Postnatal Care

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Postnatal Care Kangaroo Mother Care Scale-up
Malawi

• Evelyn Zimba
• Malawi Country OfficeWomen Deliver Conference
  London
• 19th October 2007

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Outline

• Related health indicators
• SNL 1 in Malawi
• Community maternal and newborn care package
• KMC scale-up

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Related Health Indicators(DHS 2004 MICS 2006)
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National progress to MDG 4
Updated with MICS 2006 data (Joy Lawn)
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Where in Malawi is the risk highest for newborn
deaths?
Mean NMR for rural and urban populations in
Malawi DHS survey 2000
Average Neonatal mortality rate per 1000 live
births
DHS data for Malawi 2000, provided by Shea
Rustein, analysis Lawn 2004.
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Coverage along the continuum of care in Malawi
Based on non institutional deliveries
Source Opportunities for Africas Newborns
based on DHS 2005 preliminary results
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Malawi 20,000 neonatal deaths Why?Estimated
direct causes of neonatal death for 2000
Source Estimates for Malawi for the year 2000
from Lawn JE, et al Lancet 2005. based on cause
specific mortality data and estimates for 192
countries as used in WHO World Health Report 2005
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Saving Newborn Lives Malawi

• Was launched in 2002
• To improve neonatal health and survival, hence
  reduce neonatal morbidity and mortality

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Principal Strategies for SNL Malawi Program

• Use of an Essential Newborn Care (ENC) Package to
  improve the quality of care for newborns
• Capacity building of central and district teams
  through competence-based training for ENC,
  resuscitation and Kangaroo Mother Care (KMC)
• Influencing behavior change at household,
  community and health facility levels towards
  improved neonatal care and survival
• Advocacy to prompt national commitment and focus
  on newborn health care issues

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Key Accomplishments

• A newborn care training unit was established -
  through Kamuzu College of Nursing and trained 22
  TOTs and 311 ENC service providers
• Established a KMC training unit at Zomba Central
  Hospital, trained 18 TOTs and 274 service
  providers
• ENC/KMC BCC materials were developed
• KMC National guidelines were developed
• ENC/KMC content was incorporated into the
  pre-service Midwifery training

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KMC Background in Malawi

• KMC was started at Kamuzu Central Hospital in the
  early 1990s, but was stopped after two deaths
  occurred as it was then associated with
  mortality.
• KMC was re-introduced at Zomba Central Hospital
  in 1999. Proposals were submitted to several
  organizations to renovate the nursery to include
  a KMC unit.
• The EU responded favorably and the proposed
  renovations were done. However KMC was not well
  coordinated and there was very little
  documentation

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SNL Support on KMC

• Supported the establishment of a KMC learning
  center at Zomba, with the view of expanding KMC
  services beyond Zomba.
• For advocacy (to influence buy in by national
  staff) and TA purposes organized orientation and
  training trips for staff to Zimbabwe, Cape Town
  and Columbia
• Partnered with MOH/RHU, DHOs, CHAM, PVOs and KCN
  to implement KMC services

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Benefits of KMC

• KMC is
• Useful for stable LBW babies
• Involves mother in care
• Facilitates breastfeeding
• Helps prevent and treats hypothermia
• Reduces work strain on few nursing staff
• Believed to be cost effective

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KMC accomplishments

• KMC training manual developed
• 18 TOTs and 274 H/W trained
• BCC materials developed
• Established KMC Task Force
• National KMC guidelines developed
• KMC Register monitoring sheet were developed
• Established a total of 6 KMC sites
• Introduced grandparents strategy

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Challenges

• How to provide adequate follow-up especially for
  those who do not return for follow-up care
• Continued mentoring and supervision of trained
  KMC providers

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Way Forward

• MOH in partnership with Save the Children,
  UNICEF, WHO, UNFPA, ACCESS and other partners
  are
• Piloting a community maternal and newborn care
  package
• Scaling-up KMC in all district hospitals with
  guidance from results of retrospective KMC study
• Scaling-up ENC/KMC practice to all district
  hospitals

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Community Maternal and Newborn Care Package

• Malawi is piloting a 3 year program to develop,
  implement and evaluate the feasibility, cost and
  outcomes of a scaleable strategy of high impact
  interventions to improve key maternal and
  neonatal practices and health care coverage in 3
  districts.
• The package will be delivered by Health
  Surveillance Assistants (HSAs) in the context of
  ACSD/IMCI framework
• This programme will be managed and implemented
  within the prevailing structures and staffing of
  the MOH in the three district.
• UNICEF, Save the Children, and others will
  provide technical and financial support where
  mutually agreed to support the planning,
  implementation, capacity building and monitoring
  and evaluation.

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Progress

• A design workshop was conducted in February 2007
• A task force comprising of representatives from
  different key partners and terms of reference
  developed in May 2007
• A proposal written and approved by the Ethics
  Review Board
• Conducted a formative research and final report
  submitted Oct.
• Process underway to conduct HFA by end of October
  and baseline survey by mid-November 2007
• Adaptation of the HSAs TOTs training manual
  scheduled for mid-November 2007
• Sepsis management component to be added later

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Scale-up of KMC

• KMC retrospective study done, final report to be
  out soon
• KMC Coordinator to be recruited through ACCESS to
  provide TA in the scale-up of KMC
• Dissemination of the KMC retrospective study
  results to be conducted in January 2008
• Community KMC to be included in the pilot of the
  community maternal and newborn care package

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THANK YOU