The global agenda for improved neonatal care includes the scale-up of kangaroo mother care (KMC) services. The establishment of district
clinical specialist teams (DCSTs) in South Africa (SA) provides an excellent opportunity to enhance neonatal care at district level and ensure
translation of policies, including the requirement for KMC implementation, into everyday clinical practice. Tshwane District in Gauteng
Province, SA, has been experiencing an increasing strain on obstetric and neonatal services at central, tertiary and regional hospitals in
recent years as a result of growing population numbers and rapid up-referral of patients, with limited down-referral of low-risk patients to
district-level services. We describe a successful multidisciplinary quality improvement initiative under the leadership of the Tshwane DCST,
in conjunction with experienced local KMC implementers, aimed at expanding the district’s KMC services. The project subsequently served
as a platform for improvement of other areas of neonatal care by means of a systematic approach.