In the Philippines, where close to half (48%) of the under-five mortality occurs during the neonatal period, strategies to improve newborn health have become an emergency. It is imperative that technologies such as Kangaroo Mother Care, which has been proven to be cost-effective, easily adaptable and sustainable, be prioritized, in order to help reduce neonatal mortality.
History of KMC in the Philippines
After training on Kangaroo Mother Care at Fundacion Canguro (Colombia 1999), Dr. Socorro Mendoza piloted the program at Dr. Jose Fabella Memorial Hospital in Manila. After one year, KMC was institutionalized and adopted as the standard policy of care for all LBW’s and cascaded to the local Manila Health Department covering all lying-in-clinics in 2004. The city health office, likewise, has since, adopted the technique as its standard of care for all LBW’s and effectively established its network with the pioneer Fabella center. To efficiently monitor the quality of KMC implementation, application of a KMC database encoding system was initiated in 2006, as recommended by the Colombian KMC Foundation.
To provide impetus for the faster development of KMC nationwide, the Bless-Tetada KMC Foundation was established in 2008, upon Dr. Mendoza’s retirement from the service. Standardization of protocols and procedures for training, implementation, research, monitoring & accreditation were developed. Under the aegis of the foundation, the first hospital that underwent training, pilot implementation, & accreditation as KMC Center of Excellence was Mariano Marcos Memorial Medical Center in Region 1 (2010-2011). As of 2012, one other center of excellence has been established at the Eastern Visayas Regional Medical Center, and 2 other regional hospitals are in the thick of pilot implementation. The Foundation has remained in partnership with the pioneer Fabella center, providing services for data banking, quality improvement activities, research and training. In 2011, the Foundation entered into a partnership with the Perinatal Association of the Philippines, to work together in disseminating KMC through its regional chapters, which are closely linked with other regional health facilities.
Evidence of Benefits
Research studies conducted at Fabella Hospital in over 10 years of KMC implementation identified both medical and economic benefits. Risk of mortality among LBW’s in KMC has significantly and consistently been shown to be lower (RR 0.88. CI 0.85, 0.91). Deaths due to sepsis dropped from 34% in 1998 (before KMC) to 24% over the period 1999-2004 (RR0.75; CI 0.66,0.84). Breastfeeding rates significantly higher up to 5 months post discharge compared to those not in KMC. Economic benefits translated into a drop in hospital stay by 50% and a savings of around 75% of cost of hospital stay across all low birth weight segments. Improvements in hospital resource utilization were also evident, such as personnel efficiency, nurse:patient ratio, reduced budget for medications, and zero child abandonment. Research conducted in the other established centers reinforced KMC evidence on better thermoregulation, better weight gain, and safety in transport from delivery room to the NICU.
Challenges Encountered
Most challenging area in the implementation of KMC in the Philippines is the poor follow-up rates in the ambulatory stage. Rate of out-patient consultation is low and social workers could not readily track down delinquent patients. Economics play a major role on both the hospital and the patient capabilities. Revisions in the policy on early/timely discharge are being studied, expansion of social worker’s role, networking with major cities from which population originates, and calls for integration of LBW follow-up care in local government units’ health policies.
Going Forward
Based on experiences and learning encountered in the implementation of KMC in the Philippines, several areas need to be addressed. Foremost is the promotion of KMC in various sectors of the population – mothers, medical practitioners (both public and private), social workers and community health workers. Need for the sustainability of the KMC centers and the Foundation in terms of advocates, resources and partnerships. It is also essential that a national policy be promulgated to through the Ministry of Health and the Ministry of Education. More local research studies are also needed to identify mile stones in the development of KMC, gain further support for its adoption and to identify further developments necessary in enhancing KMC practice in the Philippines.