Abstract
BACKGROUND: Kangaroo mother care (KMC) was introduced in the Tshwane Health District in South Africa in 1999. After more than two decades of the expansion of KMC services, we describe the KMC implementation trajectory in the district. METHODS: A group of district clinical specialists, clinicians and academics involved in KMC implementation wrote a reflection on the status of KMC in Tshwane District and lessons for sustaining KMC services and practice. RESULTS: The KMC implementation trajectory is described according to three phases: (1) a slow start (1999-2012); (2) consolidation (2012-2023); and (3) sustaining KMC beyond the COVID-19 pandemic. The Tshwane KMC programme activities are interpreted using a 10-component model for scaling up care for small and/or sick newborns at the district level. Major lessons for the sustainability of KMC practice and service include embedding system-wide supportive supervision in the health system's budget, encouraging multidisciplinary teamwork, conducting regular KMC refresher activities, and working on improving data to enable meaningful action. CONCLUSION: Despite great strides in KMC implementation and ongoing services in the Tshwane Health District, the road to continued sustainability remains challenging.