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. Data sharing for pure research purposes is available upon request.

中文翻译：

---

通过政策、监管和系统改革来推动菲律宾的袋鼠妈妈护理，以推动生育习惯的改变

世卫组织建议对稳定的早产和低出生体重婴儿使用袋鼠妈妈护理 (KMC)，因为与传统的基于保育箱的护理相比，它已被证明可将死亡率降低一半。尽管 KMC 适用于资源匮乏的环境，但在低/中等收入国家中对 KMC 的采用却很有限。本文回顾了促成 KMC 在菲律宾采用和扩展的因素。早期引入始于 1999 年，但直到 2014 年才在全国范围内推广缓慢，之后观察到全国采用率有了显着改善。2014 年至 2019 年间，实施 KMC 的目标医院比例从 3% 上升至 43%，到该时期末，53% 的早产儿和低出生体重儿接受了 KMC。扩张由政府领导，政府投入资源并与发展伙伴和非政府组织建立伙伴关系。KMC 的扩大建立在引入循证新生儿护理实践的基础上。多学科团队领导的基于共识的政策、协议、监管和健康保险变革促进和支持了实践变革。一种改变和维持临床实践的新方法使用医院团队进行在职临床指导，并使用本地数据来改变环境以支持实践。制度化的早期皮肤接触、母亲和新生儿不分离以及早期开始纯母乳喂养，增加对母亲的责任，推动员工和家庭之间的文化变革，使 KMC 得到更多的接受和吸收。必须持续和扩大财政和计划支持，以解决持续的挑战，包括人员配备缺口、KMC 的可用空间、一些员工采用新做法的意愿以及缺乏临床指导和随访资源。可应要求提供用于纯研究目的的数据共享。