title: The three waves in implementation of facility-based kangaroo mother care: a multi-country case study from Asia.
abstract: BACKGROUND
  Kangaroo mother care has been highlighted as an effective intervention package to address high neonatal mortality pertaining to preterm births and low birth weight. However, KMC uptake and service coverage have not progressed well in many countries. The aim of this case study was to understand the institutionalisation processes of facility-based KMC services in three Asian countries (India, Indonesia and the Philippines) and the reasons for the slow uptake of KMC in these countries.
  
  
  METHODS
  Three main data sources were available: background documents providing insight in the state of implementation of KMC in the three countries; visits to a selection of health facilities to gauge their progress with KMC implementation; and data from interviews and meetings with key stakeholders.
  
  
  RESULTS
  The establishment of KMC services at individual facilities began many years before official prioritisation for scale-up. Three major themes were identified: pioneers of facility-based KMC; patterns of KMC knowledge and skills dissemination; and uptake and expansion of KMC services in relation to global trends and national policies. Pioneers of facility-based KMC were introduced to the concept in the 1990s and established the practice in a few individual tertiary or teaching hospitals, without further spread. A training method beneficial to the initial establishment of KMC services in a country was to send institutional health-professional teams to learn abroad, notably in Colombia. Further in-country cascading took place afterwards and still later on KMC was integrated into newborn and obstetric care programs. The patchy uptake and expansion of KMC services took place in three phases aligned with global trends of the time: the pioneer phase with individual champions while the global focus was on child survival (1998-2006); the newborn-care phase (2007-2012); and lastly the current phase where small babies are also included in action plans.
  
  
  CONCLUSIONS
  This paper illustrates the complexities of implementing a new healthcare intervention. Although preterm care is currently in the limelight, clear and concerted country-led KMC scale-up strategies with associated operational plans and budgets are essential for successful scale-up.
authors.affiliation: MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa. anne-marie.bergh@up.ac.za.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bergh
authors.affiliation: Save the Children, 2000 L Street NW, Suite 500, Washington, DC, 20036, USA. jjohnson@savechildren.org.
authors.forename: Joseph
authors.initials: J
authors.lastname: de Graft-Johnson
authors.affiliation: Maternal and Child Survival Program, 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC, 20036, USA. NKhadka@savechildren.org.
authors.forename: Neena
authors.initials: N
authors.lastname: Khadka
authors.affiliation: Maternal and Child Survival Program, 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC, 20036, USA. aominiabohs@savechildren.org.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Om'Iniabohs
authors.affiliation: D Y Patil University, School of Medicine, Nerul, Navi Mumbai, India. rekha.udani@gmail.com.
authors.forename: Rekha
authors.initials: R
authors.lastname: Udani
authors.affiliation: Faculty of Public Health, Universitas Indonesia, Depok Campus, Depok 16424, West Java, Indonesia. pratomohadi@gmail.com.
authors.forename: Hadi
authors.initials: H
authors.lastname: Pratomo
authors.affiliation: Bless-Tetada Kangaroo Mother Care Foundation Phil., Inc., 7431 P. Burgos Street, San Dionisio Paranaque City Metro, Manila, Philippines. sookeemd@yahoo.com.
authors.forename: Socorro
authors.initials: S
authors.lastname: De Leon-Mendoza
mesh_terms: D003906:Developing Countries; D005260:Female; D014943:Global Health / Q000639:trends; D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight / Q000254:growth & development*; D007231:Infant, Newborn; D007234:Infant, Premature; D060127:Kangaroo-Mother Care Method / Q000706:statistics & numerical data*; D000068101:Maternal-Child Health Services; D010679:Philippines / Q000453:epidemiology; D011247:Pregnancy
references.citation: Acta Paediatr. 2000 Sep;89(9):1137-40
references.pmid: 11071099
references.citation: Indian J Pediatr. 2001 Nov;68(11):1019-23
references.pmid: 11770234
references.citation: Indian J Pediatr. 2005 Jan;72(1):35-8
references.pmid: 15684446
references.citation: Lancet. 2005 Mar 19-25;365(9464):1087-98
references.pmid: 15781104
references.citation: Acta Paediatr. 2005 May;94(5):514-22
references.pmid: 16188735
references.citation: Health Policy Plan. 2005 Dec;20 Suppl 1:i5-i17
references.pmid: 16306070
references.citation: Indian J Pediatr. 2007 Aug;74(8):747-9
references.pmid: 17785897
references.citation: Indian J Pediatr. 2008 Jan;75(1):43-7
references.pmid: 18245934
references.citation: Indian Pediatr. 2008 Jan;45(1):17-23
references.pmid: 18250500
references.citation: Lancet. 2008 Sep 27;372(9644):1151-62
references.pmid: 18926277
references.citation: Indian J Pediatr. 2009 Jan;76(1):25-8
references.pmid: 19390999
references.citation: Acta Paediatr. 2010 Jun;99(6):812-9
references.pmid: 20219028
references.citation: Acta Paediatr. 2010 Jun;99(6):820-6
references.pmid: 20219044
references.citation: Int J Epidemiol. 2010 Apr;39 Suppl 1:i144-54
references.pmid: 20348117
references.citation: Lancet. 2010 Jun 5;375(9730):2045-9
references.pmid: 20569844
references.citation: Trop Doct. 2010 Oct;40(4):199-202
references.pmid: 20667921
references.citation: Cochrane Database Syst Rev. 2011 Mar 16;(3):CD002771
references.pmid: 21412879
references.citation: J Trop Pediatr. 2012 Oct;58(5):402-5
references.pmid: 22262676
references.citation: Lancet. 2012 Jun 9;379(9832):2162-72
references.pmid: 22682464
references.citation: Implement Sci. 2012 Aug 13;7:75
references.pmid: 22889113
references.citation: Acta Paediatr. 2012 Dec;101(12):e545-9
references.pmid: 23016710
references.citation: Am J Public Health. 2013 Apr;103(4):623-31
references.pmid: 23237181
references.citation: Lancet. 2013 Aug 3;382(9890):427-451
references.pmid: 23746772
references.citation: Lancet. 2013 Nov 30;382(9907):e26-7
references.pmid: 24246562
references.citation: BMC Pregnancy Childbirth. 2013 Nov 22;13:216
references.pmid: 24261785
references.citation: Health Policy Plan. 2015 Apr;30(3):386-96
references.pmid: 24604831
references.citation: Reprod Health. 2013;10 Suppl 1:S5
references.pmid: 24625233
references.citation: Health Policy Plan. 2015 Apr;30(3):334-44
references.pmid: 24717984
references.citation: Cochrane Database Syst Rev. 2014 Apr 22;(4):CD002771
references.pmid: 24752403
references.citation: Evid Based Med. 2014 Dec;19(6):201-3
references.pmid: 24799447
references.citation: Lancet. 2014 Jul 12;384(9938):189-205
references.pmid: 24853593
references.citation: Lancet. 2014 Jul 12;384(9938):e27-9
references.pmid: 24853596
references.citation: Lancet. 2014 Jul 12;384(9938):107-9
references.pmid: 24853598
references.citation: Lancet. 2014 Aug 2;384(9941):455-67
references.pmid: 24853599
references.citation: Lancet. 2014 Aug 2;384(9941):438-54
references.pmid: 24853600
references.citation: Lancet. 2014 Jul 12;384(9938):174-88
references.pmid: 24853603
references.citation: Lancet. 2014 Jul 26;384(9940):347-70
references.pmid: 24853604
references.citation: BMC Health Serv Res. 2014 Jul 08;14:293
references.pmid: 25001366
references.citation: Lancet Glob Health. 2013 Jul;1(1):e26-36
references.pmid: 25103583
references.citation: Lancet. 2015 Jan 31;385(9966):430-40
references.pmid: 25280870
references.citation: Bull World Health Organ. 2015 Jan 1;93(1):19-28
references.pmid: 25558104
references.citation: Pan Afr Med J. 2014 Sep 16;19:37
references.pmid: 25667699
references.citation: Pediatrics. 1997 Oct;100(4):682-8
references.pmid: 9310525
references.citation: Acta Paediatr. 1998 Apr;87(4):440-5
references.pmid: 9628303
references.citation: Acta Paediatr. 1998 Sep;87(9):976-85
references.pmid: 9764894