PT  - JOURNAL ARTICLE
AU  - Anthony Pascual Calibo
AU  - Socorro De Leon Mendoza
AU  - Maria Asuncion Silvestre
AU  - John Charles Scott Murray
AU  - Zhao Li
AU  - Priya Mannava
AU  - Jacqueline Kitong
AU  - Mark Benjamin Quiazon
AU  - Howard Lawrence Sobel
TI  - Scaling up kangaroo mother care in the Philippines using policy, regulatory and systems reform to drive changes in birth practices
AID  - 10.1136/bmjgh-2021-006492
DP  - 2021 Aug 01
TA  - BMJ Global Health
PG  - e006492
VI  - 6
IP  - 8
4099  - http://gh.bmj.com/content/6/8/e006492.short
4100  - http://gh.bmj.com/content/6/8/e006492.full
SO  - BMJ Global Health2021 Aug 01; 6
AB  - The WHO recommends kangaroo mother care (KMC) for stable preterm and low birthweight babies because it has been demonstrated to reduce mortality by up to half compared with conventional incubator-based care. Uptake of KMC in low/middle-income countries has been limited, despite its suitability for low-resource environments. This paper reviews factors that contributed to the adoption and expansion of KMC in the Philippines. Early introduction began in 1999 but national scale-up was slow until 2014 after which a significant improvement in national adoption was observed. The proportion of target hospitals implementing KMC rose from 3% to 43% between 2014 and 2019, with 53% of preterm and low birthweight babies receiving KMC by the end of this period. Expansion was led by the government which committed resources and formed partnerships with development partners and non-governmental organisations. Scale-up of KMC was built on the introduction of evidence-based newborn care practices around birth. Practice changes were promoted and supported by consensus-based policy, protocol, regulatory and health insurance changes led by multidisciplinary teams. A new approach to changing and sustaining clinical practice used hospital teams to conduct on-the-job clinical coaching and use local data to make environmental changes to support practices. Institutionalisation of early skin-to-skin contact, non-separation of mother and newborn and early initiation of exclusive breast feeding, with increased responsibility given to mothers, drove a cultural change among staff and families which allowed greater acceptance and uptake of KMC. Financial and programmatic support must be sustained and expanded to address ongoing challenges including staffing gaps, available space for KMC, willingness of some staff to adopt new practices and lack of resources for clinical coaching and follow-up.Data sharing for pure research purposes is available upon request.