Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions
Insights
Kangaroo Mother Care (KMC) significantly reduces preterm infant mortality. Addressing health system bottlenecks in community ownership and financing is crucial for widespread KMC implementation globally.
Area of Science:
- Neonatal Health
- Public Health Interventions
- Health Systems Strengthening
Background:
- Preterm birth is a leading cause of global under-five mortality.
- Kangaroo Mother Care (KMC) is proven to reduce mortality in low birth weight infants.
- KMC involves skin-to-skin contact, breastfeeding support, and early discharge.
Purpose of the Study:
- To explore health system bottlenecks hindering Kangaroo Mother Care (KMC) scale-up in 12 countries.
- To propose solutions for identified KMC implementation challenges.
- To outline priority actions for scaling up KMC programs.
Main Methods:
- Utilized a bottleneck analysis tool across 12 African and Asian countries.
- Employed quantitative and qualitative methods with expert workshops.
- Combined data analysis with literature review for actionable insights.
Main Results:
- Significant differences in perceived bottlenecks between Asian and African countries.
- Community ownership and health financing identified as major KMC bottlenecks, especially in South Asia.
- Leadership, governance, and health workforce also presented significant challenges.
Conclusions:
- Identified three pathways for KMC scale-up: champion-led, project-initiated, and health system-designed.
- A combination of these pathways may accelerate KMC adoption.
- KMC can save lives, transform newborn care, and empower mothers.
Background:
Preterm birth is now the leading cause of under-five child deaths worldwide with one million direct deaths plus approximately another million where preterm is a risk factor for neonatal deaths due to other causes. There is strong evidence that kangaroo mother care (KMC) reduces mortality among babies with birth weight <2000 g (mostly preterm). KMC involves continuous skin-to-skin contact, breastfeeding support, and promotion of early hospital discharge with follow-up. The World Health Organization has endorsed KMC for stabilised newborns in health facilities in both high-income and low-resource settings. The objectives of this paper are to: (1) use a 12-country analysis to explore health system bottlenecks affecting the scale-up of KMC; (2) propose solutions to the most significant bottlenecks; and (3) outline priority actions for scale-up.
Methods:
The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale-up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for KMC.
Results:
Marked differences were found in the perceived severity of health system bottlenecks between Asian and African countries, with the former reporting more significant or very major bottlenecks for KMC with respect to all the health system building blocks. Community ownership and health financing bottlenecks were significant or very major bottlenecks for KMC in both low and high mortality contexts, particularly in South Asia. Significant bottlenecks were also reported for leadership and governance and health workforce building blocks.
Conclusions:
There are at least a dozen countries worldwide with national KMC programmes, and we identify three pathways to scale: (1) champion-led; (2) project-initiated; and (3) health systems designed. The combination of all three pathways may lead to more rapid scale-up. KMC has the potential to save lives, and change the face of facility-based newborn care, whilst empowering women to care for their preterm newborns.
Related Concept Videos
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:11Secondary Healthcare System
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:21Tertiary Healthcare System
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...