kangaroo care acceleration in rwanda khadka
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Kangaroo Care
Acceleration
in
RWANDA
Neena Khadka
Team Leader Newborn Health
MCSP
Presented during the Safe Motherhood and Reproductive Health Working
Group at the Fall CORE Meeting
October 8, 2015
Rwanda Situation
Rwanda Situation
Rwanda Situation
159
DEMOGRAPHICS
MATERNAL AND NEWBORN HEALTH
CHILD HEALTH
WATER AND SANITATION
30
644
1059
23
7 3
1990 2012
64 61
2322
11 15
2 2
1990 2012
28
643
762
26
7 3
1990 2012
16% 2%Preterm 10%
Asphyxia* 12%
Other 2%
Congenital 5%
Sepsis** 8%
0%10%
Measles 1%Injuries 7%
Malaria 4%
HIV/AIDS 1%
Other 21%
External sources
General government expenditure
Out-of-pocket expenditure
Other
Density of doctors, nurses and midwives (per 10,000 population)
POLICIES
Diarrhoeal disease treatmentPercent of children <5 years with diarrhoea:
receiving oral rehydration therapy/increased fluids with continued feeding
Embolism 2%
Haemorrhage 25%
Hypertension 16%
Indirect 29%
Other direct 9%
Abortion 10%
Sepsis 10%
Shared facilitiesImproved facilitiesOpen defecation
Percent children receiving first line treatment among those receiving any antimalarial
97 (2010)
Percent children < 5 years sleeping under ITNs
513
5670
0
20
40
60
80
100
2000MICS
2005DHS
2007-2008DHS
2010DHS
Perc
ent
Midwives authorized for specific tasks (X of 7 tasks)
Per capita total expenditure onhealth (Int$)
144
94 92 94 96 98
0
20
40
60
80
100
1992DHS
2000MICS
2005DHS
2007-2008DHS
2010DHS
Perc
ent
Antenatal carePercent women aged 15-49 years attended at least once by askilled health provider during pregnancy
Causes of maternal deaths, 2013
1624 2128
10 1221
29
0
20
40
60
80
100
1992DHS
2000MICS
2005DHS
2007-2008DHS
2010DHS
Perc
ent
Improved drinking water coverage Improved sanitation coverage
Source: WHO/UNICEF JMP 2014
UnimprovedOther improvedPiped on premises
Percent of population by type of drinking water source, 1990-2012
Total Urban Rural
Source: WHO/UNICEF JMP 2014
Percent of population by type of sanitation facility, 1990-2012
Unimproved facilities
Total Urban Rural
treated with ORS
71 (2010)
17 (2007-2008)
7, 16, 6 (2010)
5 (2010)
18 (2010)
5 (2010)
85 (2012)
(2012)
Malaria prevention and treatment
Maternity protection (Convention 183)
Source: WHO/CHERG 2014
Women with low body mass index (<18.5 kg/m2, %)
Postnatal visit for mother (within 2 days for home births, %)
Postnatal visit for baby (within 2 days for home births, %)
Neonatal tetanus vaccine
C-section rate (total, urban, rural; %)
(Minimum target is 5% and maximum target is 15%)
Malaria during pregnancy - intermittent preventive treatment (%)
Demand for family planning satisfied (%)
Surface water
35 (2010)Antenatal care (4 or more visits, %)
Globally nearly half of child deaths are attributable to undernutrition
Source: WHO 2014
Pneumonia
Diarrhoea
Causes of under-five deaths, 2012Regional estimates for Sub-Saharan Africa, 2013
General government expenditure on health as % of total government expenditure (%)
ODA to child health per child (US$)
ODA to maternal and neonatal health per live birth (US$)
22 (2012)
39 (2011)
52 (2011)
Reproductive, maternal, newborn and child health expenditure by source
No Data
Legal status of abortion (X of 5 circumstances)
Costed national implementation plan(s) for: maternal, newborn and child health available
Life Saving Commodities in Essential Medicine List:
Maternal deaths notification
International Code of Marketing ofBreastmilk Substitutes
Postnatal home visits in the first week after birth
Low osmolarity ORS and zinc for management of diarrhoea
Community treatment of pneumonia with antibiotics
SYSTEMS
FINANCING
Kangaroo Mother Care in facilities for low birthweight/preterm newborns
3
-
No
Yes
Yes
Yes
No
Yes
Yes
Reproductive health (X of 3)
Maternal health (X of 3)
Newborn health (X of 4)
Child health (X of 3)
3
7.5
3
3
National availability of Emergency Obstetric Care services (% of recommended minimum)
3
-
(2013)
(2013)
(2013)
(2013)
(2010)
-
100
80
60
40
20
0
100
80
60
40
20
0
Perc
ent
Perc
ent
Yes (2013)
Antenatal corticosteroids as part of management of preterm labour
Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent
No
Yes
Note: See annexes for additional information on the indicators above
Out of pocket expenditure as % of total expenditure on health(%)
21 (2012)
* Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis
Neonatal death: 39%
1 4
59
67
15
18
2511
1990 2012
2818
62
63
3 12
7 7
1990 2012
0 1
5967
15
19
2613
1990 2012
Fulfilling the Health Agenda for Women and Children
The 2014 Report
Rw anda
Neonatal mortality rate (NMR) = 20 deaths per 1000 live births
Leading cause:
Neonatal – 39% Pneumonia – 16% Diarrhoea – 10%
Rwanda Situation
Rwanda Situation
• MNCH national priority – Health Sector Strategic
Plan, Vision 2020, MNCH Roadmap, Neonatal
guidelines, protocols, standards; ministry led national
coordinating mechanisms
• Infrastructures, capacity building, health insurance
coverage, PBF, referral system, strong network of
community health workers: ASMs and binomes
• Heightened emphasis on metrics and measurements,
including death audits
Rwanda Situation: Neonatal Care Systems
• Neonatal units, Kangaroo Care units: district
hospitals
• Insufficient coordination mechanisms for neonatal
problems at all levels
• Weak organization of neonatal services in district
hospitals
• Lack of linkages within facility units and between
facilities
• Lack of linkages between the facilities and community
Kangaroo Care in Rwanda
• Leadership and governance: strong lead,
technical working group, policies
• Champions: ministry, partners, professional
associations, sub-national leadership
Kangaroo Care in Rwanda
• Kangaroo Care services:
• District hospitals
• Linkages between units
• Follow up at health centers
• Community follow up
• Postnatal care link
• Support for moms – male involvement, stigma of
small babies
Kangaroo Care in Rwanda
• Human resource:
• Capacity
• Rotation, turnover, motivation,
• “Poor man’s technology”
• Mentoring & supportive supervision
Kangaroo Care in Rwanda
• Metrics:
• HMIS indicators
• Registers to capture monitoring data
• Postnatal data
• Registers to capture community care
• Use of data for action
MCSP in Rwanda
• Approval from USAID and concurrence
from Ministry of Health
• Phase I – September 2016
• Integrated program: capacity building,
innovative approach
• Focus on day of birth, postnatal care,
adolescent health, community health
MCSP in Rwanda
• Clinical competence & readiness, including
community systems
• District and health center capacity to implement
integrated service delivery by CHWs
• Quality of services, youth friendly, respectful services
• Referral systems strengthening
• Collect, manage and utilize data for decision making
• Program learning for institutionalization and
informed scale up
MCSP and Kangaroo Care
• Champions – at all levels and all partners, including
professional associations, communities and families
• Perception of kangaroo care as poor man’s technology:
engage professional associations
MCSP and Kangaroo Care
• Staff skills: rotation, turnover, motivation, leadership
• Capacity of facility staff to manage Kangaroo Care unit,
including smooth transition from labor room to and between
nursery and Kangaroo Care units
• Capacity building through innovative approaches: low dose
high frequency approach, MOH led mentoring and supportive
supervision
• Accreditation and standard operating procedures for
Kangaroo Care
MCSP and Kangaroo Care
• Follow up - health centers, CHWs and postnatal care
role
• Linkages with community and home care through
strong community health program: emphasis on back
referral from facility to CHWs
MCSP and Kangaroo Care
• Focused programming
for adolescent
mothers
• Gender focus with
emphasis on husband’s
care and support for
moms providing KMC
For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the
United States Agency for International Development (USAID), under the terms of the Cooperative
Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not
necessarily reflect the views of USAID or the United States Government.
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