Malaria Vaccine Introduction in Cameroon: Early Results 30 Days into Rollout.

Cameroon introduced the malaria vaccine in its routine immunization program on 22 January 2024 in the 42 districts out of 200 that are among the most at risk of malaria. A cross-sectional analysis of the data on key vaccine events in the introduction roadmap and the vaccine uptake during the first 30 days was conducted. In addition to available gray literature related to the introduction of the malaria vaccine, data on the malaria vaccine uptake by vaccination session, collected through a digital platform, were analyzed. A total of 1893 reports were received from 22 January 2024 to 21 February 2024 from 766 health facilities (84% of overall completeness). Two regions out of ten recorded less than 80% completeness. As of 21 February 2024, 13,811 children had received the first dose of the malaria vaccine, including 7124 girls (51.6%) and 6687 boys (48.4%). In total, 36% of the children were vaccinated through outreach sessions, while 61.5% were vaccinated through sessions in fixed posts. The overall monthly immunization coverage with the first dose was 37%. Early results have shown positive attitudes towards and acceptance of malaria vaccines. Suboptimal completeness of data reporting and a low coverage highlight persistent gaps and challenges in the vaccine rollout.

Setting up a data system for monitoring malaria vaccine introduction readiness and uptake in 42 health districts in Cameroon.

Three months after the first shipment of RTS,S1/AS01 vaccines, Cameroon started, on 22 January 2024, to roll out malaria vaccines in 42 districts among the most at risk for malaria. Cameroon adopted and implemented the World Health Organization (WHO) malaria vaccine readiness assessment tool to monitor the implementation of preintroduction activities at the district and national levels. One week before the start of the vaccine rollout, overall readiness was estimated at 89% at a national level with two out of the five components of readiness assessment surpassing 95% of performance (vaccine, cold chain and logistics and training) and three components between 80% and 95% (planning, monitoring and supervision, and advocacy, social mobilisation and communication). 'Vaccine, cold chain and logistics' was the component with the highest number of districts recording below 80% readiness. The South-West and North-West, two regions with a high level of insecurity, were the regions with the highest number of districts that recorded a readiness performance below 80% in the five components. To monitor progress in vaccine rollout daily, Cameroon piloted a system for capturing immunisation data by vaccination session coupled with an interactive dashboard using the R Shiny platform. In addition to displaying data on vaccine uptake, this dashboard allows the generation of the monthly immunisation report for all antigens, ensuring linkage to the regular immunisation data system based on the end-of-month reporting through District Health Information Software 2. Such a hybrid system complies with the malaria vaccine rollout principle of full integration into routine immunisation coupled with strengthened management of operations.

Status of Routine Immunization Coverage in the World Health Organization African Region Three Years into the COVID-19 Pandemic.

Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed to assess the status of routine immunization in the WHO African Region disrupted by the COVID-19 pandemic. In 2022, coverage for the first and third doses of the diphtheria-tetanus-pertussis-containing vaccine (DTP1 and DTP3, respectively) and the first dose of the measles-containing vaccine (MCV1) in the region was estimated at 80%, 72% and 69%, respectively (all below the 2019 level). Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose children were recorded (19.0% of the target population). Ten countries in the region accounted for 80.3% of all zero-dose children, including the four most populated countries. Reported administrative coverage greater than WUENIC-reported coverage was found in 19 countries, highlighting routine immunization data quality issues. The WHO African Region has not yet recovered from COVID-19 disruptions to routine immunization. It is critical for governments to ensure that processes are in place to prioritize investments for restoring immunization services, catching up on the vaccination of zero-dose and under-vaccinated children and improving data quality.

First Field Test of the Novel Integration Mapping Tool for COVID-19 Vaccination Integration into National Immunization Programs and Primary Healthcare-A Case Study from Côte d'Ivoire.

INTRODUCTION: With the containment of the COVID-19 pandemic in Côte d'Ivoire, efforts were made to seamlessly integrate COVID-19 vaccination into the national immunization program. A collaborative initiative involving UNICEF, WHO, GAVI, and partner organizations resulted in the creation of the COVID-19 Vaccine Integration Mapping Tool. This paper presents a case study documenting the field testing of the integration mapping tool and assessing the integration of COVID-19 vaccination within primary healthcare and routine immunization in Côte d'Ivoire. The study aims to describe the pilot process, gather feedback on tool usefulness and challenges, and establish integration priorities through roadmap development. METHODS: Under the guidance of the Ministry of Health and Universal Coverage Cabinet, a workshop was conducted with participants from major health programs to field test the tool. Data analysis was performed using Excel, and the results were presented through tables, heat maps, and line graphs. RESULTS: The first-of-its-kind field test of the integration mapping tool in Côte d'Ivoire showcased its potential to bring key partners together to discuss the current state of integration, improve transparency about resource allocation, and enhance data management for the incorporation of COVID-19 vaccination into existing immunization systems. The integration of COVID-19 vaccines in Côte d'Ivoire showed a moderate level of progress, with improvement needed in resource allocation, payment systems, targeting of highest-risk groups and vaccine administration. Support should be increased for target population identification, distribution points, quality of care mechanisms, and health personnel training. Health information systems and access to essential medicines were relatively satisfactory. Integration into existing programs, intersectoral collaboration, national health strategy, communication strategy, community participation, and data utilization require improvement. The post-workshop satisfaction survey gave the tool a score of 7 out of 10. Early lessons from Côte d'Ivoire provide guidance on enhancing integration, focusing on data-driven decision-making, collaboration, stakeholder engagement, and effective leadership. CONCLUSIONS: The field test of the integration mapping tool (IMT) in Côte d'Ivoire is groundbreaking as it exemplifies the transformative potential of innovative tools in immunization practices. Application of the IMT sets a precedent for seamless COVID-19 vaccination integration worldwide, emphasizing data-driven decision-making, collaboration, timing, and leadership. The success of the pilot exercise in Côte d'Ivoire was attributed to political commitment, well-facilitated workshops, assessments, and the fact that the team in the country had previously developed an initial integration plan.

Polio outbreaks in Cameroon following the COVID-19 pandemic.

Polio is an infectious and disabling life-threatening disease caused by the poliovirus. This disease is prevented through vaccination. Though this viral infection has been eliminated in most parts of the world, a few countries are still endemic to wild poliovirus. In 2020, the World Health Organization (WHO) African Region, including Cameroon, was certified free of wild poliovirus. Some countries recurrently report circulating vaccine-derived poliovirus cases (cVDPV) despite recorded achievements. Also, the risk of importing poliovirus from endemic settings remains, particularly in the context of coronavirus disease (COVID-19). This study aimed to assess the state of polio in Cameroon and identify the situation during COVID-19. A data review was conducted from February to March 2023. Data on polio cases and vaccination coverage per region of Cameroon were reviewed from 2014 to 2022. Data were analyzed with Microsoft Excel, and the results were presented as proportions. The last wild poliovirus was reported in Cameroon in 2014, and the country benefitted from a response. No case of poliovirus was detected in the country from 2015 to 2018. After that, an increasing number of type two cVDPV were reported across 50% of the country's regions from 2019 to 2022. The outbreaks benefitted from responses with various oral polio vaccines, including the type two novel oral polio vaccine (nOPV-2). Though wild polioviruses have been eliminated in most countries, including Cameroon, cVDPV remains a significant problem. There is an urgent need to strengthen disease surveillance and vaccination to prevent cVDPV-2 in this country, particularly in the COVID-19 context.

Beyond the numbers: An in-depth look at Cameroon's fifth national COVID-19 vaccination campaign through geographical and gender lenses.

BACKGROUND: Cameroon has been struggling with low Covid-19 vaccination coverage, with only 4.5 % of the population receiving the primary series as of November 2022. The COVID-19 Vaccine Delivery Partnership (CoVDP) conducted a high-level mission to Cameroon to assess progress and advocate for actions to address bottlenecks. The objective of the mission was to administer at least 3,000,000 doses of vaccines during the 5th Mass vaccination campaign. This study examines the factors contributing to the success of the campaign and uses a geographical and gender lens to assess the results. METHODS: The study is a secondary analysis of data from the DHIS2 collected during the 5th mass vaccination campaign for Covid-19. Descriptive statistics were used to assess coverages per location and gender expressed in OR. sccess factors, and chi-squared tests were used to assess differences in vaccine distribution across regions and by gender. RESULTS: This 5th vaccination campaign benefitted from a strong political commitment facilitated by CoVDP's mission, international support, collaboration, planning, supervision, and demand generation. The campaign recorded 2 019 118 administered vaccine doses, a staggering 46-fold increase in vaccinated individuals relative to the first round, with vaccination coverage reaching 10.1 % of the general population. However, the study reveals regional and gender disparities in vaccination coverage. Men had higher odds of being vaccinated than women in the three Sahel regions. Among individuals with comorbidities, the national coverage rate was only 14 %, and the Far North and East regions exhibited the lowest coverage rates. Janssen was the most used vaccine, and the total AEFI cases reported were 2 per 1000 vaccine doses. CONCLUSION: The 5th COVID-19 vaccination campaign in Cameroon saw a strong political commitment and was the most successful so far. Despite the gains, there was gender disparity in coverage in some regions. It is important to continue the established momentum, ensure equitable access in the Sahel regions, and reach high-priority groups with primary series and booster doses.

A rapid increase in coverage of COVID-19 vaccination, Central African Republic.

Problem: In 2021, Central African Republic was facing multiple challenges in vaccinating its population against coronavirus disease 2019 (COVID-19), including inadequate infrastructure and funding, a shortage of health workers and vaccine hesitancy among the population. Approach: To increase COVID-19 vaccination coverage, the health ministry used three main approaches: (i) task shifting to train and equip existing community health workers (CHWs) to deliver COVID-19 vaccination; (ii) evidence gathering to understand people's reluctance to be vaccinated; and (iii) bundling of COVID-19 vaccination with the polio vaccination programme. Local setting: Central African Republic is a fragile country with almost two thirds of its population in need of humanitarian assistance. Despite conducting two major COVID-19 vaccination campaigns, by January 2022 only 9% (503 000 people) of the 5 570 659 general population were fully vaccinated. Relevant changes: In the 6 months from February to July 2022, Central African Republic tripled its coverage of COVID-19 vaccination to 29% (1 615 492 out of 5 570 659 people) by August 2022. The integrated polio-COVID-19 campaign enabled an additional 136 040 and 218 978 people to be vaccinated in the first and second rounds respectively, at no extra cost. Evidence obtained through surveys and focus group discussions enabled the health ministry to develop communication strategies to dispel vaccine hesitancy and misconceptions. Lessons learnt: Task shifting COVID-19 vaccination to CHWs can be an efficient solution for rapid scaling-up of vaccination campaigns. Building trust with the community is also important for addressing complex health issues such as vaccine hesitancy. Collaborative efforts are necessary to provide access to COVID-19 vaccines for high-risk and vulnerable populations.

Implementation of targeted cholera response activities, Cameroon.

Objective: To describe the implementation of case-area targeted interventions to reduce cholera transmission using a rapid, localized response in Kribi district, Cameroon. Methods: We used a cross-sectional design to study the implementation of case-area targeted interventions. We initiated interventions after rapid diagnostic test confirmation of a case of cholera. We targeted households within a 100-250 metre perimeter around the index case (spatial targeting). The interventions package included: health promotion, oral cholera vaccination, antibiotic chemoprophylaxis for nonimmunized direct contacts, point-of-use water treatment and active case-finding. Findings: We implemented eight targeted intervention packages in four health areas of Kribi between 17 September 2020 and 16 October 2020. We visited 1533 households (range: 7-544 per case-area) hosting 5877 individuals (range: 7-1687 per case-area). The average time from detection of the index case to implementation of interventions was 3.4 days (range: 1-7). Oral cholera vaccination increased overall immunization coverage in Kribi from 49.2% (2771/5621 people) to 79.3% (4456/5621 people). Interventions also led to the detection and prompt management of eight suspected cases of cholera, five of whom had severe dehydration. Stool culture was positive for Vibrio cholerae O1 in four cases. The average time from onset of symptoms to admission of a person with cholera to a health facility was 1.2 days. Conclusion: Despite challenges, we successfully implemented targeted interventions at the tail-end of a cholera epidemic, after which no further cases were reported in Kribi up until week 49 of 2021. The effectiveness of case-area targeted interventions in stopping or reducing cholera transmission needs further investigation.

A rapid increase in coverage of COVID-19 vaccination, Central African Republic

Problem In 2021, Central African Republic was facing multiple challenges in vaccinating its population against coronavirus disease 2019 (COVID-19), including inadequate infrastructure and funding, a shortage of health workers and vaccine hesitancy among the population. Approach To increase COVID-19 vaccination coverage, the health ministry used three main approaches: (i) task shifting to train and equip existing community health workers (CHWs) to deliver COVID-19 vaccination; (ii) evidence gathering to understand people's reluctance to be vaccinated; and (iii) bundling of COVID-19 vaccination with the polio vaccination programme. Local setting Central African Republic is a fragile country with almost two thirds of its population in need of humanitarian assistance. Despite conducting two major COVID-19 vaccination campaigns, by January 2022 only 9% (503 000 people) of the 5 570 659 general population were fully vaccinated. Relevant changes In the 6 months from February to July 2022, Central African Republic tripled its coverage of COVID-19 vaccination to 29% (1 615 492 out of 5 570 659 people) by August 2022. The integrated polio­COVID-19 campaign enabled an additional 136 040 and 218 978 people to be vaccinated in the first and second rounds respectively, at no extra cost. Evidence obtained through surveys and focus group discussions enabled the health ministry to develop communication strategies to dispel vaccine hesitancy and misconceptions. Lessons learnt Task shifting COVID-19 vaccination to CHWs can be an efficient solution for rapid scaling-up of vaccination campaigns. Building trust with the community is also important for addressing complex health issues such as vaccine hesitancy. Collaborative efforts are necessary to provide access to COVID-19 vaccines for high-risk and vulnerable populations.

Challenges, best practices, and lessons learned from oral cholera mass vaccination campaign in urban Cameroon during the COVID-19 era.

BACKGROUND: Since 1971, Cameroon has been facing an ever-growing series of cholera epidemics; despite all the efforts made by the government to address this substantial public health problem. In 2020, in addition to the COVID-19 pandemic, Cameroon recorded a high cholera case fatality rate of 5.3% following epidemics noted in the South, Littoral, and South-West regions which is far higher than the 1% World Health Organization acceptable rate. METHODOLOGY/PRINCIPAL FINDINGS: The Ministry of Public Health organized a reactive vaccination campaign against cholera to address the high mortality rate in the affected health districts. The first round was in August 2020 and the second in March 2021. We conducted a cross-sectional study and reviewed this vaccination campaign's challenges, best practices, and lessons. The vaccination coverage for the two doses of the oral cholera vaccine was 80.4%, with a refusal rate as high as 67%. People 20 years and above recorded the lowest vaccination coverage. The main challenge was misinformation about the cholera vaccine. The best practice was thorough population sensitization through community actors. CONCLUSION: Proper communication will always brave the odds of hesitancy and favor mass population vaccination to thwart hesitancy and consolidate herd immunity.

Stillbirths in Cameroon: an analysis of the 1998-2011 demographic and health surveys.

BACKGROUND: Many countries, including Cameroon, have found it challenging to estimate stillbirths, as there are limited available reports accurately. This analysis aimed to assess stillbirth rates and identify risk factors for stillbirth in Cameroon using successive Demographic and Health Survey data. METHODS: We conducted a cross-sectional analysis of data collected during the Demographic and Health Surveys of 1998, 2004, and 2011. Data were analyzed using SPSS 20.0. Logistic regressions were used to identify factors associated with stillbirth through odds ratios (ORs) at 95% confidence intervals (CI). Results were considered statistically significant at p-value less than 0.05. RESULTS: The crude stillbirth rate was 21.4 per 1,000 births in 2004 and 24 per 1,000 births in 2011, with respective standard errors of 1.8 and 1.3. The stillbirth rate increased with the mother's age (p < 0.001). The stillbirth rate reduction was prolonged between 1998 and 2011, with an annual reduction rate of 1.6%. The study observed that residing in rural areas, low socioeconomic status, and low level of education were risk factors associated with stillbirths. CONCLUSION: Cameroon's stillbirth rate remains very high, with a slow reduction rate over the last 20 years. Although some efforts are ongoing, there is still a long way forward to bend the curve for stillbirths in Cameroon; supplementary strategies must be designed and implemented, especially among rural women, the poor, and the less educated.

The first 30 days of COVID-19 vaccination in Cameroon: achievements, challenges, and lessons learned.

Introduction: Cameroon's national vaccination campaign was launched on April 12, 2021, amid a nationwide outbreak of COVID-19 with two types of vaccines. This study provides preliminary evidence to assess early outputs of the COVID-19 vaccination response strategy implementation. Methods: a cross-sectional study was conducted from April 12, 2021, to May 11, 2021, and data on COVID-19 vaccination were reviewed from the Ministry of Public Health database. Descriptive statistical analyses were conducted. Results: thirty days after the introduction of COVID-19 vaccines, just about five percent of the target population was vaccinated. Women represented one-third of the people vaccinated regardless of age and health conditions. Although AEFI reported were minor and scanty with both vaccines, most of the vaccinated did not come back for their second dose. There was a need to build confidence among eligible beneficiaries to expand the benefits of vaccination to control the current pandemic. Conclusion: the country was still far below the target, which was worrisome given that vaccine uptake was slow. Also, 391 200 doses of the Covishield were at risk of expiration in August 2021. This study offers insights into those early efforts contributing to significant discussions about the approaches to improve service delivery and vaccine uptake.

Reactive mass vaccination campaign against cholera in the COVID-19 context in Cameroon: challenges, best practices and lessons learned.

INTRODUCTION: since 1971, Cameroon is facing a growing series of cholera epidemics despite all the efforts made by the government to address this huge public health threat. In 2020, in addition to the COVID-19 pandemic, Cameroon recorded a high cholera case fatality rate of 4.3% following epidemics noted in the South, Littoral and South-West regions. The Cameroon Ministry of Public Health, has thus organized a reactive vaccination campaign against cholera to address the high mortality rate in the affected health districts of those regions. The objective of this study was to describe the challenges, best practices and lessons learned drawing from daily experiences from this reactive vaccination campaign against cholera. METHODS: we conducted a cross-sectional study drawn from the results of the campaign. We had a target population of 631,109 participants aged 1 year and above resident of the targeted health areas. RESULTS: the overall vaccination coverage was 64.4% with a refusal rate ranging from 0-10% according to health districts. Vaccination coverage was the lowest among people aged 20 years and above. The main challenge was difficulty maintaining physical distanciation, the main best practice was the screening of all actors taking part at the vaccination against COVID-19 and we found that emphasizing on thorough population sensitization through quarter heads and social mobilizers and adequately programming the campaign during a good climate season is crucial to achieving good vaccination coverage. CONCLUSION: lessons learned from this study could serve to inform various agencies in the event of planning rapid mass vaccination programs during pandemics.

A reactive vaccination campaign with single dose oral cholera vaccine (OCV) during a cholera outbreak in Cameroon.

BACKGROUND: Cameroon chose Oral Cholera Vaccine (OCV) mass vaccination campaign in addition to other interventions to respond to outbreaks since 2015. There is still a persistent controversy on the effectiveness of reactive OCV mass vaccination campaign. OBJECTIVE: This article aimed to share evidence-based observations on the effect of a reactive single-dose OCV mass vaccination campaign on cholera cases in Cameroon. METHODS: Health area centered risk analysis was used to identify nine high risk health areas among four health districts in the |North Region as hotspots. About 537,274 people at risk of cholera transmission one year of age and above including pregnant women were eligible to receive OCV. A total of 537,279 doses of OCV was deployed for vaccination from August 1-5, 2019 through door-to-door strategy for urban health districts, and fixed/ temporary fixed posts strategies for rural health districts. RESULTS: The overall vaccination coverage was 99.9%. Vaccine wastage rate was less than 0.5% (0.0011%). Independent monitoring showed vaccination coverage at 97.2%. The 2019 epidemic curve went down after OCV intervention on the contrary to that in the year 2018 at the same period. After OCV intervention, cholera cases dropped from about 10.5 to 9.3 cases per week at the regional level while at the district level, they dropped from 5.3 to 2.1, 2.2 to 1.7, 0.6 to 0 and 1.7 to 1.5 cases per week respectively for Garoua, Garoua II, Tchollire and Pitoa. Though not statistically significant (p = 1.4, α = 0.05), cases per 1000 population seemed to remain unchanged among OCV zones (0.32/1000) and non-OCV zones (0.31/1000) in 2018 while they increased from 0.37 (OCV zones) to 0.53 (non-0CV zones) cases per 1000 population in 2019. CONCLUSION: There might have been a general trend in the reduction of the number of new cases after a reactive single-dose OCV campaign.

[Using anthropology to improve newborn health care in Cameroon]. / Une anthropologie impliquée pour améliorer les soins aux nouveau-nés au Cameroun.

INTRODUCTION: Policy directions in the health sector are based on research which provides insight into implemented actions and helps to formulate improvement recommendations for health. In Cameroon, an innovative experience of anthropological research on newborn health was followed by a process of appropriating findings by the Ministry of Public Health aiming at improving the quality of care. We suggest reporting this Cameroonian experience of interdisciplinary collaboration and involved research. METHOD: Coinciding with the anthropological study on newborn care in hospital maternities and at home conducted by researchers in the field of anthropology from December 2016 to June 2017, a process of appropriating findings was carried out. This article accurately describes this process both at the peripheral level, during "reflexive returns" in investigated maternity hospitals, and at the central level within the framework of work conducted by the study's steering committee. It reports on the changes that have taken place as a result of the study both at the level of health structures and at the level of national policies and strategies with a view to improving the quality of newborns care. RESULTS: The output of this process is twofold. At the peripheral level, activities of "reflexive returns" led to in situ changes of some harmful practices detrimental to the survival of the newborn, such as inappropriate use of the cradle in the birth room and lack of knowledge relative to the fight against hypothermia through the practice of skin-to-skin contact. At central level, changes concerned communication and strengthening policies and strategies of newborn care. CONCLUSION: The contribution of anthropology in the production evidence-based data is of paramount importance for the implementation of strategies to improve the quality of neonatal care. It opens up new perspectives for the sustainable improvement of the quality of care for newborns.

Une anthropologie impliquée pour améliorer les soins aux nouveau-nés au Cameroun.

INTRODUCTION: Policy directions in the health sector are based on research which provides insight into implemented actions and helps to formulate improvement recommendations for health. In Cameroon, an innovative experience of anthropological research on newborn health was followed by a process of appropriating findings by the Ministry of Public Health aiming at improving the quality of care. We suggest reporting this Cameroonian experience of interdisciplinary collaboration and involved research. METHOD: Coinciding with the anthropological study on newborn care in hospital maternities and at home conducted by researchers in the field of anthropology from December 2016 to June 2017, a process of appropriating findings was carried out. This article accurately describes this process both at the peripheral level, during "reflexive returns" in investigated maternity hospitals, and at the central level within the framework of work conducted by the study's steering committee. It reports on the changes that have taken place as a result of the study both at the level of health structures and at the level of national policies and strategies with a view to improving the quality of newborns care. RESULTS: The output of this process is twofold. At the peripheral level, activities of "reflexive returns" led to in situ changes of some harmful practices detrimental to the survival of the newborn, such as inappropriate use of the cradle in the birth room and lack of knowledge relative to the fight against hypothermia through the practice of skin-to-skin contact. At central level, changes concerned communication and strengthening policies and strategies of newborn care. CONCLUSION: The contribution of anthropology in the production evidence-based data is of paramount importance for the implementation of strategies to improve the quality of neonatal care. It opens up new perspectives for the sustainable improvement of the quality of care for newborns.

Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future.

BACKGROUND: Globally, complications of prematurity are the leading cause of death in children under five. Preterm infants who survive their first month of life are at greater risk for various diseases and impairments in infancy, childhood and later life, representing a heavy social and economic burden for families, communities and health and social systems. Kangaroo mother care (KMC) is recommended as a beneficial and effective intervention for improving short- and long-term preterm birth outcomes in low- and high-income settings. Nevertheless, KMC is not as widely used as it should be. The International Network on KMC runs biennial workshops and congresses to help improve the coverage and quality of KMC worldwide. This paper reports the results of the two-day workshop held in November 2016, where 92 participants from 33 countries shared experiences in a series of round tables, group work sessions and plenaries. FINDINGS: Barriers to and enablers of KMC are discussed with regard to parents, health workers and the health system. Key factors for effective implementation and uptake relate to appropriate training for health staff, adherence to protocols and the creation of a welcoming environment for families. Recommendations for planning for national programmes are made according to a six-stage change model. Resources and the cost of making progress are discussed in terms of investment, maintenance, and acceleration and scaling-up costs. KMC training requirements are presented according to three levels of care. To ensure quality KMC, key requisites are proposed for the different KMC components and for sensitive communication with caregivers. The group attending to the monitoring and evaluation of KMC at a national and subnational level highlight the lack of standard indicator definitions. Key priorities for investment include health services research, harmonisation of indicators, development of a costing tool, programming and scaling up, and the follow-up of preterm infants. CONCLUSION: It is hoped that this report will help to further scale-up and sustain KMC through a systematic approach that includes raising commitment, identifying key strategies to address the main barriers and using existing facilitators, ensuring training and quality, agreeing on indicators for monitoring and evaluation, and advancing implementation research.