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Table 1 Planning for a national KMC programme using a stages-of-change approach

From: Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future

Stage Important factors to consider
1. Create awareness • Leaders and champions at different levels (global, national, regional)
• Use of best available, applicable evidence
• Advocacy by key government officials and others
• Key stakeholders for potential funding and other contributions
• Exploring policy formulation and integration of KMC into different state programmes
2. Commit to implement • Leadership and government commitment in the context of a team approach
• Technical working group
• Government guidelines; begin drafting standard operating procedures/protocols
• Potential resources
• Draft operational plan
• Accountability measures for different stakeholders
3. Prepare to implement • Needs assessment and cost-benefit analysis
• Targets formulated
• Policies, operational plans and protocols refined
• Budgets drafted and resources allocated (government and donors) – accountable tracking of allocations included
• Selection of key staff to be trained and scale-up of training in a manageable way (often integrated into other training programmes, e.g. Essential Newborn Care)
• Centre(s) of excellence (CoE) identified, strengthened or established – systematic linkages between CoEs and district/regional health facilities ensured
• Monitoring and evaluation system with key indicators to allow for learning from processes – regular feedback and mid-course corrections
4. Implement • KMC team empowerment
• Continued advocacy and work with media
• Programme integrated into state and central budgets (a ‘budget line’)
• Donor and insurance agencies and companies on board
• System for information, education and communication (IEC) established and materials developed
• Number of CoEs expanded
• Conducive environment created at health facility level (e.g. KMC culture, peer group work, in-service training)
5. Integrate into routine practice • Continuation of leadership and advocacy
• Continued financial support from government and international community
• Monitoring framework established (preferably electronic) (capacity for collecting, analysing and using data)
• Clinical outcomes measured at facility and health system level
• Further evidence generated through research (at CoE and district level)
• Integration with institutional quality assurance and quality improvement
• Well-organised follow-up system for growth monitoring and promotion of neurodevelopment
• Expansion of parent education opportunities
6. Sustain new practices • Monitoring of national progress
• Continuous policy review
• Budgetary support (including insurance) sustained
• Accountability teams overseeing monitoring and feedback
• Continued training and refreshers
• Newly generated evidence disseminated at national conferences
• KMC integrated into pre- and in-service education
• Champions nurtured and new ones identified