Thirteen years of KMC Practice in Malawi

Scaling up to a continuum of facility-based and community KMC

Enelesi Kachule Ministry of Health Malawi

Background

KMC introduced in Malawi in 1999 Zomba Central Hospital 2001-2005: Training and support to 6 hospitals (SNL1)

KMC introduced in all Central/referral hospitals

2005: National KMC guidelines 2007: Retrospective evaluation of KMC 2008-2011:

KMC included in integrated maternal and newborn training manuals (SNL2 & MCHIP) KMC established in majority of district hospitals 7 learning districts expansion to community KMC

KMC FACILITIES GOVT -104 CHAM- 17 # facilities 1 2 1 1 1 1 0 7

Slow up-take Central teaching hospitals

Year

1999 Year

Country-wide scale-up
# facilities

2002

2003

2004

2005

2006

2007

Pre-2008 2008 2009 2010 2011 TOTAL

7 11 14 54 45 121

Total

Progress with implementation

6. Sustain new practices

Cumulative score

Score per stage: (6)

30 28 26 24 22 20 18 16 14

(7)

5. Integrate into routine practice

(7)

4. Implement

3. Prepare to implement 2. Commit to implement 1. Create awareness

12 10 8 (4) 6 4 (2) 2 (2) 0

14 facilities from central hospital to community health centres evaluated

Progress with implementation

6. Sustain new practices

scorescore 30 Cumulative Maximum 30

Score per stage: (6)

(7)

28 26 24 22 20 18 16 14

MEAN SCORE: 16.33

4. Implement

5. Integrate into routine practice

(7)

3. Prepare to implement 2. Commit to implement 1. Create awareness

Score range: 10.34 20.07

12 10 8 (4) 6 4 (2) 2 (2) 0

KMC practice

KMC is routine care for LBW/preterm babies in Malawi Lower cadre staff provide most of the services in KMC units

There is a link with HSAs on discharge for continuum of care

LBW/preterm babies delivered at home are referred to the facility for KMC

Types of KMC

Continuous KMC. Intermittent KMC. Criterion: Facility KMC- Birth weight <1800g Ambulatory KMCBirth weight 1800g <2000g. Community KMC2000g -<2500g (2499g)

Achievements

Policy guidelines are available. KMC incorporated in the pre-service training curricula. Community acceptance is high. Malawi has provided KMC TA to other counties.

Achievements Cont.

KMC services established in all the 28 districts All central hospital and district hospitals provide KMC All mission hospitals provide KMC In the 7 learning districts, HSAs are trained in KMC

Challenges

Inadequate supervision by the district officials

Commodity insecurity.

Linkage between the facilities and the HSAs

Mission hospitals do not provide food for mothers

Challenges 2

Distances to return for follow-up review

Documentation and data management.

Monitoring of feeds in the KMC units

HSAs in some districts not trained in CBMNH

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