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.
CONCLUSION : 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.
