Programmatic implementation of kangaroo mother care: a systematic synthesis of grey literature

BackgroundEvidence on the effectiveness of kangaroo mother care (KMC) is available and guidelines have been formulated. However, little is known about the programmatic implementation of KMC at national and subnational levels. MethodsA structured search of grey literature was conducted to identify reports of national or subnational level implementation of KMC to understand the population-based coverage of KMC, availability of KMC services at national and subnational levels, programmatic approaches to scale, and health systems actions that may influence KMC scale-up. The search strategy included two rounds of screening using a variety of grey literature search engines, portals, repositories, and targeted websites, as well as snowball sampling. Data from 212 documents were extracted and transferred into a database with an extensive topic list. These documents were then classified as "for in-depth analysis", "possible nuggets", and "not important". Further analysis of 42 information-rich documents was conducted with NVivo software to identify recurring themes. FindingsWe found information on KMC implementation on a national or subnational scale for 18 countries. Estimates for national- or subnational-level population-based coverage of KMC were available from only six countries (Colombia 63%, the Philippines 53%, Malawi 22%, Bangladesh 22%, India 13%, Viet Nam 8%). Information on the availability of KMC services was scant and fragmented, with no information on their quality. Programmatic KMC implementation is characterised by leadership from a variety of implementation partners and by different implementation trajectories. Countries for which information on KMC implementation was available shared common health system actions such as the inclusion of KMC in national policy, recognition of KMC as a priority newborn health intervention and strong advocacy by champions at all levels, dedicated investment in KMC and in some cases insurance cover for KMC, capacity building and motivation among health workers, dedicated space for KMC with equipment and supplies, support for KMC practice, and data collection and use. ConclusionProgrammatic implementation of KMC requires action in multiple health system building blocks with a focus on monitoring and evaluation of availability and quality of services, along with coverage.