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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


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