Kangaroo Mother Care—High on Evidence, Low on Reach

October 12th, 2017 | Viewpoint


Every year, more than 20 million infants are born weighing less than 2.5 kgover 96% of them in developing countries. These low birth weight infants are at an increased risk of early growth retardation, infectious disease, developmental delay, and death during infancy and childhood.

A health worker coaches a new father in providing Kangaroo Mother Care (KMC) to his infant. Photo credit: JSI India.

Conventional neonatal care can be expensive and resource intensive. Kangaroo Mother Care (KMC) is a low-resource, safe, and effective alternative to care for low birth weight and/or preterm newborns, and it has been shown to reduce mortality among low birth weight newborns by up to 36%. Newborns receiving KMC are held in skin-to-skin contact with their caregiver (usually a mother or father) who provides the infant with heat and stimulation, nutrition (i.e. breastfeeding), and close monitoring.

Through the USAID-supported Vriddhi project, JSI India, in partnership with IPE Global and the Government of India, piloted KMC programs in two high-load Sick Newborn Care Units (SNCUs) and used lessons learned from these pilots to develop a strategic roadmap to roll out KMC at all high-load newborn care facilities across India.

On August 10, 2017, JSI and the Ministry of Health and Family Welfare (MoHFW) hosted a national workshop to discuss the challenges and opportunities associated with implementing KMC in public and private health facilities. The workshop included representatives from the MoHFW, state governments, professional organizations, the private sector, implementing partners, development partners, and academia.

This event discussed lessons learned from implementing KMC and identified recommendations to strengthen the expansion of KMC in India. A few best practices emerged from the discussion, including:

1. Institutionalizing strong KMC programs in health facilities

Both facilities in the JSI-supported KMC pilot successfully institutionalized KMC programs by adopting KMC policies, creating KMC champions, and orienting staff. As a result, initiation of KMC in these facilities was nearly 90% among eligible newborns. Drawing lessons learned from the pilot, Dr. Amrita Misra, Senior Technical Advisor for JSI, recommended creating KMC champions in health facilities, empowering nurses to implement KMC, improving counseling in health facilities, and generating family support for mothers practicing KMC.  

While discussing the major challenges for facility-based KMC, Dr. Suman Rao, Head of Paediatrics for St. Johns Medical College, Bangalore, observed that “KMC has been too medicalized,” and Dr. Vishwajeet Kumar, Founder of the Community Empowerment Lab, Lucknow, observed that facilities too often “focus on technique rather than humans.”

As a result, panelists recommended that facilities “demystify” KMC by presenting mothers and nurses with simple, doable actions that are easily understandable. Panelists also recommended introducing the concept of KMC to mothers before childbirth (for example, in antenatal care visits) to promote understanding of KMC. In addition, Dr. P. K. Prabhakar, Deputy Director for Newborn Health at the MoHFW, stressed the need to initiate activities that build trust between parents and nurses, such as allowing parental access in SNCUs.

2. Expanding the reach of KMC within community

A number of panelists noted that communities must embrace KMC to make it a socially acceptable practice and increase its uptake. Dr. Damera Yadaiah, Paediatrician for SNCU Nalgonda, stressed the importance of grandparents as influencers and support systems in many homes.

Recommendations for increasing community engagement for KMC include ensuring KMC programs are adapted to the local context and norms; orienting and training community health workers on KMC; and generating community support for KMC through information, education, and communication (IEC) efforts.

Moving Forward

In his closing remarks, Dr. Sanjay Kapur, Country Director for JSI, called upon medical colleges and private hospitals to be critical partners in increasing the reach of KMC across India. This workshop was a crucial first step in generating key recommendations and momentum to create what Dr. Harish Chellani, Professor of Paediatrics at Vardhman Mahavir Medical College and Safdarjung Hospital, described as a “culture of KMC” that will bring this life-saving practice to newborns across India.

Visit the Vriddhi website to learn more about how JSI India is supporting the Government of India’s efforts to improve neonatal and child survival.

Written by Amrita Misra and Sarah Cunningham

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