Introduction
Rwanda has experience with the implementation of kangaroo mother care (KMC) since 2007. A major thrust was the inclusion of KMC in the upgrading of neonatal services and training in neonatology in 2010 to 2011 that included all district hospitals. KMC was also included in the emergency obstetric and newborn care program. In 2011 a number of important publications also saw the light, amongst others the National KMC Guidelines, the Essential Newborn Care Reference Manual, and Neonatal Protocols. In 2012 Rwanda 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 7 district hospitals known to implement KMC was selected. The facilities were visited by a team of locally trained assessors under the guidance of a consultant. The team 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 7 hospitals visited scored more than 10 out of 30, with an average score of 18.14. Four hospitals reached the level of integration of KMC into routine practice, with scores between 18 and 24 out of 30. One of these hospitals was on the way to sustainable practice.