S Y D N E Y D A C O S T A

Kangaroo Mother Care in Rwanda

Rwanda’s Health Care System

Countries Health Care System

�  Country is divided into 5 provinces ¡  Those provinces are further subdivided into 30 districts, 416 sectors,

2,148 cells and 14,837 villages �  Decentralized health system is modeled after the

divisions �  Each sector is supposed to have a health center

¡  According to the distances from the health center, the sector can decide is health posts are needed

�  Each village has three community health workers ¡  One is the agent de santé maternelle

÷  Specialized health worker who follows the mother during pregnancy and postpartum and the newborn after birth

÷ Must be a literate female village resident between 20 and 50 with enough available time

Health Care System Cont’d

�  Three important innovations aimed at improving barriers in healthcare ¡  In order to support the national poverty reduction pans, the

government has ownership of all development plans ÷ All donor funds are integrated into one framework or compact

agreement ÷ The aim of this arrangement is to ensure sustainability of

interventions in the long term ¡  The Mutuelle de Santé

÷ Community-based health insurance aimed at improving coverage ÷  Its success would contribute to improved newborn care and enable

more babies to receive KMC ¡  The introduction of a performance-based pay system in an attempt to

improve staff motivation for following guidelines and demonstrating positive attitudes

Kangaroo Mother Care

•  Three main components

•  Two main forms

Main Components of KMC

�  Skin-to-skin position ¡  The baby is secured upright in a skin-to-skin position against

the mothers chest �  Nutrition

¡  Exclusive breastfeeding (which includes the feeding of expressed breast milk) is the preferred choice of feeding whenever possible

�  Discharge and Follow-up ¡  The baby is discharged home in the skin-to-skin position as

soon as breastfeeding has been established, the infant has gained weight and the mother is competent in the handling of her baby and has received ambulatory care with regular follow-up/review visits to a health care facility

Intermittent Continuous

�  Skin-to-skin care is practiced for a few hours per day

�  Skin-to-skin care for 24 hours per day

�  Recommended as the preferred method whenever possible

Two Main Forms of KMC

Pra

ctic

e of

KM

C �  Who decides when it is time?

¡  In some hospitals the doctor decides when the baby is ready for KMC

¡  In others it is a joint decision with nurses ¡  Sometimes the mother demands KMC to

begin �  How are the mothers taught?

¡  Verbal education to the mothers ¡  Mostly during transfer to KMC ¡  It is not included in health education

�  Intermittent KMC is practiced when there is no space in the KMC unit or when the mother does not have a guardian to help her in carrying the bay 24 hours a day

KMC Position

�  Mothers provide their own material to tie the baby to them �  Putting twins together in the skin-to-skin position does not

happen in Rwanda ¡  One of the babies may not be in the KMC position when the other is

because there is no guardian to assist the mother �  All mothers are allowed a guardian or companion

¡  Assist with daily chores and other needs, including skin-to-skin holding �  Many of the neonatal units are not heated

¡  Are the babies warm enough in the incubators? �  Many babies do not have caps (hats) and mothers do not

appear to be aware of the potential heat loss when there is no cap for the babies head

�  Mothers are allowed to walk around while in skin-to-skin contact

KMC Nutrition and Weight Monitoring

�  Breastfeed babies day and night �  When needed, mothers use expressed breast milk

that is fed by cup or nasogastric tube �  Weigh babies regularly once a day

�  Staff at every hospital trained in KMC �  Either as a stand alone or as a part of unit

(newborn care, neonatology) �  Special orientation programs for new

staff coming in to work in sections where KMC is located ¡  Done verbally or through practical

demonstrations

�  Supervision of KMC babies ¡  Duties of the doctors and nurses on

neonatology unit ¡  Concern when the section becomes busy

because some hospitals combine neonatology and maternity

KM

C Staff

Discharge and Follow-Up

�  Doctors generally discharge the babies �  Most babies are initially followed-up at:

¡  The hospital where they were born ¡  Where they received KMC services ¡  In a pediatric outpatient unit, neonatology unit, KMC unit

�  Many mothers so not follow-up due to the distance of travel ¡  How can this be changed? How can mothers be encouraged to follow-

up? �  Encourage mothers to bring their babies back for follow-up

through the education of the mothers ¡  In-depth explanation on the consequences of low body weight babies

not being followed-up on ¡  Through the reinforcement and repetition of this message

References

Bergh, A., Sayinzoga, F., Mukarugwiro, B., Zoungrana, J., Abayisenga, G., Karera, C., & Ikiriza, C. (2012, May). EVALUATION OF KANGAROO MOTHER CARE SERVICES IN RWANDA . Retrieved February 19, 2017, from http://www.mchip.net/sites/default/files/ Rwanda%20KMC%20Evaluation%20Report_0.pdf

Mushimijimana, D. (2016, March 17). Rwanda: Kangaroo Mother Care - A Remedy

for Preterm Babies. Retrieved February 19, 2017, from http:// allafrica.com/stories/201603171464.html