Resistance to implementing Kangaroo Mother Care in developing countries, and proposed solutions

Background: Randomized clinical trials have shown that Kangaroo Mother Care (KMC) can decrease morbidity and mortality due to low birthweight. Between 1994 and 2004, 44 teams in 25 developing countries were trained in KMC in Bogota, Colombia; however, not all the teams were successful in initiating their own programmes and, of those that started, not all replicated the validated model. Aim: To identify factors involved in unsuccessful KMC implementation and find solutions. Methods: A study was conducted in which 17 open-ended questionnaires were sent by e-mail to the coordinators of functioning KMC programmes in 15 countries, and 15 site visits were made to institutes that reported problems in starting programmes. The information was classified according to the perceived obstacle and the KMC model component involved. Results: The early-discharge component (including ambulatory follow-up) was that found most difficult to implement. Resistance from health professionals, mothers and families was often related to local cultural practices. Conclusion: Active surveillance for and appropriate identification of obstacles usually indicated the appropriate solution. Some of the obstacles were common to many second-generation KMC programmes, making this information valuable for the implementation of programmes.