Evaluation of Kangaroo mother care implementation after the DIB project in three health facilities in the central region of Cameroon.

backgroundNeonatal mortality remains high in Cameroon, stagnating at 28 per 1,000 live births since 2014 according to the 2018 Demographic and Health Survey (DHS). As part of the strategy to reduce this mortality, the Development Impact Bond (DIB) project was implemented in ten health facilities in Cameroon from January 2019 to January 2021, over a two-year period. Our objective was to determine the level of implementation of Kangaroo Mother Care (KMC) and its effect on neonatal mortality in three health facilities in the Centre region.

methodsWe conducted a cross-sectional study using a mixed-methods approach (quantitative and qualitative) with simultaneous triangulation and retrospective data collection. To assess the level of KMC implementation, we adopted the progress monitoring model proposed by Bergh et al. in [1]. On the qualitative side, we used an observation grid and a semi-structured interview guide to collect participants' accounts across the different phases of KMC implementation. We also analyzed mortality trends throughout the implementation process.

resultsAnalysis of the post-DIB project evaluation indicated that all assessed health facilities had progressed to the institutionalization stage according to the measurement framework developed by Bergh et al. in [1]. Scores obtained were 24.5, 25, and 27.5 out of 30 points for YGOPH, YUTH, and BDH respectively. However, although positioned at the institutional level, none of these care centers had achieved sustainable KMC practice. During the program implementation phase, a gradual decrease in mortality was documented, with reduction ratios of 1.6, 2, and 4 times for YGOPH, YUTH, and BDH respectively. An upward mortality trend was observed in two first-category urban health facilities, particularly YUTH and YGOPH. Several barriers appeared to explain this deterioration in outcomes once the project ended. Notable gaps were observed in the involvement of administrative leadership, motivational burnout among caregivers, staff turnover, and the discontinuation of free emergency services and financial incentives that had characterized the DIB implementation phase.

conclusionFollowing the DIB project, and with the support of other neonatal care strategies, the level of KMC implementation had reached the institutionalization stage in all health facilities. Two of them were on the "path" toward sustainable KMC practice without having fully achieved it. A mortality rebound was observed six months after the end of the DIB project. Several barriers to KMC implementation could help explain the failure to progress toward sustainable practice, owing to certain instabilities caused by managerial, social, technical, and environmental challenges.