Kangaroo mother care (KMC) is an evidence-based intervention to improve neonatal survival, yet it has low coverage in many countries, including Uganda. In 2022, the WHO extended the global guidelines on preterm care to include KMC initiated as soon as possible after birth, regardless of clinical stability, at all levels of facility-based newborn care.  However, cost and infrastructure requirements were not defined. A previous study by our team found that substantial investment was required for infrastructure improvements, notably expansion of neonatal unit floor space, and the purchase of essential equipment and supplies to enable safe implementation of early KMC across the five hospitals participating in the OMWaNA trial in Uganda. These findings highlighted the need for dedicated funding to adopt this intervention as well as budgeting tools and national investment cases to inform scale-up.

Importantly, before early KMC can be safely implemented, hospital care for small and sick newborns needs to be provided in accordance with WHO standards. Yet there are many gaps in coverage, quality and equity. The Ugandan government has requested an investment case to cost the national scale-up of small and sick newborn care, including the incremental cost of early KMC, to reach 80 percent of district hospitals. We are working with the Ugandan Ministry of Health, policymakers and healthcare providers to develop this investment case, including the following steps: 1) mapping relevant government targets and policies; 2) conducting impact modeling to project lives saved and deaths averted from meeting these targets; 3) estimating the setup and running costs, including infrastructure, equipment and human resources at district hospitals and lower-level facilities; 4) calculating the projected return on investment; 5) analyzing the budget impact. In partnership with the Uganda Pediatric Association and the national Newborn Steering Committee, we will co-develop an ‘early KMC implementation toolkit,’ including a portfolio of tools and resources to support implementation of small and sick newborn care.