Scaling up kangaroo mother care (KMC): A change package developed through the integration of quality improvement and implementation research for the NEST360 Alliance in Ethiopia, Kenya, Malawi, Nigeria, and Tanzania

Abstract Background Kangaroo mother care (KMC) is an evidence-based intervention known to reduce newborn mortality. NEST360 is an initiative supporting mortality reduction in small and sick newborns in five countries in Africa (Ethiopia, Kenya, Malawi, Nigeria, and Tanzania) including through increase in KMC coverage. Combining quality improvement (QI) and implementation research (IR), NEST360 developed a facility-level resource to improve KMC adoption and quality of care. Methods Using data from QI projects, team meetings, literature, and interviews with high-performing facilities, NEST360 developed a change package including a driver diagram and change ideas. Input from multidisciplinary experts, including NEST360’s external advisory committee for improving quality, facility and NEST360 QI leads, clinical experts, and the African Neonatal Association refined the package, aligning it with NEST360’s QI training materials and global and national guidelines. Change ideas were mapped to the implementation research (IR) Expert Recommendations for Implementation Change (ERIC) implementation strategies. Results The driver diagram included five primary drivers mapped to 62 change ideas, with mechanisms linked to barriers and measurable process measures. Sixty-one of the 62 change ideas were mapped to ERIC strategies, with change physical structure and equipment and conduct ongoing trainingsthe most common. The package is being piloted at select NEST360-supported sites to improve KMC coverage and quality while assessing user preferences. Conclusions This project offers a practical example for combining QI and implementation research to address KMC barriers and enhance quality of care and newborn survival. This approach provides great value, taking local solutions and turns them into generalizable knowledge that can be shared and used in other hospitals and/or countries. Next steps include refining the package, as well as analyzing QI project data to evaluate change idea effectiveness.