Table 2 Model to scale up KMC

Pre-facility

• All pregnancies identified, registered and followed at regular intervals

All home and HC births identified

• Weigh all home and HC births delivered in the catchment areas

• Refer all babies who are < 2000 g from HC and home

• All referred babies access the referral site

Community and PHCU

• Favourable community awareness regarding facility delivery and care of small babies including KMC

• KMC education during ANC visits

• Established register of all pregnant mothers at health posts

• Active reporting of home births by HDAs and HEWs

• HEWs weigh all babies delivered at home (within 24 h)

• Well-functioning referral system for small babies born at home

• Proper counselling of mothers and family on KMC and small baby care during referral

• Referral to facilities facilitated

Supportive supervision to lower tier health facilities regarding the referral, identification and referral

• Organize (with the RHB) community sensitization forums in public gatherings

• Use PHCU meetings to pass KMC information on to HEWs and HDAs

• Train HDAs and HEWs on the advantages of KMC and counselling on referral

• Support HEWs through training and supervision to register pregnant mothers at health posts more actively

• Establish a communication channel for HEWs with HDAs, 1–5 networks and pregnant mothers for birth notification

• Avail and validate portable weighing scales (also train in their use).

• Develop aids for referral and communication

Supporting integration of KMC mentoring and supervision in the existing system

Continuously assesses the barriers and enablers for KMC implementation at the catchment areas and presents its findings to the IST every two weeks.

Facility

• Initiation of KMC for all babies < 2000 g (in-born and referral) as soon as they fulfil eligibility criteria(

• Continue safe implementation of KMC at facilities

• Build women’s confidence and capacity to continue KMC at home

L & D

• All babies weighed properly

• Babies below 2000 g referred to NICU/ KMC Unit (KMCU) of the district hospitals

Skin-to-skin initiated within the first 1 h for all births

• Train and coach midwives on ECSB/KMC and proper weighing and calibration (and provide scales if none)

Support hospitals to establish STS for all babies with in 1 h through training, mentoring and supervision

NICU

Babies who are below 2000 g actively transferred to the KMCU if they are stable; initiate KMC for sick babies as soon as they are stable

Training (including practical) and coaching on counselling of mothers and other family members while referring the baby to the KMC unit

KMC Unit

• KMCU established and renovated at hospitals

• Mothers and family members educated on how to practice KMC

• KMC practiced following the guidelines and developed follow up tools

All mothers and family counselled on advantages of KMC

• Support hospitals in establishing dedicated KMC units

• Provide dolls to KMC staff and train on how to use them for family training

• Train and coach KMC staff on counselling mothers and family on KMC and caring for small babies

KMC/ECSB training

Post- facility

• Establish early contact after discharge

• Support mothers to continue KMC at home

Post discharge

PNC

• Addresses for all mothers discharged from the KMC units recorded

• Strong linkage between mothers who are discharged, and community health workers established

• HEWs do PNCs at 1,3,7 days after discharge and check on KMC practice, mother and baby health

• Update KMC registers (to include address for PNC tracking)

• Develop and implement a communication system between hospitals (mentors) and CHWs (mentors call HEWs when a baby is discharged and follows up).

• Calling mothers after discharge

• Develop and implement PNC tracking cards for HEWs (with addresses of a contact person)