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Table 1 Planning for a national KMC programme using a stages-of-change approach

From: Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future

Stage Important factors to consider
1. Create awareness • Leaders and champions at different levels (global, national, regional) • Use of best available, applicable evidence • Advocacy by key government officials and others • Key stakeholders for potential funding and other contributions • Exploring policy formulation and integration of KMC into different state programmes
2. Commit to implement • Leadership and government commitment in the context of a team approach • Technical working group • Government guidelines; begin drafting standard operating procedures/protocols • Potential resources • Draft operational plan • Accountability measures for different stakeholders
3. Prepare to implement • Needs assessment and cost-benefit analysis • Targets formulated • Policies, operational plans and protocols refined • Budgets drafted and resources allocated (government and donors) – accountable tracking of allocations included • Selection of key staff to be trained and scale-up of training in a manageable way (often integrated into other training programmes, e.g. Essential Newborn Care) • Centre(s) of excellence (CoE) identified, strengthened or established – systematic linkages between CoEs and district/regional health facilities ensured • Monitoring and evaluation system with key indicators to allow for learning from processes – regular feedback and mid-course corrections
4. Implement • KMC team empowerment • Continued advocacy and work with media • Programme integrated into state and central budgets (a ‘budget line’) • Donor and insurance agencies and companies on board • System for information, education and communication (IEC) established and materials developed • Number of CoEs expanded • Conducive environment created at health facility level (e.g. KMC culture, peer group work, in-service training)
5. Integrate into routine practice • Continuation of leadership and advocacy • Continued financial support from government and international community • Monitoring framework established (preferably electronic) (capacity for collecting, analysing and using data) • Clinical outcomes measured at facility and health system level • Further evidence generated through research (at CoE and district level) • Integration with institutional quality assurance and quality improvement • Well-organised follow-up system for growth monitoring and promotion of neurodevelopment • Expansion of parent education opportunities
6. Sustain new practices • Monitoring of national progress • Continuous policy review • Budgetary support (including insurance) sustained • Accountability teams overseeing monitoring and feedback • Continued training and refreshers • Newly generated evidence disseminated at national conferences • KMC integrated into pre- and in-service education • Champions nurtured and new ones identified