Promoting the Kangaroo Mother Care (KMC) in Indonesian Hospitals: Barriers and Progress to Date Hadi Pratomo presented at HPH Conference Taipeh,

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1 Promoting the Kangaroo Mother Care (KMC) in Indonesian Hospitals: Barriers and Progress to Date Hadi Pratomo presented at HPH Conference Taipeh, April 12, 2012

2 Indonesia 17,000+ islands (6,000 inhabited) 243,000,000 inhabitants (2010 est.) 4 th largest country and largest Muslim country in world 500+ languages spoken one official language: Bahasa Indonesia Highly decentralised system of government (30 provinces)

3 Scale-up project in 13 hospitals in three provinces on the island of Java 2 teaching hospitals 5 regional / district hospitals 1 mother and child hospital 1 maternity hospital 4 district hospitals

4 Mortality per 1,000 births. National progress to MDG Neonat al Mort alit y Rat e Under 5 Mort alit y Rat e MDG 4 Target Year 56% of child deaths in Indonesia are newborns. Source: UNICEF, IDHS 2002/3

5 Estimated causes of newborn deaths in Indonesia Asphyxia 30% Congenital 7% Other 9% Tetanus 1% Low birth weight rate 9% Diarrhoea 1% Infection 20% Preterm 32% Source: Lawn JE, Cousens SN, Zupan J IJE 2006, based on cause specific mortality data and estimates for 192 countries

6 Family/community Integrated interventions in MNCH packages CHILDBIRTH CARE: MATERNAL and NEWBORN CARE: Oupatient/outreach Clinical Skilled obstetric care at birth and essential newborn care (hygiene, warmth, breastfeeding) and resuscitation, PMTCT Emergency obstetric care and immediate emergency newborn care ANTENATAL CARE: 4-visit focused package that integrated with: Malaria prevention, IPTp and ITN Tetanus immunization Healthy home behaviors for the woman in pregnancy: reducing work load, danger sign recognition, emergency preparedness Community behaviors, emergency transport and funding schemes Where skilled care is not available, clean delivery, and simple early newborn care including warmth and immediate breastfeeding Normal delivery and emergency care Integrated management of childhood illness including the newborn Extra care for preterm babies, including kangaroo mother care POSTNATAL CARE: Promotion of healthy behaviors for mother and baby Early detection and referral of complications Extra visits for preterm babies PMTCT for HIV, including appropriate feeding (pilot) Family planning Healthy home behaviors including: exclusive breastfeeding, hygienic cord/skin care, extra care for preterm babies Water, sanitation, hygiene Promoting demand for quality skilled care, danger sign recognition and care-seeking Case management of diarrhea with ORS. Pregnancy Birth Postnatal

7 HISTORY OF KMC: 1978,Dr Edgar Rey (Pediatrician), Bogota, Colombia, Latin America) 2000 m above see level, delivery 30,000/year Lack of incubator, impact of separating newborn and mother

8 KMC Definition: A universally available and biologically sound method of care for all newborns but in particular for premature babies with 3 components: Skin-to-skin contact, Exclusive breastfeeding, and Support to mother-infant dyad re.com/whatis01.htm

9 Indonesian policies supporting KMC Mother- and baby-friendly hospital (RSSIB) Part of Safe Motherhood since 2001 KMC integrated into RSSIB National KMC Working Group Need for the further scaling up of KMC Project with 10 hospitals 2008: KMC leaders in 2 teaching hospitals trained in South Africa 2010: 2 teaching hospital served as training centres for another 8 hospitals

10 Four stages of the intervention 1. Baseline assessment 2. Training workshops at two teaching centres 3. Two supervisory visits to each of the 8 hospitals 4. Endline assessment Month 1-2 (Jan Feb 2010) Month 2 (Feb 2010) Months 3 5 (March May 2010) Month 6 (June 2010)

11 Patient profile in 8 hospitals Indicator n (%) Total number of LBWs 979 LBW infants receiving any form of KMC 208 (21.2%) KMC infants born by caesarean section 70 (33.7%) Infants receiving KMC for one day or less before discharge 71 (34.1%) Number of infant deaths in KMC period 3 Mean number of days between birth and starting any form of KMC 7.7

12 Progress in implementation Hospital not implementing Training centres 2. Adopting the concept (8) 1. Creating awareness (12) 6. Sustainable practice (15) 5. Evidence of routine & integration (20) 4. Evidence of practice (20) 3. Taking ownership (25)

13 BARRIERS Needs strong commitment of relevant stakeholders Revisit of clients (transport, economic reason, distance etc) It is a change process and needs time and Continuous Monitoring & Evaluation Requires policy advocacy to relevant stakeholders

14 Progress To Date KMC could be implemented in the hospitals Initiated an integration of KMC in the selected teaching/ district hospitals Trained technical and management of hospital as a team Built hospital as a model of KMC services prior to the community

15 Future Challenges Development of a hospital-household continuum of KMC (network development of urban hospitals and Public Health Centers and community workers) Development model of both teaching and district hospitals integrating KMC Dissemination of information of newborn care including KMC to the public Integrating of KMC into pre service training of health personnel

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