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
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.