CORE Group GHPC15 October 8, 2015 Working Group Session: Safe Motherhood and Reproductive Health

1. Kangaroo Care
Acceleration
in
RWANDA
Neena Khadka
Team Leader Newborn Health
MCSP
Presented during the Safe Motherhood and Reproductive HealthWorking
Group at the Fall CORE Meeting
October 8, 2015

2. Rwanda Situation

3. Rwanda Situation

4. Rwanda SituationDEMOGRAPHICS
MATERNAL AND NEWBORN HEALTH
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%
Indirect
Other direct
9%
Abortion 10%
Seps
94 92 94 96 98
100
Antenatal care
Percent women aged 15-49 years attended at least once by a
skilled health provider during pregnancy
Causes of ma
Source: WHO/CHERG 2014
Malaria during pregn
treatment (%)
Demand for family pl
Antenatal care (4 or m
Globally nearly
half of child
deaths are
attributable to
undernutrition
Pneumonia
Diarrhoea
Causes of under-five deaths, 2012
* Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis
Neonatal
death: 39%
Rw anda
Neonatal mortality rate (NMR) =
20 deaths per 1000 live births
Leading cause:
Neonatal – 39%
Pneumonia – 16%
Diarrhoea – 10%

5. Rwanda Situation

6. 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

7. 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

8. Kangaroo Care in Rwanda
• Leadership and governance: strong lead,
technical working group, policies
• Champions: ministry, partners, professional
associations, sub-national leadership

9. 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

10. Kangaroo Care in Rwanda
• Human resource:
• Capacity
• Rotation, turnover, motivation,
• “Poor man’s technology”
• Mentoring & supportive supervision

11. Kangaroo Care in Rwanda
• Metrics:
• HMIS indicators
• Registers to capture monitoring data
• Postnatal data
• Registers to capture community care
• Use of data for action

12. 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

13. 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

14. 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

15. 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

16. 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

17. MCSP and Kangaroo Care
• Focused programming
for adolescent
mothers
• Gender focus with
emphasis on husband’s
care and support for
moms providing KMC

18. 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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