Introduction
Uganda has experience with the implementation of kangaroo mother care (KMC) since 1999 in the central/teaching hospital. After a slow start up to 2006, advocacy for KMC in keeping babies warm and promoting infant survival increased and newborn health (including KMC) became more prominent in the policy environment with the formation of the Newborn Steering Committee (NSC). This was followed by increased visibility for KMC in policy documents such as the Standards for Newborn Health Care Services (2010) and the Health Sector Strategic and Investment Plan (2010/11 – 2014/15). In 2012 Uganda was one of four countries selected for an in-depth evaluation, using standard measurement tools, to systematically measure the scope and institutionalisation of KMC services and describe the barriers and facilitators to sustainable implementation.
Methodology
A convenience sample of 11 health care facilities was selected, including one central, one regional, 4 district and 3 private, not-for-profit hospitals, plus 2 health centres IV. The facilities were visited by two teams of locally trained assessors under the guidance of a consultant. The teams interviewed key informants and KMC focal persons and observed the KMC services.
Results were interpreted by means of a model with six stages of change. Facilities received a score out of 30. Facilities scoring above 10 out of 30 demonstrate implementation of KMC or evidence of KMC practice; those scoring above 17 out of 30 demonstrate the integration of KMC into routine practice; and those with more than 24 out of 30 show sustainable KMC practice.
Results
The 11 health care facilities achieved implementation scores ranging between 8.28 and 21.72 out of the possible 30 points, with an average score of 14.45. Two facilities were still on the level of preparing for KMC implementation. Eight facilities were at the level of implementing KMC, whereas one facility demonstrated some evidence of integrating KMC into routine practice. No facilities have yet demonstrated sustainable practice.