Introduction
Malawi has experience with the implementation of kangaroo mother care (KMC) since 1999 and developed national KMC guidelines in 2005. After a slow start up to 2007 when the first retrospective evaluation of KMC implementation was done, the scale up process was accelerated in the period 2008 to 2011, with 121 health care facilities providing KMC services by September 2011. In 2012 Malawi 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 14 health care facilities was selected, including one central hospital, nine district hospitals, one hospital of the Christian Health Association of Malawi (CHAM), one rural hospital and two community health centres (CHCs). 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 and 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
All 14 health care facilities visited scored more than 10 out of 30, with an average score of 16.33. Five facilities reached the level of integration of KMC into routine practice, with scores between 19 and 20 out of 30. No facilities have yet demonstrated sustainable practice.