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Lessonslearnedinimple

mentingkan

garoomothercarein

LatinAm

ericanandCaribbeancountriesthrou

gha

regionalnetwork

NathalieCharpak

fundacion.c

anguro@gmail.c

om

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

2/15

051015202530354045

TMN

TMI

TMM5

TasadeMortalidadpor1000NV

1990

2010

50%

57%

52%

Chang

esinNeona

tal,Infanta

ndlessthan5

years

mortalityin

LatinAmer

icancountries

1990-2010

Source:WorldHealthStatistics2012

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

3/15

0

.0

5

.0

10

.0

15

.0

20

.0

25

.0

30

.0

35

.0

40

.0

45

.0

1990

2010

TasadeMortalidadpor1000NV

TMM5

TMI

TMN

43%

50%

38%

28%

22%

19%

Fuente:WorldHealthStatistics2012

Mort

alityofles

sthan5ye

arschildren

acco

rdingtoth

ecompon

entinLatin

AmericanCountries1990-2010

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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MaindiagnosisofInfantmortalityin

LatinA

mericana

ndCaribbeancountries

Fuente:Estimaciones

deFCH/CAconbasededatosdeHA-OPS,2010

Post-ne

onatal(29%)

N

eonatal(71%)

Infec

tions

32%

Asp

hyx

ia29%

LBW

an

d

prema

turi

ty

24%

Congen

ital

abnorma

lities1

0%

Others

5%

Pneumona

/IRA48%

Diarr

hea3

6%

Desnu

trition

9%

Others

7%

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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Kangar

ooMotherC

are(KMC)is

anevidence-

basedtechnologythathasbeen

shownusefu

lfor

amelio

ratingLBWe

ffectsoninfa

ntmortality

and

morbid

ity,nutrition

andearlydevelopment.

Majorcomponents

ofKMCareK

angarooPos

ition

(prolon

gedskin-to-skincontact)

Kangaroo

nutrition(breastmilkbasednutrition)and

kangaroodischarge

policies(ear

lydischargein

kangaroopositiona

thomeorin

aKMCward

and

strictfollowup)

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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Oneofthemajorcontributorstoth

eso-called90-10

gaptha

tbringsapart

affluentandle

ssdeveloped

countriesistheinade

quateaccesst

oknowledge

(knowle

dgetransfer)andwhenaccessible,the

insufficienttranslationofthatknow

ledgeintoaction.

Agroup

ofresearchersandhealthc

areprofession

als

decided

totacklethis

doublechallengebycreatin

ga

nongovernmentalno

nforprofitorganizationcalled

theFu

ndacinCanguro(KangarooFoundation)

in

1994in

Bogot,Colom

bia.

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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KM

Ctraining:howtodoit?

Traditiona

lly,cooperatio

ninhealthisorganizedand

thoughtinaoneway

direction,

from

NorthtoSou

th

countries.Itoftenmeetsresistance

sbecauseof:

1)Badfun

ctioningoftheprojectonce

thefinancial

supportisover,espec

iallywhenthe

longterm

sustainabilitywasnot

planned.

2)Difficultiesinthemaintenanceofte

chnological

materia

l.

3)Poorac

ceptanceofnewknowledge

becausescien

tific

evidenc

esaretoooftenproducedinthenorthern

countriesandnotada

ptedtolocalcircumstances.

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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Current

lySouth-to-So

uthcooperationisinadyna

mic

expansion.Middleinc

omecountrieshavenow

technicalcompetenciesandexcellencecentersin

alot

offoref

rontfieldsincludinghealtha

ndareclaimin

gfor

moreparticipationin

cooperationd

ecisions.

Knowle

dgetransferis

usuallybetteracceptedbec

ause

contentsaremoreap

propriate.Professionalsfrom

middle

incomecountrieshavethee

xperienceofm

ore

depress

edterritories

withlowlevel

ofdevelopme

ntin

theirow

ncountriesandveryoftenhaveseenlife

inthe

samesituationinpastyears.

Itallowsamoreegalitarianandrespectfulknowle

dge

transfer,moredirectandmoreadaptedtolocal

situatio

nwithmorep

ossibilitiestobesuccessful.

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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Since1

994moreth

an60multid

isciplinaryhealth-

carete

amsmainlyfromcrowdedcities'hosp

itals

inmorethan25developingcountrieshaveb

een

trained

inBogotin

ourcenterw

iththefinancial

supportofvariousofficialandnonofficialNG

O

andinstitutions.Wewantspeciallytothank

USAIDS,PegMarshall,GoldyMa

ziasandJorg

e

Herminda,whosup

portedusdu

ringthesela

st2

yearsforthetrainin

gofSalvador,Honduras,

Guatem

ala,Nicarag

ua,RepublicaDominican

aand

theFrenchembassyofHaitiwhosupportedKMC

implem

entationinthiscountry(2andsoon3

KMCP)

incollaborationwithUnicef

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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Moret

han60teamsfrom25countrieshavebeen

trainedin

Bogota,

Colo

mbia.

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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ThetrainingmodeloftheKF

Seeon

e,

doone,t

eachone

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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Themo

delofKMCdiffusionwecho

seisseeone,

do

one,teachone,meaningthatinordertotranslat

e

KMCto

anothergeographicallocationweinvitehealth

carelea

derstobetrainedinKMCin

ourcenter(see

one),im

plementaKM

Cprogramin

theirhome

institutions(doone)a

ndafterwards,trainother

centers

intheirregion

andhelpthemimplementit

(teacho

ne).Thesuccessofknowledgetransferin

Central

AmericaandCaribbeancountrieshasbeen

high:ne

arlyallteams

trainedinBog

otimplemen

ted

withsuccess,

despite

specificneeds

anddifficultie

s

encoun

teredbyeach

programinea

chsetting.Various

KMCprogramsalread

ybegananationalKMCtraining

diffusio

nprogramintheircountries

(Republica

Dominicana).

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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Trainedteamsare

alsoprovide

dwiththebasic

tools

fortranslatin

gknowledgeintohealth

care

actions.

Anew

multimediaKMCkitisn

owavailable

on

ourh

omepage,constructionw

assupporte

dby

theColombianhealthministry

andtheWorld

Food

Programand

EnglishtranslationbyM

CHIP,

JSIan

dtheKangarooFoundation.Wejust

receivedagrantfo

rtheFrench

translation.

Wedevelopthism

ultimediaKMCkit,

free,easy

toread,tosuppor

tlocaldiffusionandto

empo

werthenew

lytrainedKM

Ccentreas

an

excellencecentre

intheircoun

try

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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Co

mments

Guideline

sbythemselv

esarenotenoughtodevelopa

goodqualityprogram.

Ourexperienceshowsthattrainingandexposure

to

successfulpracticeha

nds-on

trainin

g

inreference

KMCcent

ershasbeenkeytosuccessfuldissemina

tion

7/28/2019 Charpak: Lessons Learned in Implementing Kangaroo Mother Care in LAC Countries Through a Regional Network

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Mayor

difficultie

sintheK

MCdiffus

ion

Rightcho

iceoftheteamto

betrained

Adaptatio

nofthe3componentsofKMCtolo

calcircumstances,

patientneedsandlevelofc

are.

Earlydischargeandambula

toryfollowupclin

ic

InsufficientaccesstoKanga

roonetworkands

cientificliterature

on

KMC

Insufficientlocalresearchandmonitoringcap

ability

Costs:Dir

ectcostoftrainingkangarooteam,costofKMCstaffa

nd

physicals

tructure

Quickturnoverofadministrativeandmedical

staff

Sustainab

ility

Integratio

ninthepublichealthpoliciesoftheheathministry