Table 4 Key lessons regarding the institutionalization of KMC
Theme | Facilitating factors | Challenges |
|---|---|---|
Training and orientation | ● Pre-service curricula include KMC | ● Lack of clarity of what transpires during training |
● In-service training | ● Trainers lack knowledge, skills and experience | |
● Non-optimal workplace implementation of KMC | ||
Supportive supervision | ● Project-driven interventions bring additional resources for supervision | ● Supervision not sustained because of |
- staff workload | ||
- lack of transport | ||
- distances | ||
- decentralization | ||
Integrating KMC into quality improvement | ● Use of KMC registers | ● No standardized reporting on KMC required at a higher level |
● Inclusion of KMC in mortality and morbidity review meetings | ||
● Available data aggregations not used | ||
● Poor quality of record keeping | ||
● Recommendations from review meetings not followed up | ||
Continuity of care beyond the facility | ● KMC included in antenatal care | ● KMC not included in antenatal care |
● Adequate follow-up system for KMC babies | ● Poor follow-up of KMC babies due to: | |
● Use of community health workers to encourage caregivers to go for follow-up | - poverty | |
- travel distances | ||
Governmental and institutional support | ● Existence of national KMC policy documents or guidelines | ● Unavailability of guideline documents at facility level |
● KMC champions at different levels in the health system | ||
● Support from district and facility management | ||
Client-oriented care | ● Promotion of companions in the care of mother and baby | ● Low uptake in the use of maternal and newborn services |
● Cultural beliefs (e.g. baby should be carried on the back) |