in terms of infant feeding and weight gain and reduced infection risks, as well as improved maternal physical and psychological health, with an accompanying reduction in health institution utilisation. [3][4][5][6][7] The KMC components include securing infants skin-to-skin to their mothers' chests in an upright position by means of a cloth or wrap, exclusive breastfeeding, early hospital discharge and adequate support of the mother-infant pair by health workers and family members.[8]The current global implementation and research agenda for improved newborn care includes accelerated KMC scale-up. [2,9] KMC has also become part of South African (SA) health policy through initiatives such as the Tshwane Declaration [10] and the Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa.[11] The primary healthcare re-engineering process currently under way in SA is an excellent opportunity to enhance neonatal care and ensure translation of these policies into practice.[12] The district clinical specialist teams (DCSTs), comprising senior medical and nursing personnel in the fields of primary, maternal, paediatric and emergency care, form one of the pillars of this health system improvement initiative. [13,14] Their roles include training, supportive supervision, clinical governance and helping to establish the necessary linkages between hospital-based neonatal units, primary healthcare facilities, district-based health programme staff and communitybased organisations, all of which can potentially greatly enhance the neonatal care continuum. DCSTs are not facility based and are therefore not constrained by systems boundaries between the dif...

“It brought hope and peace in my heart:” Caregivers perceptions on kangaroo mother care services in Malawi

“…6 Center of Bioethics for Eastern & Southern Africa (CEBESA), Blantyre, Malawi. 7 Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, University of British Columbia, Vancouver, Canada.…”

“…Effective KMC practice involves a multidisciplinary team [7] that centers on the newborn's caregiver to deliver the care with support from health workers [4]. In addition to skin-to-skin contact and supporting exclusive breastfeeding, a key component of KMC is the goal of early discharge from the hospital [8], which requires caregiver knowledge and acceptance [6].…”

“So sometimes, it looks like it’s a neglected ward”: Health worker perspectives on implementing kangaroo mother care in southern Malawi

“…It strengthens capacity for and value of monitoring. Other studies on implementing KMC in sub-Saharan Africa identified maternal emotional and practical support from health workers as a key enabler for the practice [18,19,21,[30][31][32][33][34].…”

Quality improvement in Kangaroo Mother Care: learning from a teaching hospital

“…19 20 Skill-based KMC training and reorientation improves the quality of care. [21][22][23][24] In a quality improvement project, Joshi et al improved KMC with simple measures involving family members, positive reinforcement and felicitation of healthcare workers. 25 26 In the initial phase, we aimed to improve the coverage of KMC in admitted eligible neonates from a baseline of 20%-80% within 15 days.…”