Conclusion
The five Ugandan hospitals in the OMWaNA trial required substantial inputs, notably for infrastructure improvements, to allow safe implementation of iKMC, highlighting the need for dedicated funding to adopt this intervention, especially in facilities that cannot afford basic equipment such as incubators. However, it also raises questions about the affordability and cost-effectiveness of recommending widespread scale-up of iKMC across LMICs. These findings should help inform planning and budgeting as well as decisions about if, where, and how to implement iKMC, particularly in LMIC settings where space, devices, and specialised staff for inpatient newborn care are often unavailable. The impact of higher quality care for small and sick newborns is expected to be substantial, so even with high set-up costs, these investments may prove cost-effective. More context-specific evidence is needed to inform policymakers, especially regarding the incremental cost-effectiveness of iKMC added to high-quality, level-2 newborn care.