Table 1 Summary of bottlenecks and solution themes for scale-up of kangaroo mother care.
From: Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions
Health system building block | Subcategory | Significant bottleneck | Number of countries | Solution themes |
|---|---|---|---|---|
Leadership & governance | Policy and guidelines | Absence of national KMC policies/strategies and/or creation and dissemination of service guidelines to support the implementation and scale-up of KMC | 10 | • Advocacy and sensitisation • Policies / include in national MCH objectives / guidelines/ strengthen role of Ministry of Health |
|  | Awareness | Poor or no awareness of KMC by leadership | 3 | • Implementation modalities and curriculums |
Health financing | Funding | Funding limited or not available for implementation and scale-up | 6 | • Advocacy for increased budget/funding |
|  | Out-of-pocket costs | Burden of out-of-pocket expenditures by caregivers | 6 | • Development of a costed master plan |
|  | Policy | Lack of integration of KMC in national costing plans/policies | 2 | • Increased donor support • Insurance and/or community financing schemes |
Health workforce | Number, competence, distribution of health workers | Shortage of competent health workers and poor distribution of properly trained personnel authorised to provide care for LBW babies and support KMC | 8 | • Training and capacity development |
|  | Training | Lack of training of health workers on KMC | 7 | • Increasing number and capacity of health workers and creating a dedicated cadre for KMC |
|  | Mentorship and supervision | Lack of mentorship and supervision mechanisms for KMC | 5 | • Development and implementation of job descriptions and mentoring guidelines |
|  | Knowledge and awareness | Poor knowledge and awareness of health workers regarding importance and utility of KMC | 4 | • Setting up supervision and monitoring and evaluation mechanisms |
| Â | Attitudes | Negative health worker attitudes towards KMC | 3 | Â |
| Â | Job descriptions | Lack of job descriptions for health workers supporting KMC | 3 | Â |
Essential medical products & technologies | Resources | Unavailability of resources and supplies needed to perform KMC | 10 | • Budget with funding for equipment |
|  | Procurement | Poor procurement and supply chain logistics for KMC | 2 | • Procurement of basic supplies • Standard list of equipment in facilities |
Health service delivery | Physical and logistical constraints | Lack of space and logistical constraints related to support and monitoring of mothers/caregivers performing KMC | 8 | • Investment in space |
|  | Quality | Poor quality of care issues and lack of quality improvement related to the implementation of KMC | 4 | • KMC follow-up made a part of existing services |
|  | Follow-up | Lack of follow-up of KMC practice after discharge | 3 | • Integration of KMC and breastfeeding promotion |
| Â | Availability and delivery | Unavailability of services / disparities in delivery of KMC | 2 | Â |
| Â | Referral system | Lack of referral system in place for KMC (transport and access) | 1 | Â |
Health information system | Availability of information | Lack of information, records and data on coverage of KMC and non-use of information when available | 11 | • Development of indicators and inclusion in records |
|  | Quality of information | Poor quality information available on LBW babies | 2 | • Capacity building for use of data to monitor trends and improve services |
|  | Knowledge and awareness | Lack of awareness and knowledge of and mobilisation around KMC in the community | 10 | • Increase awareness including amongst men |
|  | Promotion | Lack of proper mechanisms to promote KMC in the community | 5 | • Promotion of KMC in the community (better IEC programmes and empowerment of community health workers in KMC; translation of material to local languages) |
Community ownership & partnership | Socio-cultural barriers | Socio-cultural barriers to the practice of KMC | 4 | • Community empowerment and acceptance (action plan to address community perception) |
| Â | Acceptability | Lack of acceptability of KMC among community members | 3 | Â |
| Â | Engagement | Poor or no engagement and support of men and the community | 2 | Â |
| Â | Financial barriers | Financial barriers to support KMC uptake at the community level | 1 | Â |
| Â | Access | Poor access to services at the health facility | 1 | Â |