Scaling Kangaroo Mother Care — The Final Phase
Social Finance is working with Cameroonian and Canadian partners to scale Kangaroo Mother Care for premature and low birth weight infants in Cameroon using a Development Impact Bond (DIB).
We recently embarked on the final design phase for the Cameroon Newborn DIB, which will roll out Kangaroo Mother Care (KMC), an evidence-based intervention that improves maternal and newborn health outcomes in low resource settings, in 10–11 hospitals across 5 regions in Cameroon. I visited Cameroon a couple of weeks ago to kick off some costing assessments in potential partner hospitals and begin the work of developing the data system that will be used to monitor performance in the DIB, paving the way for a launch in a few months’ time.
I had planned to spend most of my week in Laquintinie Hospital in Douala, currently the only KMC Centre of Excellence in Cameroon. The objective was to help our local consultants who would be carrying out the costing work in hospitals to understand KMC as far as possible and to get a good idea of the current data flows and use of data in the hospital. In developing the data system I would be working with our partner Bluesquare, a Belgian data systems company with extensive experience in results-based health programmes in Africa. In addition, although I’d read a great deal about it, I had never seen KMC in action before and was excited to learn about the day-to-day realities of delivering this life-changing intervention.
Laquintinie Hospital is a set of brightly coloured blue and white buildings in the Akwa district of Douala, the economic capital of Cameroon. It sits on a dusty main road busy with street vendors, taxis, motorcycles, bicycles and pedestrians. Security guards in yellow uniforms man the gate and the entryways for most wards. I take a series of taxis to and from the hospital every day. The journeys are unmetered, and I never pay the same fee twice.
Even though the KMC unit at Laquintinie is the best equipped and best staffed in the country, I discover that the team is facing its fair share of challenges. The multi-disciplinary KMC team is made up of 7 staff, a paediatrician, a GP, two nurses, a physiotherapist, a psychotherapist and a data manager. They are a close-knit, hardworking group. They operate at maximum capacity on the minimum staffing levels required, and there are no substitutes in case of illness or holidays. Salaries are modest, and some staff members have taken on additional jobs outside the KMC unit as a hedge against potential wage instability from funding ebbs and flows.
The typical day of a nurse begins with paperwork at around 7am, followed by rounds of the neonatal and KMC wards, follow-up appointments if it is a Monday or Thursday and hours of training for mothers and families learning to care for their fragile newborns. The early start and the crowded roads into central Douala mean that staff have to leave their home for the hospital before dawn every day.
There are other daily challenges, both small and big. The data manager, Marius, described an intermittent internet connection (he uses his personal mobile data to upload and share KMC information), malfunctioning power sockets (he charges his laptop elsewhere in the hospital before bringing it over to the KMC unit) and a lack of office space (he sets up his desk in the corridor outside the follow-up unit). The usual neonatal and KMC wards have been under renovation for the past few months to upgrade their oxygen lines, and the staff have to find ways of controlling infection and maintaining the quality of KMC in quarters that are smaller and more crowded than is ideal.
Despite all this, the KMC programme at Laquintinie continues to see growing success in reducing the mortality rate and improving nutrition for premature and low birth weight babies. Every Thursday they crowd into a small, stuffy room at the KF Cameroon office for their team meeting. Each team member presents a handwritten report on the new cases, key challenges and statistics from the KMC ward that week. Through robust, passionate discussions, the team develops its capacity for collective problem-solving and risk management. In the face of challenges, they make no excuses and instead work harder, dig deeper. They weather long commutes, long hours and resource constraints to ensure they deliver the quality of care that every tiny, vulnerable baby needs.
One of the strengths of the Impact Bond model is that it provides upfront funding for crucial frontline services like Kangaroo Mother Care. While our budget for each hospital is still relatively modest, the launch of the Cameroon Newborn DIB will mean an unprecedented measure of stability and provision of resources for the team at Laquintinie and for 9–10 new teams across the country. We strive to complete the design and launch of the DIB for this very purpose.
Now back in my airconditioned office, when I think of the KMC staff persevering in Douala’s 37 degree heat, these words from the cellist Pablo Casals come to mind:
“We should say to each of [our children]: Do you know what you are? You are a marvel. You are unique…look at your body- what a wonder it is! Your legs, your arms, your cunning fingers, the way you move! You may become a Shakespeare, a Michelangelo, a Beethoven. You have the capacity for anything…You must work — we must all work — To make this world worthy of its children.”