Title; Technical assistant on Kangaroo Mother Care (KMC) guidelines development
Duration :Four months
No. of consultants: One
Reporting to Newborn and child health team coordinator, MoH and Health Specialist, UNICEF
In Ethiopia Under-5 mortality declined from 123 deaths per 1,000 live births in 2005 to 59 deaths per 1,000 live births in 2019 (decreased by 52%). Over the same period, infant mortality declined from 77 to 47 deaths per 1,000 live births, (39% reduction) and Neonatal mortality declined from 39 deaths per 1,000 live births to 33 deaths per 1,000 births (reduction of 15%). As the neonatal mortality has been stagnant in the past decades, the country needs to work more to achieve the HSTP II target of reducing neonatal mortality to less than 21 per 1000 live births in 2024/25. Despite increasing accessibility to services, uneven distribution of health resources, sub-optimal quality of care, low child health care seeking behavior of communities, low coverage of Kangaroo Mother Care (KMC) services, and shortage of essential health commodities and equipment at service delivery points remain to be key challenges contributing to the high rates of neonatal mortality. Child survival interventions, such as Integrated Community Management of Newborn and Childhood Illness (iCMNCI) and Integrated Management of Newborn and Childhood Illness (IMNCI), Neonatal Intensive Care Unit (NICU), Essential Newborn Care (ENC) and KMC have high impact on the reduction of newborn, infant and child mortality. Globally, each year 15million neonates are born preterm and consequently at a high risk of mortality. South Asia and sub-Saharan Africa account for almost two-thirds of the world's preterm babies.
More than 80% of all newborn deaths result from three preventable and treatable conditions – complications due to prematurity, intrapartum-related deaths (including birth asphyxia), and neonatal infections. In 2017, in Ethiopia, for example, 30% were associated with intrapartum-related events (birth asphyxia and trauma), 27% with infections, and 26% with preterm birth complications.KMC is a method of care delivered to preterm infants. KMC is a low-cost intervention involving early, continuous and prolonged skin-to-skin contact between mother and baby and promoting exclusive breastfeeding. KMC is demonstrated to promote physiologic stability, a thermally supportive environment, reduce risk of serious infections and reduce the mortality among hospitalized, stable preterm and low birth weight (LBW) infants. Properly practiced KMC would avert 51% of deaths related to prematurity or low birth weight (LBW). Despite clear evidence of impact in improving survival and health outcomes among premature and low-birth-weight infants, KMC coverage has remained low globally.
KMC introduced in Ethiopia in 1996 at Black Lion Hospital. Since then, KMC services have been expanding to other hospitals and health facilities. Recently, KMC was included in a series of policy documents issued by the Ministry of Health: Newborn and Child Survival Strategy 2021–2025, the Health Sector Transformation Plan II, and the Ethiopian National Health Care Quality Strategy. The KMC target in the NNCSDS was set to reach 70% of preterm babies by 2025. Despite the emphasis that the government has put into reducing newborn mortality by using evidence-based strategies such as KMC, the number of preterm/low-birth weight newborns initiated in KMC remains low. In Ethiopia, KMC is found to be initiated only for 46.4% of all LBW babies and the quality of KMC services was poor (59.0% on average) on a basic index of service readiness. The national Minimum care package for KMC service (developing under the Saving Little Lives project) includes redesigning the newborn care ward to integrate intermittent KMC (iKMC) and continuous KMC or establish KMC ward; providing onsite training & mentorship for health workers on KMC position, nutrition, support for parents, infection prevention & follow up; providing furniture and supplies (diapers, feeding cup, pajamas, KMC wrap), equipment (weight scale, thermometer, refrigerator). The country may also aspire to introduce immediate KMC and community KMC.
Challenges related to KMC include poor maternal awareness and uptake, lack of adequate premises within the facility to render KMC services, gaps in supportive supervision and mentoring, lack of adequate funding due to the belief that there are no direct costs involved to run KMC services and lack of national KMC technical and implementation guideline.
A national minimum package exists for KMC, but guidelines are lacking especially for how to implement this package. Hence, the national newborn and child health program under the MNCAYH-N directorate of the ministry of health planned to develop a national KMC technical and implementation guide by end of this year (2014 EC). Thus, MoH decided to appoint experienced consultant in the area to prepare standardized document through closely consulting/working with the TWG and reviewing other countries experience, research findings and recommendations, WHO guidelines and national documents. Moreover, the document should be finalized by this fiscal year; and it is found to be mandatory to appoint a consultant who should fully engage her/himself for the preparation of the guideline.
- To map KMC activities in different national guidelines, manuals, or job-aids,
- To identify the various types of KMC activities that are currently implemented at local and global levels
- To identify KMC activities to be implemented at all level of health facilities and at community level,
- To develop KMC technical and implementation guide based on the above findings, and
- To develop KMC mentorship/ program specific supportive supervision checklist
Main duties and responsibilities.
The consultant is expected to carry out the following tasks under the guidance and support of the Newborn and Child Health team Coordinator of MOH and of newborn and child health Technical Working Group (TWG):
- Prepare a detailed plan of action based on the Terms of Reference (TOR) and share to TWG for inputs,
- Conduct a quick desk review on important manuals and guidelines. Some important national materials to be referred in the process of developing KMC technical and implementation guidelines include:
- The national IMNCI materials
- ICMNC job-aids
- Paediatric Pocket book of hospital care for children adapted to the Ethiopian setting
- WHO KMC practical and implementation guidelines
- The SLL minimum care packages for KMC and NICU
- Child health road map
- HSTP II and national newborn and child health & development strategy
- National BEmONC/CEmONC training materials and
- Obstetrics management protocols for the health centres and hospitals
- National HBS /ENC training material/ guide
- NICU training job-aids/manuals
- ECD job-aids/strategies
- All other relevant global and national materials
- Closely work with and get support from the national newborn and child health technical working group to
- Collect relevant information from TWG members and KMC implementation supporting organizations through interviews, group discussions, meetings and other communications,
- Visit selected health facilities (hospitals, health centres and health posts) to observe the readiness and practice of KMC in the health facilities,
- Develop a first draft KMC technical and implementation guidelines, a mentorship/supportive supervision (SS) checklist and share with TWG for review and inputs,
- Facilitate two-three consultative discussions with the TWG either virtual or face-to-face meetings,
- Revise the KMC technical and implementation guidelines, and mentorship/SS checklist based on inputs from TWG,
- Organize a field test in the selected health facilities and get input and revise the guidelines and checklist,
- Facilitate a national consultative validation workshop with the key stakeholders including Regional Health Bureaus and developing partners to jointly review the field-tested KMC technical and implementation guidelines, and
- Finalize the KMC technical and implementation guidelines, and checklist based on feedback from consultative workshop and submit the final document to MOH,
The consultant will be hired through ABH. S/he will be deployed at Directorate, MoH.
The consultant reports and is supervised by Newborn and Child Health team Coordinator with in MNCAYH-N directorate of MOH
- Agreed upon plan-of-action/inception report
- Draft and final, tested KMC technical and implementation guideline (including mentorship guide/checklist) which is approved by human resource development directorate of MOH in both hard and soft copies, and
- Summary power point presentation of the guidelines, and checklist.
Time Frame and Mode
The consultant will be hired for four months starting from 15 April 2022 with third party (ABH), human resource hiring firm.
Payment will be based on approved, high-quality deliverables, and 100% payment will be done once after the submission and approval of the deliverables