Thirteen years of KMC in Malawi

Scaling up to a continuum of facility-based and community

KMC

Richard Luhanga MCHIP/Save the Children, Malawi

Background

• KMC introduced in Malawi in 1999 – Zomba Central Hospital

• 2001-2005: Training and support to 6 hospitals (SNL1)

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

– KMC included in integrated maternal and newborn manuals and training (SNL2 & MCHIP)

– KMC established in majority of district hospitals– 7 “learning districts” expansion to community KMC

Approach in the learning districts

• Strengthening KMC services in health care facilities first – Movement towards facility-based deliveries for all women (54%)– These health workers must be sufficiently skilled

• Followed by training of health surveillance assistants (HSAs = community health workers) in integrated maternal and newborn care package

• Development of a continuum of KMC services:– Facility-based KMC: in district hospital (babies <1800 g)– Ambulatory KMC: follow-up at health centres (1800-2000 g)– Community KMC: home visits by HSAs in collaboration with

health centres (2000-2500 g)

• Documentation of visits – problem of collating data

Introduction of KMC

Year # facilities

1999 1

2002 22003 12004 12005 12006 12007 0

Total 7

Central teaching hospital

Slow take-up

7Pre-2008

12145541411

# facilities

20102009

Year

2008

2011TOTAL

Country-wide scale-up

Distribution of facilities with KMC services

Government facilities No. Mission

facilities No.

Health centres 67 Health centres 1

Rural hospitals 6 Rural hospitals 3

District hospitals 27 Mission hospitals 13

Central hospitals 4

Total 104 Total 17

02468

1012141618202224262830

1.1. CCreate awarenessreate awareness2.2. Commit to implementCommit to implement

3.3. Prepare to implementPrepare to implement

4.4. ImplementImplement

5.5. Integrate into Integrate into routine practice routine practice

6. Sustain new6. Sustain newpracticespractices

(2)(2)

(4)

(7)

Cumulative score

Score per stage:

(7)

(6)

Progress with implementation

14 facilities from central hospital to community health centres

evaluated

02468

1012141618202224262830

1.1. CCreate awarenessreate awareness2.2. Commit to implementCommit to implement

3.3. Prepare to implementPrepare to implement

4.4. ImplementImplement

5.5. Integrate into Integrate into routine practice routine practice

6. Sustain new6. Sustain newpracticespractices

(2)(2)

(4)

(7)

Cumulative score

Score per stage:

(7)

(6)

Progress with implementation

MEAN SCORE: 16.33

Maximum score30

Score range:

10.34 – 20.07

KMC practice• Most of the care for mothers and babies in

KMC provided by lower cadre health workers (patient/hospital attendants)

• Nine hospitals designated baby friendly• Continuous KMC not optimally practised in

some facilities• Gaps in documentation and record keeping• Importance of guardians/companions to

support mothers and baby in KMC

KMCspace

Resources

• Challenges of managing and sustaining resources at facilities:– Procurement of continuous supplies of consumables– Calibrated feeding cups not always available– Registers, stationary, batteries for scales

• Resource challenges for mothers and families:– Ability to afford more than one local cloth for wrapping

baby– Mission hospitals do not provide food for mothers– Distances to return for follow-up review

Thank you