Lessons Learned Across Asia and Africa in Evaluating KMC Scale-up Using the Six Stages of Implementation

Session: Scale-up of Kangaroo Mother Care: What Works, What Doesn’t, and What’s Next

Presenter: Anne-Marie Bergh, MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria
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Background:  A stages-of-change model is available for evaluating facility-based kangaroo mother care (KMC) services. Implementation progress at facility- and country level is measured according to six stages: (1) create awareness; (2) commit to implementation; (3) prepare for implementation; (4) implement; (5) integrate into routine practice; and (6) sustain practice. Each stage has its own progress markers or indicators.

Methodology: Individual healthcare facilities’ progress is scored with a standardised tool. A collation of facility scores and other descriptive statistics provides information on the status of KMC service provision in a country/province/district or on readiness for implementation. Open-ended items provide qualitative information on barriers and enablers, explaining why some facilities struggle and others excel with KMC. This evaluation tool has been applied in a number of African and Asian countries (Ghana, Malawi, Mali, Rwanda, South Africa, Uganda, Bangladesh, India, Indonesia, Philippines).

Results: The following are scale-up enablers at the different stages of change:   Stages 1 and 2 (stakeholder readiness for scale-up): high-level buy-in from government and donors; well-defined country-led scale-up strategies; sensitisation of health workers and end users Stages 3 and 4 (health-system readiness for scale-up): KMC from the onset embedded in the health system with job descriptions and performance indicators for health workers and management; multidisciplinary health-worker training (including allied/rehab staff)  Stage 5 and 6 (coverage and quality of care): all KMC components well developed with standard operating procedures and proper recordkeeping; KMC included in newborn accreditation standards and in quality-improvement activities (e.g. morbidity and mortality reviews; supportive supervision); client-oriented care.

Conclusion: Intensive stakeholder preparation is the foundation for getting the health system ready for implementation. Progress markers can be used as agenda points in planning for action. The stages-of-change model has been applied for understanding scale-up of other maternal and newborn interventions (e.g. perinatal audit; emergency obstetric and newborn care).