title: Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa.
abstract: BACKGROUND
  Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda.
  
  
  METHODS
  A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress.
  
  
  RESULTS
  Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care.
  
  
  CONCLUSIONS
  The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems.
authors.affiliation: MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa. anne-marie.bergh@up.ac.za.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bergh
authors.forename: Kate
authors.initials: K
authors.lastname: Kerber
authors.forename: Stella
authors.initials: S
authors.lastname: Abwao
authors.forename: Joseph
authors.initials: J
authors.lastname: de-Graft Johnson
authors.forename: Patrick
authors.initials: P
authors.lastname: Aliganyira
authors.forename: Karen
authors.initials: K
authors.lastname: Davy
authors.forename: Nathalie
authors.initials: N
authors.lastname: Gamache
authors.forename: Modibo
authors.initials: M
authors.lastname: Kante
authors.forename: Reuben
authors.initials: R
authors.lastname: Ligowe
authors.forename: Richard
authors.initials: R
authors.lastname: Luhanga
authors.forename: Béata
authors.initials: B
authors.lastname: Mukarugwiro
authors.forename: Fidèle
authors.initials: F
authors.lastname: Ngabo
authors.forename: Barbara
authors.initials: B
authors.lastname: Rawlins
authors.forename: Felix
authors.initials: F
authors.lastname: Sayinzoga
authors.forename: Naamala Hanifah
authors.initials: NH
authors.lastname: Sengendo
authors.forename: Mariam
authors.initials: M
authors.lastname: Sylla
authors.forename: Rachel
authors.initials: R
authors.lastname: Taylor
authors.forename: Elise
authors.initials: E
authors.lastname: van Rooyen
authors.forename: Jeremie
authors.initials: J
authors.lastname: Zoungrana
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D003430:Cross-Sectional Studies; D006302:Health Services Research; D060127:Kangaroo-Mother Care Method; D008295:Malawi; D008302:Mali; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D012432:Rwanda; D014454:Uganda; D007231:Infant, Newborn