Barriers and Facilitators to Kangaroo Mother Care Implementation in Côte D’Ivoire: A Qualitative Study

Background: Kangaroo Mother Care (KMC) is a key high impact intervention, low technology and cost-effective for the care of preterm and low birth weight newborn. Côte d’Ivoire has adopted the intervention and opened the first KMC unit in 2019. After one year of functioning, we aimed to assess barriers and facilitators of KMC implementation as well as proposed solutions to improve KMC implementation in Côte d’Ivoire. Method: This was a qualitative study, using semi-structured interviews, carried out in September 2020 in the first KMC unit opened at the Teaching Hospital of Treichville. The study involved healthcare providers providing KMC and mothers of newborn who were receiving or received KMC at the unit. A thematic analysis was performed using Nvivo 12. Results: A total of 44 semi-structured interviews were conducted, 12 with healthcare providers and 32 with mothers. The barriers identified were lack of supplies, insufficiency of human resources, lack of space for admission, lack of home visits, lack of food for mothers, lack of collaboration between health services involved in newborn care, increased workload, the beliefs of carrying the baby on the chest, partner resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, leadership, the cost of the intervention, the value of the intervention for healthcare providers, mothers −healthcare providers relationship, mothers’ adherence to KMC.The proposed solution to improve KMC implementation were volunteer staff motivation, intensifying mothers and families education and counselling, the recruitment of a psychologist and the involvement of all stakeholders. Conclusions: Our study highlighted the challenges to implement KMC in Côte d’Ivoire with unique and specific barriers to implementation. We recommend to researchers and decision makers to respectively design strategies and adopt intervention that specifically address these barriers and facilitators to a better uptake of KMC. Decision makers should also take into account the proposed solution for a better implementation and scaling up of KMC intervention.