Kangaroo Care

Acceleration

in

RWANDA

Neena Khadka

Team Leader Newborn Health

MCSP

Presented during the Safe Motherhood and Reproductive Health Working

Group at the Fall CORE Meeting

October 8, 2015

Rwanda Situation

Rwanda Situation

Rwanda Situation

159

DEMOGRAPHICS

MATERNAL AND NEWBORN HEALTH

CHILD HEALTH

WATER AND SANITATION

30

644

1059

23

7 3

1990 2012

64 61

2322

11 15

2 2

1990 2012

28

643

762

26

7 3

1990 2012

16% 2%Preterm 10%

Asphyxia* 12%

Other 2%

Congenital 5%

Sepsis** 8%

0%10%

Measles 1%Injuries 7%

Malaria 4%

HIV/AIDS 1%

Other 21%

External sources

General government expenditure

Out-of-pocket expenditure

Other

Density of doctors, nurses and midwives (per 10,000 population)

POLICIES

Diarrhoeal disease treatmentPercent of children <5 years with diarrhoea:

receiving oral rehydration therapy/increased fluids with continued feeding

Embolism 2%

Haemorrhage 25%

Hypertension 16%

Indirect 29%

Other direct 9%

Abortion 10%

Sepsis 10%

Shared facilitiesImproved facilitiesOpen defecation

Percent children receiving first line treatment among those receiving any antimalarial

97 (2010)

Percent children < 5 years sleeping under ITNs

513

5670

0

20

40

60

80

100

2000MICS

2005DHS

2007-2008DHS

2010DHS

Perc

ent

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure onhealth (Int$)

144

94 92 94 96 98

0

20

40

60

80

100

1992DHS

2000MICS

2005DHS

2007-2008DHS

2010DHS

Perc

ent

Antenatal carePercent women aged 15-49 years attended at least once by askilled health provider during pregnancy

Causes of maternal deaths, 2013

1624 2128

10 1221

29

0

20

40

60

80

100

1992DHS

2000MICS

2005DHS

2007-2008DHS

2010DHS

Perc

ent

Improved drinking water coverage Improved sanitation coverage

Source: WHO/UNICEF JMP 2014

UnimprovedOther improvedPiped on premises

Percent of population by type of drinking water source, 1990-2012

Total Urban Rural

Source: WHO/UNICEF JMP 2014

Percent of population by type of sanitation facility, 1990-2012

Unimproved facilities

Total Urban Rural

treated with ORS

71 (2010)

17 (2007-2008)

7, 16, 6 (2010)

5 (2010)

18 (2010)

5 (2010)

85 (2012)

(2012)

Malaria prevention and treatment

Maternity protection (Convention 183)

Source: WHO/CHERG 2014

Women with low body mass index (<18.5 kg/m2, %)

Postnatal visit for mother (within 2 days for home births, %)

Postnatal visit for baby (within 2 days for home births, %)

Neonatal tetanus vaccine

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Malaria during pregnancy - intermittent preventive treatment (%)

Demand for family planning satisfied (%)

Surface water

35 (2010)Antenatal care (4 or more visits, %)

Globally nearly half of child deaths are attributable to undernutrition

Source: WHO 2014

Pneumonia

Diarrhoea

Causes of under-five deaths, 2012Regional estimates for Sub-Saharan Africa, 2013

General government expenditure on health as % of total government expenditure (%)

ODA to child health per child (US$)

ODA to maternal and neonatal health per live birth (US$)

22 (2012)

39 (2011)

52 (2011)

Reproductive, maternal, newborn and child health expenditure by source

No Data

Legal status of abortion (X of 5 circumstances)

Costed national implementation plan(s) for: maternal, newborn and child health available

Life Saving Commodities in Essential Medicine List:

Maternal deaths notification

International Code of Marketing ofBreastmilk Substitutes

Postnatal home visits in the first week after birth

Low osmolarity ORS and zinc for management of diarrhoea

Community treatment of pneumonia with antibiotics

SYSTEMS

FINANCING

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

3

-

No

Yes

Yes

Yes

No

Yes

Yes

Reproductive health (X of 3)

Maternal health (X of 3)

Newborn health (X of 4)

Child health (X of 3)

3

7.5

3

3

National availability of Emergency Obstetric Care services (% of recommended minimum)

3

-

(2013)

(2013)

(2013)

(2013)

(2010)

-

100

80

60

40

20

0

100

80

60

40

20

0

Perc

ent

Perc

ent

Yes (2013)

Antenatal corticosteroids as part of management of preterm labour

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

No

Yes

Note: See annexes for additional information on the indicators above

Out of pocket expenditure as % of total expenditure on health(%)

21 (2012)

* Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Neonatal death: 39%

1 4

59

67

15

18

2511

1990 2012

2818

62

63

3 12

7 7

1990 2012

0 1

5967

15

19

2613

1990 2012

Fulfilling the Health Agenda for Women and Children

The 2014 Report

Rw anda

Neonatal mortality rate (NMR) = 20 deaths per 1000 live births

Leading cause:

Neonatal – 39% Pneumonia – 16% Diarrhoea – 10%

Rwanda Situation

Rwanda Situation

• MNCH national priority – Health Sector Strategic

Plan, Vision 2020, MNCH Roadmap, Neonatal

guidelines, protocols, standards; ministry led national

coordinating mechanisms

• Infrastructures, capacity building, health insurance

coverage, PBF, referral system, strong network of

community health workers: ASMs and binomes

• Heightened emphasis on metrics and measurements,

including death audits

Rwanda Situation: Neonatal Care Systems

• Neonatal units, Kangaroo Care units: district

hospitals

• Insufficient coordination mechanisms for neonatal

problems at all levels

• Weak organization of neonatal services in district

hospitals

• Lack of linkages within facility units and between

facilities

• Lack of linkages between the facilities and community

Kangaroo Care in Rwanda

• Leadership and governance: strong lead,

technical working group, policies

• Champions: ministry, partners, professional

associations, sub-national leadership

Kangaroo Care in Rwanda

• Kangaroo Care services:

• District hospitals

• Linkages between units

• Follow up at health centers

• Community follow up

• Postnatal care link

• Support for moms – male involvement, stigma of

small babies

Kangaroo Care in Rwanda

• Human resource:

• Capacity

• Rotation, turnover, motivation,

• “Poor man’s technology”

• Mentoring & supportive supervision

Kangaroo Care in Rwanda

• Metrics:

• HMIS indicators

• Registers to capture monitoring data

• Postnatal data

• Registers to capture community care

• Use of data for action

MCSP in Rwanda

• Approval from USAID and concurrence

from Ministry of Health

• Phase I – September 2016

• Integrated program: capacity building,

innovative approach

• Focus on day of birth, postnatal care,

adolescent health, community health

MCSP in Rwanda

• Clinical competence & readiness, including

community systems

• District and health center capacity to implement

integrated service delivery by CHWs

• Quality of services, youth friendly, respectful services

• Referral systems strengthening

• Collect, manage and utilize data for decision making

• Program learning for institutionalization and

informed scale up

MCSP and Kangaroo Care

• Champions – at all levels and all partners, including

professional associations, communities and families

• Perception of kangaroo care as poor man’s technology:

engage professional associations

MCSP and Kangaroo Care

• Staff skills: rotation, turnover, motivation, leadership

• Capacity of facility staff to manage Kangaroo Care unit,

including smooth transition from labor room to and between

nursery and Kangaroo Care units

• Capacity building through innovative approaches: low dose

high frequency approach, MOH led mentoring and supportive

supervision

• Accreditation and standard operating procedures for

Kangaroo Care

MCSP and Kangaroo Care

• Follow up - health centers, CHWs and postnatal care

role

• Linkages with community and home care through

strong community health program: emphasis on back

referral from facility to CHWs

MCSP and Kangaroo Care

• Focused programming

for adolescent

mothers

• Gender focus with

emphasis on husband’s

care and support for

moms providing KMC

For more information, please visit

www.mcsprogram.org

This presentation was made possible by the generous support of the American people through the

United States Agency for International Development (USAID), under the terms of the Cooperative

Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not

necessarily reflect the views of USAID or the United States Government.

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