Building Spaces that make Kangaroo Mother Care possible

A baby born too soon is often so small that fear enters the room before hope. As Moses Wahome from Kenya shares his story, he had never seen a preterm baby before. When he first walked into a newborn unit to meet his baby, nothing could have prepared him for the sight that met his eyes. It was overwhelming. He glanced at his tiny baby, Zoe, and felt a rush of disbelief; she looked so fragile, and he struggled to comprehend that Zoe was alive.

This is the story of many parents at the birth of a small, sick newborn. Kangaroo Mother Care (KMC), an evidence-based intervention, has long been recognized for its potential to improve neonatal outcomes, particularly for newborns in low-resource settings. Moses can attest to this. When his daughter, Zoe, was a fragile newborn, he performed KMC to support his wife so she could get some rest. Providing Zoe with the benefits of KMC and the love of a father. His daughter, Zoe, is now 10 years old and is living proof that those early moments of skin-to-skin care can save lives.

Mitslal Asefa, a mother of triplets, a neonatal nurse, and the Head of the Neonatal Intensive Care Unit (NICU) at Suhul General Hospital in Tigray, Ethiopia, knows firsthand the power of KMC. She has served as a nurse for more than a decade, including six years leading the NICU at Suhul General Hospital, one of the busiest delivery healthcare facilities in Ethiopia. “KMC is an effective practice. I know its benefits from both my experience as a mother and my professional experience as a neonatal nurse. As a practicing nurse, I observe a significant difference between babies who receive KMC and those who do not. Whether it is a single baby, twins, or triplets, family members should support the mother, especially if she is physically challenged or has undergone a cesarean section delivery. Grandmothers, husbands, aunts, and others should help her practice KMC because it is very exhausting,” she says.

Data Driven Action

Through the NEST360 Implementation Tracker (NEST‑IT) dashboard, clinicians like Mitslal, hospital managers, and ministries of health can monitor KMC coverage across program, country, and hospital levels. The dashboard turns routine data into actionable insights, showing trends over time, progress toward targets, and enabling cross‑country learning through multi‑country comparisons.

Over the past year, the data highlight encouraging progress: across the five NEST360 partner countries – Ethiopia, Kenya, Malawi, Nigeria, and Tanzania – an average of 75% of babies weighing 1000–1999 g in NEST360‑implementing hospitals were initiated on KMC, reflecting a growing commitment to evidence‑based newborn care.

Mentorship and Quality Improvement (QI) initiatives under the NEST360 program are transforming KMC by addressing not only coverage gaps but also the quality of care. Data from the NEST-IT dashboard guides the development and progress of QI interventions. Early initiation of KMC, preferably within the first hour, has seen a steady increase over the last year (April 2025 – April 2026). This rise has been supported by the QI teams in the countries, who work closely with hospitals to identify gaps and improve the quality of care delivered. These efforts build local capacity through mentorship and structured QI approaches, leading to the development of facility-level change packages that guide hospitals in scaling up KMC practices. Beyond capacity building, mentorship provides continuous bedside coaching, peer-to-peer learning, and role modeling by experienced clinicians, which builds staff and caregiver confidence while ensuring consistent practice. 

KMC needs more investment

Providing KMC is not as simple as telling Mitslal or Moses to hold their baby close; it takes space to allow the mother-baby dyad to room together. They cannot provide skin-to-skin care while sitting in a chair in an overcrowded ward with no privacy, poor ventilation, and nowhere to rest. Exposing a baby to a crowded and poorly ventilated space can result in higher rates of infection and, sadly, increased mortality. Unfortunately, most government hospitals were designed without consideration for the infrastructural needs to support the care of babies born too small or too sick. It is common to see government hospitals use unsuitable, makeshift rooms as a space to care for babies.

“In our facility’s Special Care Baby Unit, we practice KMC. However, we don’t have a dedicated KMC ward or any reclining or KMC beds. Infrastructure investments must be tailored towards addressing these gaps to enhance the implementation of KMC in our facilities,” says one of the doctors from a hospital in Nigeria.

KMC adoption and implementation remain inconsistent across many health systems due to barriers such as space, staffing, caregiver support, and training for healthcare professionals. KMC needs dedicated spaces that are warm, clean, quiet, and welcoming. Spaces where mothers can sleep beside their babies, breastfeed comfortably, and feel comfortable staying for days or even weeks.

Dedicated KMC infrastructure helps create safe, functional, and family-centered environments that support skin-to-skin care, breastfeeding, thermal regulation, caregiver participation, and overall quality neonatal care. Improved infrastructure also supports workflow optimization, reduces overcrowding, and strengthens infection prevention practices.

Infrastructure Fund

NEST360 has prioritized the adoption and institutionalization of KMC for small and sick newborns. The NEST360 Infrastructure Fund supports targeted infrastructure improvements that strengthen the quality of maternal and newborn care across NEST360-implementing facilities in Ethiopia, Kenya, Malawi, Nigeria and Tanzania. The fund works in collaboration with hospital, subnational, and national leadership through a co-investment approach to identify and address infrastructure gaps that directly affect newborn survival and the quality of care.

Launched two years ago, the fund has supported investments that include the renovation and construction of newborn units and KMC wards, the installation of backup power systems, upgrades to biomedical engineering workshops, and the procurement of ward furnishings and essential newborn care equipment. As of December 2025, almost 50 projects have commenced across the five countries, with 27 already completed. A fifth of the projects have provided KMC-related support to the NEST360-implementing hospitals.

“Previously, we were unable to set up iKMC in our newborn unit due to limited space. Thanks to this fund, we have been able to renovate the dedicated KMC ward where iKMC services have also been introduced. This will have a positive impact by promoting immediate bonding between mothers and babies, reducing infections through decongestion, and boosting mothers’ and caregivers’ confidence in caring for their newborns. Ultimately, we expect this to reduce hospital stays and neonatal mortality,” says Eileen Muhavi, Nurse in Charge – Newborn Unit, Kakamega County Teaching and Referral Hospital in Kenya.

Renovation of the labour ward as well as purchase of essential furnishings at Machakos Level 5 hospital in Kenya

Country Snapshots

Immediate KMC in Ethiopia

Immediate Kangaroo Mother Care (iKMC), like the name suggests, means that Kangaroo care is started immediately after birth in the delivery room. This shifts the traditional approach of separation of the baby from the mother to allow for stabilization, keeping the baby and the mother close while stabilizing them, hence zero separation. By bringing families closer to the baby, immediate KMC reduces reliance on incubators, supports early breastfeeding, helps babies come off oxygen earlier, shortens hospital stays, and eases pressure on overcrowded newborn units. Additionally, it strengthens teamwork and linkage among the labor ward, the newborn unit, and the postnatal wards. In Ethiopia, seven hospitals are undergoing structural renovations to facilitate the implementation of iKMC.

Last year, NEST360 ran a cross-country learning experience on implementing iKMC at the WHO iKMC site at Hawassa Teaching and Referral Hospital. The learning experience involved 19 clinicians (including nurses and pediatricians) from 5 hospitals implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania. The staff spent time with the local team implementing iKMC in Hawassa, and they were prepared, inspired, and empowered to initiate iKMC in their own facilities. These initial 5 hospitals have since implemented the same in their hospitals and served as iKMC learning sites in their countries. The KMC implementation ladder below was used to assess the readiness of each hospital and guide implementation. The effect of this learning experience is already being seen as the number of hospitals implementing iKMC has increased from the initial 5 to 23, with over 350 babies in total already started on iKMC and discharged home.

Mentor mother supporting mothers with KMC in Kenya

As staffing continues to be a challenge for most hospitals, in Kenya, hospitals turn to mentor mothers to support the adoption of KMC in their dedicated KMC wards. These mentor mothers have all successfully walked the challenging road. They have carried premature babies’ skin-to-skin for hours, days, and weeks. They understand the exhaustion, the fear, and the hope. Today, they return to neonatal units not as patients, but as mentors. Trained to guide others, they bring empathy, credibility, and cultural resonance that no textbook or clinical instruction can match. Their presence transforms wards: mothers who once felt isolated now find encouragement, practical coaching, and a sisterhood of support. The impact is remarkable. In two hospitals implementing with NEST360 in Kenya, KMC coverage rose from 74% to 100% at one hospital and from 58% to 95% at another. Read more about mentor mothers here.

Data-Driven Action in Malawi

Low KMC coverage in Malawi last year was first identified through the NEST-IT dashboard, which enables hospitals to track performance against their targets and pinpoint gaps in newborn care delivery. To turn the tide, healthcare professionals used quality improvement methods to identify hospital-specific challenges. This exercise uncovered two key root causes: poor data capturing and inconsistent staff allocation to KMC wards. In response, the hospitals strengthened data collection, improved nurse and support staff deployment in the wards, and actively involved mothers through task shifting and empowerment. These targeted changes helped build stronger nurse–mother relationships and created a more responsive, supportive environment for increasing KMC uptake.

Nigeria Kangaroo Mother Care Operational Guidelines

In Nigeria, NEST360, together with other partners, supported the MoH in finalizing and validating a set of Kangaroo Mother Care (KMC) Operational Guidelines. This collaboration aimed to seamlessly integrate the WHO’s expert recommendations into Nigeria’s existing KMC framework. This guideline assists programme and health facility managers in establishing KMC units across Nigeria. It also provides service providers with a clear idea of what KMC is and how KMC techniques can be implemented when caring for low birth weight infants, helping reduce neonatal mortality. These guidelines align with the World Health Organization’s best practices for the care of preterm and low-birth-weight infants.

KMC Wards Infrastructure Improvement in Tanzania

In many communities, cultural and social norms can make it difficult for fathers to participate openly in KMC within shared maternity or newborn spaces. To meet this challenge, newborn care spaces are being improved across regional, district, and tertiary hospitals to accommodate family-centered care for KMC services. Amana Regional Referral Hospital in Tanzania has created a dedicated Kangaroo Father Care room with two beds to provide a private, respectful environment where fathers can bond skin-to-skin with their babies, support the mothers, and actively participate in newborn care. In addition to the Father’s Care room, a 15-bed KMC unit primarily for new mothers has been added, and renovations to the neonatal ward have been completed at the hospital.

At Mawenzi Regional Referral Hospital in Moshi, Tanzania, NEST360 upgraded the Neonatal Intensive Care Unit (NICU), refurbishing the KMC room with beds and distributing life-saving technologies, including CPAP machines, oxygen concentrators, and phototherapy devices, which are critical for the survival of small and sick newborns. At the district level, a major renovation of the neonatal unit at Mabwepande District Hospital was completed. One of the most impactful developments in this neonatal care unit was the introduction of Kangaroo Mother Care services. Learn more about KMC at Mabwepande District Hospital.

KMC shows what is possible when evidence, high-quality care, and well-designed health systems work together. For KMC to truly save lives at scale, it must be supported by the basics: functioning newborn spaces for the mother-infant dyad, reliable power, skilled healthcare professionals, and the right equipment in the right space. For resources on strengthening and implementing KMC, check out the Change Package Ideas on our website and the KMC Implementation Pathway on the Newborn Toolkit Website.