Scaling up kangaroo mother care in the Philippines using policy, regulatory and systems reform to drive changes in birth practices

Abstract

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.

Keywords: child health; health policy; health systems; public health.

Figure 1

Facilities introducing Essential Intrapartum and Newborn Care (EINC) and kangaroo mother care (KMC) and total newborn insurance package claims, Philippines, 2008–2019. Data sources: Biennial regional EINC progress assessments, 2015, 2017 and 2019 and Philippines Insurance Corporation statistics, 2011–2018.

Figure 2

Facility-based estimates of early newborn care practices, Philippines, 2008–2019. Data sources: 2008: Baseline observations of 451 births at 51 hospitals; 2015: 179 postpartum maternal interviews from a sample of 17 national and subnational hospitals; 2017: 272 postpartum maternal interviews from a sample of 28 national and subnational hospitals; 2019: 478 postpartum maternal interviews from a sample of 45 national and subnational hospitals. KMC, kangaroo mother care.