Background
Each year, nearly 15 million babies are born preterm (< 37 weeks’ gestation) [KMC is an evidence-based intervention involving prolonged skin-to-skin contact, promotion of exclusive breastmilk feeding, facilitation of early hospital discharge, and adequate support and follow-up at home [We aim to inform decisions about if, where, and how to implement iKMC by analysing baseline data from OMWaNA, a pragmatic RCT evaluating the mortality impact of KMC initiated before stabilisation compared to standard care in Uganda. Specifically, the objectives of this analysis are to: i) describe the actions undertaken to safely implement facility-based iKMC before the start of the trial; ii) estimate the financial and economic costs of these essential resources and infrastructure improvements; and iii) assess service readiness for small and sick newborn care following these improvements at five hospitals in Uganda. Our purpose is to provide evidence on the process and costs of the required improvements to allow safe implementation of iKMC. We consider the generalisability of our findings to other hospitals in LMICs and the implications for scale-up of iKMC in contexts without neonatal intensive care.