How Innovations Stick: The Case of Kangaroo Mother Care
Global health is full of innovative products and programs that, once they reach the point of care in the field, either are never taken up or are not sustained. The range of “failed” innovations goes from high technology machines to simple standards of care. One exception to this trend is Kangaroo Mother Care (KMC), an innovative program for premature infants at high risk of early mortality which has become one of the most widely followed infant care programs ever. But what makes such innovations stick?
A key starting point is the scope of the problem. There needs to be a “burning” issue that demands attention. The WHO’s Sustainable Development Goal 3.2 (SDG 3.2) sets out to end preventable deaths of newborns and children under five years of age. In recent decades, numerous efforts to promote children’s wellbeing have resulted in a 60% reduction in under-five mortality rates. From 1990 through 2022, for every 1,000 live births the level of fatalities over the first five years of life has plummeted from 93 deaths to 37. However, there is still a considerable journey ahead to reach SDG 3.2.
As we see with many global health challenges, the bulk of this burden is carried by low-income countries. Although we must celebrate countries such as Canada and Belgium that have achieved SDG 3.2, the massive difference across countries is both a global equity issue and the source of disease outbreaks that can reach across national borders. This creates an imperative to improve the health systems that do not have the facilities or resources to make the same progress. Under-five mortality is a major indicator of the strength of a health system because of how often cases are preventable. It reflects efficiency in access to care, particularly for women and children, implies health education levels and quality of infrastructure, overall showing the performance of that facility.
Of the five million deaths of children under-five in 2022, 2.4 million occurred in the first 28 days of life. This is often caused by premature birth and inadequate care for these infants. It’s necessary to promote specific initiatives that target the under-five population, including immunization programs, nutritional interventions, emphasis on maternal health, efforts to reduce poverty, and a multitude of others. These initiatives are becoming increasingly important to promote, particularly in the face of immunization refusal that is predicted to cause spikes in the under-five mortality.
The next element of innovations that stick is having a simple approach. KMC is a method to care for preterm and low-birth-weight infants. This low-cost, adaptable guidance system is recorded to be highly effective in reducing the mortality rates of babies born prematurely. The entire program can be laid out in a simple box:
A third element for sustained innovations is reliance on hard facts. Investment was made in analyzing the impact of KMC and these studies have shown that KMC reduced neonatal sepsis rates, hypothermia, hypoglycemia, and hospital readmissions. Newborns who were treated using KMC have reduced pain measures, better temperature control, saw head circumference growth and higher oxygen saturation, all essential components of healthy growth.
KMC has now become the standard of care in both low- and high- income countries. To reach SDG 3.2, this low-cost, implementable and simple solution is essential for equitable access to care when resources are not available. KMC is a modern method of care that can be used regardless of access to funding and technology.
So, what other factors contributed to KMC becoming standard of care?
Various studies have showed us that uptake of KMC is strongly influenced by awareness and acceptance, readiness, socio-cultural settings, hospital policies, advocacy for KMC and an individual’s intention to perform KMC.
KMC was developed in the 1970s as a response to high rates of infant mortality being experienced in Colombia. In addition to the scientific studies mentioned above, KMC seems to have stuck and become standard of practice precisely because its implementation was extensively studied from a sociological perspective as it was put in place. Partially based on these studies, the KMC program was made highly adaptable to a variety of socio-economic and geographic settings. Finally, partly because of the investment in data and adaptability, KMC of course also benefited from international support from major organizations, such as the World Health Organization. Governments and NGOs alike have led education campaigns, published research, advocated for it, and taken many other steps to ensure it becomes a mainstream treatment.