Open Access Highly Accessed Research article

Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa

Anne-Marie Bergh1*, Kate Kerber2, Stella Abwao34, Joseph de-Graft Johnson34, Patrick Aliganyira5, Karen Davy1, Nathalie Gamache3, Modibo Kante6, Reuben Ligowe7, Richard Luhanga7, Béata Mukarugwiro89, Fidèle Ngabo10, Barbara Rawlins49, Felix Sayinzoga10, Naamala Hanifah Sengendo5, Mariam Sylla11, Rachel Taylor34, Elise van Rooyen1 and Jeremie Zoungrana89

Author Affiliations

1 MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa

2 Save the Children, Cape Town, South Africa

3 Save the Children, Washington, DC, USA

4 Maternal and Child Health Integrated Program (MCHIP), Washington, DC, USA

5 Save the Children International, Kampala, Uganda

6 Save the Children International, Bamako, Mali

7 Save the Children International, Lilongwe, Malawi

8 Maternal and Child Health Integrated Program (MCHIP), Kigali, Rwanda

9 Jhpiego, Washington, DC, USA

10 Ministry of Health, Kigali, Rwanda

11 Department of Paediatrics, Gabriel Toure Teaching Hospital, Bamako, Mali

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BMC Health Services Research 2014, 14:293  doi:10.1186/1472-6963-14-293

Published: 8 July 2014



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.


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.


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.


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.

Delivery of health care; Implementation; Infant premature; Kangaroo mother care; Neonatal mortality; Newborn health